[Efficacy of verapamil in mania crises]

The authors review the different studies on the use of calcium antagonists in the treatment of acute mania. They present 7 cases, of which 4 with manic-depressive psychosis and 3 with schizo-affective disorder, during acute mania as defined by DSM III criteria, treated by verapamil at the dose of 320 mg/day. Four patients improved (2 manic-depressive, 2 schizo-affective), of which one that had responded neither to haloperidol nor to clonidine, and another for which all other treatment was contra-indicated due to important side effects. Three of these patients entered into acute depressive state between the 12th and the 15th day of treatment. The two most severe (manic-depressive) cases did not respond. The role of calcium in neuron physiology and the mode of action of calcium antagonists are outlined. The authors discuss the physiopathological hypothesis of Dubovsky.