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Loading Strategies in Acute Mania

Published online by Cambridge University Press:  07 November 2014

Abstract

Treatment of acute mania has been greatly influenced by loading strategies. Loading has potential benefits, including rapid symptom reduction in mania and a shortened length of stay. Disadvantages include an increased likelihood of adverse effects of the medications. Loading strategies for lithium, valproic acid (divalproex sodium), carbamazepine, oxcarbazepine, olanzapine, and haloperidol decanoate in the treatment of acute mania are discussed. Recent studies high-light this treatment option for selected patients. It is the unique properties of the medications that influence their use in loading. Issues in patient selection for loading strategies with each medication are also considered.

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 2001

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References

REFERENCES

1. Clayton, PJ. Bipolar illness. In: Winokur, G, Clayton, PJ, eds. The Medical Basis of Psychiatry. 2nd ed. Philadelphia, Pa: WB Saunders; 1994:4768.Google Scholar
2. Hardman, JG, Goodman, LS, Gilman, A, et al. Goodman and Gilman's The Pharmacological Basis of Thempeutics. 9th ed. New York, NY: McGraw-Hill; 1995:25.Google Scholar
3. American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder. Am J Psychiatry. 1994;151(supp1):140.CrossRefGoogle Scholar
4. Bowden, CL, Brugger, AM, Swann, AC, et al. Efficacy of divalproex vs lithium and placebo in the treatment of mania. JAMA. 1994;271:918924.CrossRefGoogle ScholarPubMed
5. Perry, PJ, Alexander, B, Prince, RA, et al. A single point dosing protocol for predicting steady state lithium levels. Br J Psychiatry. 1982;148:401405.CrossRefGoogle Scholar
6. Malone, RP, Delaney, MA, Luebbert, JF, et al. The lithium test dose prediction method in aggressive children. Psychopharmacol Bull. 1995;31:379382.Google ScholarPubMed
7. Perry, PJ, Alexander, B, Liskow, BI. Psychotropic Drug Handbook. 6th ed. Cincinnati. Oh: Harvey Whitney Books Co; 1991:93117.Google Scholar
8. Perry, PJ. Alexander, B, Dunner, FJ, et al. Pharmacological protocol for predicting steady state lithium levels. J Clin Psychopharmacol. 1986;2:114118.Google Scholar
9. Moscovich, DG, Shapira, B, Lerer, B, et al. Rapid lithiumization in acute manic patients. Hum Psychopharmacol. 1992;7:343345.CrossRefGoogle Scholar
10. Kook, KA, Stimmel, GL, Wilkins, JN, et al. Accuracy and safety of a priori lithium loading. J Clin Psychiatry: 1985;46:4951.Google ScholarPubMed
11. Keck, PE. The use of divalproex [monograph]. J Clin Psychiatry. 1997:15:1822.Google Scholar
12. Keck, PE, McElroy, SL, Tugrul, KC, et al. Valproate oral loading in the treatment of acute mania. J Clin Psychiatry. 1993;54:305308.Google ScholarPubMed
13. Keck, PE. A pharmacoeconomic model of divalproex vs lithium in the acute and prophylactic treatment of bipolar disorder. Medscape Ment Health. 1997;2:13.Google Scholar
14. Hirschfeld, RMA, Allen, MH, McEvoy, J, et al. Oral loading of divalproex safe for bipolar patients with acute mania. J Clin Psychiatry. 1999;60:815818.CrossRefGoogle Scholar
15. Grunze, H, Erfurth, A, Amann, B, et al. Intravenous valproate loading in acutely manic and depressed bipolar I patients. J Clin Psychopharmacol. 1999;19:303309.CrossRefGoogle ScholarPubMed
16. Dunn, RT, Frye, MS, Tim, KA, et al. The efficacy and use of anticonvulsants in mood disorders. Clinical Neuropharmacol. 1998;21:215235.Google ScholarPubMed
17. Van Der Meyden, CH, Kruger, AJ, et al. Acute oral loading of carbamazepine-CR and phenytoin in a double-blind randomized study of patients at risk of seizures. Epilepsia. 1994;35:189194.CrossRefGoogle Scholar
18. Cohen, H, Howland, MA, Luciano, DJ, et al. Feasibility and pharaiacokinetics of carbamazepine oral loading doses. Am J Health Syst Pharm. 1998;55:11341140.CrossRefGoogle ScholarPubMed
19. Brown, B. The use ol generic mood stabilizers: carbamazepine [monograph]. J Clin Psychiatry. 1997;15:1117.Google Scholar
20. Lerer, B, Moore, N, Meyendorf, E, et al. Carbamazepine versus lithium in mania, a double-blind study. J Clin Psychiatry: 1987;48:8993.Google Scholar
21. Glazer, W, Fawver, J, Maguire, G. Rethinking strategies for managing the acutely psychotic patient [oral presentation]. Available at: http://www.psychlink.pwpl.com/announee_pdfs/2000/031500CMEannounce.pdf. Accessed March 15,2000.Google Scholar
22. Keck, PE, McElroy, SL, Bennet, JA. Pharmacologic loading in the treatment of acutemania. BipolarDisord. 2000;2:1117.Google Scholar
23. Karagianis, JL, Dawe, IC, Thakur, A, et al. Rapid tranquilization with olanzapine in acute psychosis: a case series. J Clin Psychiatry. 2001;62(suppl 2):1216.Google ScholarPubMed
24. Sernyak, MJ, Godleski, LS, Griffin, RA, et al. Chronic neuroleptic exposure in bipolar outpatients. J Clin Psychiatry. 1997;58:193195.CrossRefGoogle ScholarPubMed
25. McElroy, SL, Keck, PE, Stauton, SP, et al. A randomized comparison of divalproex oral loading versus haloperidol in the initial treatment of acute psychotic mania. J Clin Psychiatry: 1996;57:142146.Google ScholarPubMed
26. Haldopendol decanoate. Physicians Desk Reference. 51st ed. Montvale, NJ: Medical Economics Company; 1997:15881589.Google Scholar
27. Keck, PE, McElroy, SL, Bennett, JA. Health-economic implications of the onset of action of antimanic agents. J Clin Psychiatry: 1996;57(suppl 13):1318.Google ScholarPubMed