Efficacy of olanzapine and sodium valproate given alone or as add-on therapy in acute mania. A comparative study

Acute mania requires hospitalization and prompt control of symptoms. The aim of this study was to compare the efficacy of sodium valproate and olanzapine administered alone or in combination in patients suffering from acute mania. Patients (N = 30) suffering from acute mania were divided into two equal groups. Group 1 patients were treated with sodium valproate 250 mg 3 times a day and Group 2 patients received olanzapine 5 mg twice daily. In both groups sodium valproate or olanzapine was given as add-on therapy at 3 weeks. The primary method of assessment was 50% or more improvement on the Young Mania Rating Scale (YMRS). The serum levels of valproic acid were also measured. Sodium valproate and olanzapine were effective in the treatment of acute mania with all patients demonstrating a 50% or more improvement on the YMRS. Sodium valproate-treated patients receiving olanzapine in the third week had a 15.3% decrease in the YMRS score and patients on olanzapine receiving sodium valproate had a 23.7% decrease. Patients who attained serum valproic acid levels of 100 μg/mL showed improvement on the YMRS. The present study supports combination therapy in the management of acute mania and suggests that serum valproic acid levels of 100 microg/mL are necessary for clinical response.