Which Are Best for Active Mania?

Overall, antipsychotic drugs were significantly more effective than mood stabilizers for the treatment of acute mania, a difference attributable primarily to the superior efficacy of haloperidol, risperidone, and olanzapine.

Haloperidol, risperidone, olanzapine, lithium, aripiprazole, quetiapine, carbemazepine, asenapine, valproate, and ziprasidone were significantly more effective than placebo.

Olanzapine, risperidone, and quetiapine led to significantly fewer discontinuations than did lithium, lamotrigine, placebo, topiramate, and gabapentin.

Considering both efficacy and tolerability, risperidone, olanzapine, and haloperidol should be considered among the best of the available options for the treatment of manic episodes.

A major limitation of the meta-analysis is that all studies were of no more than three weeks' duration, making it impossible to assess postmania depression as well as metabolic and other side effects associated with the drugs.