Lithium in the treatment of mania

Lithium is clearly more effective than placebo in the treatment of mania but the delay in its action requires that alternative drugs be used in the control of the acute episode. This review examines the comparative effects of lithium and neuroleptics and the combination of lithium with (i) haloperidol, (ii) carbamazepine and (iii) L-tryptophan in the treatment of mania. The administration of lithium and carbamazepine together seems to be particularly advantageous in the treatment of manic states refractory to lithium. Features that predict a good response to lithium in mania are described and a brief description of the management of the manic patient given. It is argued that stable premorbid personality is associated with good response in this condition.