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Risperidone alone or in combination for acute mania.

J M Rendell, H J Gijsman, M S Bauer

    The Cochrane Database of Systematic Reviews
    |January 27, 2006
    PubMed
    Summary
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    Risperidone effectively reduces manic symptoms as a standalone or combined treatment. While comparable to haloperidol, it causes more weight gain but fewer extrapyramidal side effects.

    Area of Science:

    • Psychiatry
    • Pharmacology
    • Clinical Trials

    Background:

    • Risperidone, an atypical antipsychotic, is utilized for managing mania, both as monotherapy and in conjunction with other medications.
    • Bipolar disorder management often involves atypical antipsychotics to address manic episodes.

    Purpose of the Study:

    • To conduct a systematic review of randomized controlled trials evaluating the efficacy and tolerability of risperidone in treating acute manic or mixed episodes.
    • To compare risperidone's effectiveness and side effect profile against placebo and other established treatments for mania.

    Main Methods:

    • A comprehensive literature search was performed across multiple databases (e.g., CENTRAL, EMBASE, MEDLINE, PsycINFO) up to December 2004.
    • Six randomized controlled trials involving 1343 participants were included, comparing risperidone (monotherapy or adjunctive) with placebo or haloperidol.

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  • Data extraction and quality assessment were independently conducted by two reviewers, with efforts to obtain missing information.

    • Main Results:

    • Risperidone monotherapy demonstrated superior efficacy over placebo in reducing manic symptoms (Young Mania Rating Scale) and achieving response, remission, and sustained remission.
    • Both monotherapy and adjunctive risperidone were better tolerated than placebo, evidenced by a lower incidence of treatment discontinuation.
    • Common adverse effects associated with risperidone included weight gain, extrapyramidal disorder, sedation, and increased prolactin levels. Efficacy was comparable to haloperidol, with similar acceptability but differing side effect profiles (more weight gain, less extrapyramidal disorder).

    Conclusions:

    • Risperidone is an effective treatment for reducing manic symptoms, whether used alone or as an add-on therapy.
    • Key adverse effects to monitor include weight gain, extrapyramidal symptoms, and sedation.
    • Further high-quality trials are recommended to refine the understanding of risperidone's cost-benefit profile in mania management.