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Evidence summaries

Olanzapine Alone or in Combination for Acute Mania

Olanzapine is an effective treatment for mania and may be more efficacious than divalproex, though leads to more weight gain. Level of evidence: "A"

A Cochrane review (abstract , review [Abstract]) included 6 studies with a total of 1422 patients. Olanzapine was superior to placebo at reducing manic symptoms as monotherapy (Young Mania Rating Scale (YMRS) - weighted mean difference (WMD): -5.94, 95% CI -9.09 to -2.80) and in combination with lithium/valproate (YMRS) (WMD -4.01, 95% confidence interval -6.06 to -1.96). Olanzapine was superior to divalproex at reducing manic symptoms (standardised mean difference (SMD): -0.29, 95% CI -0.50 to -0.08). Olanzapine did not lead to a statistically higher rate of clinical response than haloperidol (RR: 1.03, 95% CI 0.77 to 1.38). Fewer patients discontinued treatment on olanzapine than placebo (RR: 0.62, 95% CI 0.48 to 0.80). Olanzapine caused greater weight gain than placebo (WMD 1.91Kg, 95% CI 1.29 to 2.53) or divalproex (WMD: 1.54, 95% CI 1.02 to 2.05).

    References

    • Rendell JM, Gijsman HJ, Keck P, Goodwin GM, Geddes JR. Olanzapine alone or in combination for acute mania. Cochrane Database Syst Rev 2003;(3):CD004040. [PubMed]

Primary/Secondary Keywords