Valproate-Risperidone versus Valproate-Lithium combination in acute mania

We evaluated the efficacy of valproate plus risperidone versus valproate plus lithium combination in thetreatment of acute mania.methods: in 2-week, randomized, double-blind, parallel group study , 46 acute manic patients according to dsm-ivcriteria were randomly assigned to receive combination of valproate 20 mg/ kg/day plus risperidone 2-4 mg/day (n23)or lithium600- i200 rug/day (n=23). the assessment of efficacy measures were according to young mania rating scale(ymrs) and clinical global impressions-severity (cgi-s) and improvement (cgi-i) scale. other effectiveness measuresincluded ymrs response (ymrs reduction;::50 %) and ymrs remission (ymrs total scores ~12).results: in each group, 16 of23 patients (70 %) completed the study. ymrs response, cgi-improvement, and reductionin the total scores ofymrs and cgi-s observed in both groups, significantly greater for valproate-risperidone thanvalproate-lithiurn combination group (p=0.006, p=o.015, p=0.004, and p0.007, respectively).ymrs remission wereshown in both groups without statistical significance (p=o.073). the total scores of ymrs at 4th, 8th, and 14th days oftrial were lower in valproate-risperidone than valproate-lithium combination group (p=0.017, p=0.005, and po.004,respectively). the rate of adverse events and mean weight gain in both groups were not statistically different.conclusion: in acute manic patients, both combinations of valproate with lithium or with risperidone had efficacy inacutely manic patients, but valproate-risperidone combination was more effective. both treatments were safe and welltolerated. considering the small sample size and limited period of observation, further studies need to be conducted tofind out the best combination in the treatment of acute mania.