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Pharmacological treatment of acute mania

Table 3.1: Recommendations for pharmacological treatment of acute mania


First line

Lithium, divalproex, olanzapine, risperidone,  quetiapine, quetiapine XR, aripip- razole, ziprasidone, lithium or divalproex + risperidone, lithium or divalproex + quetiapine, lithium or divalproex + olanzapine, lithium or divalproex + aripiprazole

Second line

Carbamazepine, ECT, lithium + divalproex, asenapine, lithium or divalproex + asenapine, paliperidone monotherapy

Third line

Haloperidol, chlorpromazine, lithium or divalproex + haloperidol, lithium + carbamazepine, clozapine, oxcarbazepine, tamoxifen

Not recommended

Monotherapy with gabapentin, topiramate, lamotrigine, verapamil, tiagabine, risperidone + carbamazepine, olanzapine + carbamazepine


ECT = electroconvulsive therapy


Adapted with permission from Yatham et al., 2009.