Dose-Specific Network Meta-Analysis Reaffirms Antipsychotics for Acute Mania

This dose-resolved network meta-analysis adds granular, dose-level and age-stratified efficacy estimates for acute bipolar mania pharmacotherapy while cautioning that larger effect sizes track with lower study quality.

risperidoneolanzapinehaloperidollithiumvalproatequetiapineasenapinearipiprazolecariprazinepaliperidoneziprasidonetamoxifencelecoxiballopurinolantipsychoticsmood stabilizersbipolar disorderacute manianetwork meta-analysisdose-responsepediatric psychiatry Psychiatry / Psychopharmacology

Background Information

Risperidone tops the list for acute bipolar mania efficacy.

Acute bipolar mania significantly impacts individuals' social and economic well-being, making effective management crucial. The network meta-analysis shows risperidone 3 mg/day was most effective, while several other drugs also significantly outperformed placebo in symptom improvement. The findings align with existing guidelines, highlighting the need for careful consideration of drug efficacy versus lower-quality evidence indicated by larger effect sizes. Risperidone and several other medications are effective for acute bipolar mania, but quality of studies should guide usage.

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Authors: Fornaro M, Di Lorenzo C, Kishi T, Daray FM

Citation: Fornaro M, Di Lorenzo C, Kishi T, et al. Efficacy, acceptability, and related outcomes of pharmacological interventions for acute bipolar mania: a systematic review and dose-related network meta-analysis across different age groups. Journal of affective disorders. 2026:122329. doi:10.1016/j.jad.2026.122329

Article Links: PubMed · Journal / DOI

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