Haloperidol alone or in combination for acute mania.

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Trials

Background:

• Mania treatment aims to control dangerous behavior, reduce suicide risk, provide sedation, and shorten mood episodes.
• Haloperidol is a long-standing treatment for psychotic patients but has a notable side effect profile.

Purpose of the Study:

• To evaluate haloperidol's efficacy and tolerability in treating acute mania.
• To compare haloperidol against placebo and other active treatments, as monotherapy or add-on therapy.

Main Methods:

• Systematic review of randomized controlled trials comparing haloperidol with placebo or other drugs for acute mania.
• Searched multiple databases (Cochrane, MEDLINE, EMBASE, CINAHL, PsycINFO) and contacted experts.
• Independent assessment of trial quality and data extraction, including adverse effects.

Main Results:

• Haloperidol demonstrated greater efficacy than placebo in reducing manic symptoms, both as monotherapy and adjunctive treatment.
• Haloperidol was less effective than aripiprazole but showed no significant differences compared to risperidone, olanzapine, carbamazepine, or valproate.
• Haloperidol was associated with a lower failure to complete treatment rate than placebo but a higher incidence of tremor and movement disorders compared to placebo and less weight gain than olanzapine.

Conclusions:

• Haloperidol is an effective option for acute mania treatment.
• Efficacy is comparable to olanzapine and risperidone, but potentially less than aripiprazole.
• Tolerability and side effect profiles are crucial factors for clinicians and patients in treatment selection due to limited comparative data.