A double-blind comparative study of clinical efficacy of verapamil versus lithium in acute mania

Objectives. The importance of intracellular calcium ions to processes that may be involved in mania and the calcium antagonist action of mood stabilizers suggest a role of verapamil in the treatment of mania. This study was undertaken to compare the clinical efficacy and tolerability of verapamil versus lithium in manic patients. Methods. Patients with acute mania were randomized to receive lithium (N =25) or verapamil (N =25) in a 4-week double-blind comparative study. Both groups were homogeneous with regard to demographic and disease variables. The primary efficacy measures were the mean change from the baseline to the last assessment in BRMS (Bech-Raefelson Mania Rating Scale) and YMRS (Young-Mania Rating scale) total score. The rating scales were administered to the patients on day 1, 3, 5, 7, 11, 13, 17, 21, 28 of the study. Attendant's assessment of relief and adverse events were recorded during the study. Results. Both treatment groups showed significant decrease in mean BRMS and YMRS score assessed at different points of time. The study showed an equal efficacy of verapamil compared with lithium in the treatment of mania. The findings were supported by good tolerability of verapamil treatment. Conclusion. This study found equal benefit of verapamil over lithium in treating acute mania.