Keck P E, McElroy S L, Bennett J A
Department of Psychiatry, College of Medicine, University of Cincinnati, Ohio 45267, USA.
J Clin Psychiatry. 1996;57 Suppl 13:13-8; discussion 19-22.
Three medications, lithium, valproate, and carbamazepine, have been shown to be effective in the treatment of acute mania in randomized, controlled clinical trials. Additional research over the past decade has provided data regarding potential differences between these medications according to their time course of onset and clinical predictors of response in acute mania. These differences have potential impact on both the choice of medication and the health-economics of the treatment of acute mania.
Published reports regarding the time course of onset, clinical factors associated with response, and health-economic impact of the treatment of acute mania with lithium, valproate, and carbamazepine were reviewed (PAPERCHASE data base, 1966 to present, terms: bipolar disorder, drug treatment, lithium, valproate, and carbamazepine).
Valproate, when administered via an oral loading dosage, may have a more rapid onset of action than lithium and carbamazepine. Preliminary data suggest that specific clinical factors associated with response differ between the three medications. Health-economic studies suggest that treatment of acute mania with valproate may be associated with greater cost savings due to shorter lengths of hospital stay, particularly in patients with mixed mania and rapid cycling. Patients treated with the combination of carbamazepine and lithium also had reduced hospital lengths-of-stay in one study. Lithium may have greater cost savings in patients with classic mania.
Preliminary data from studies reviewed suggest that important differences exist between lithium, valproate, and carbamazepine in their time course of onset and factors associated with response in the treatment of patients with acute mania. These differences may also impact the cost savings associated with treatment with these agents.
在随机对照临床试验中，三种药物——锂盐、丙戊酸盐和卡马西平——已被证明对治疗急性躁狂有效。过去十年的进一步研究提供了有关这些药物在起效时间过程以及急性躁狂反应的临床预测因素方面潜在差异的数据。这些差异对药物选择和急性躁狂治疗的卫生经济学都有潜在影响。
回顾了已发表的有关锂盐、丙戊酸盐和卡马西平治疗急性躁狂的起效时间过程、与反应相关的临床因素以及卫生经济影响的报告（PAPERCHASE数据库，1966年至今，检索词：双相情感障碍、药物治疗、锂盐、丙戊酸盐和卡马西平）。
丙戊酸盐经口服负荷剂量给药时，起效可能比锂盐和卡马西平更快。初步数据表明，三种药物之间与反应相关的特定临床因素有所不同。卫生经济研究表明，丙戊酸盐治疗急性躁狂可能因住院时间缩短而节省更多费用，尤其是在混合性躁狂和快速循环型患者中。在一项研究中，接受卡马西平和锂盐联合治疗的患者住院时间也有所缩短。锂盐在经典躁狂患者中可能节省更多费用。
所回顾研究的初步数据表明，锂盐、丙戊酸盐和卡马西平在治疗急性躁狂患者时的起效时间过程以及与反应相关的因素存在重要差异。这些差异也可能影响使用这些药物治疗的费用节省情况。
