Inpatient clinical trial of lorazepam for the management of manic agitation.

Antipsychotic medications have traditionally been used for their sedative effects in the management of the behavioral and emotional agitation of mania while awaiting the therapeutic effect of lithium. On the premise that a nonantipsychotic sedative might satisfactorily and more specifically control this agitation without neuroleptic or hypotensive side effects and without prolongation of the acute illness, the authors conducted an open trial with four acutely manic patients in which only the benzodiazepine lorazepam was administered along with lithium; no antipsychotic medications were used. Lorazepam, administered in oral and parenteral form on an as-needed basis to maintain patient cooperation with the treatment plan and milieu, was found to be rapid and effective in controlling the manic agitation of these patients, with few troublesome side effects, and with no obvious prolongation of the acute illness.