Mania (Manias)

A state of elevated excitement with over-activity sometimes accompanied with psychotic symptoms (e.g., PSYCHOMOTOR AGITATION, inflated SELF ESTEEM and flight of ideas). It is often associated with mental disorders (e.g., CYCLOTHYMIC DISORDER; and BIPOLAR DISEASES).

Also Known As:

Manias; Manic State; Episode, Manic; Hypomanias; Hypomanic Episodes; Manic Episodes; Hypomania; Hypomanic Episode; Manic Episode

Networked: 5486 relevant articles (788 outcomes, 1092 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Bipolar Disorder (Manic Depressive Psychosis)
2.	Mania (Manias)
3.	Schizophrenia (Dementia Praecox)
4.	Psychotic Disorders (Schizoaffective Disorder)
5.	Mood Disorders (Mood Disorder)

Experts

1.	Vieta, Eduard: 111 articles (11/2022 - 06/2002)
2.	Quevedo, João: 73 articles (01/2022 - 05/2006)
3.	Calabrese, Joseph R: 66 articles (01/2022 - 01/2002)
4.	Valvassori, Samira S: 61 articles (01/2022 - 05/2006)
5.	Yatham, Lakshmi N: 60 articles (01/2022 - 01/2002)
6.	Tohen, Mauricio: 54 articles (01/2022 - 01/2002)
7.	Bowden, Charles L: 46 articles (01/2021 - 01/2002)
8.	Berk, Michael: 45 articles (01/2022 - 04/2001)
9.	Keck, Paul E: 45 articles (11/2021 - 01/2002)
10.	Suppes, Trisha: 43 articles (03/2022 - 01/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Mania:

1.	LithiumIBA 11/01/2017 - "Although lithium is still considered a first-line treatment for bipolar mania in most practice guidelines, its use may be overshadowed by newer psychotropic medications. " 11/01/2014 - "Recently, it has been found that temperamental features of hypomania (a hyperthymic temperament) and a lack of cognitive disorganization predict the best results of lithium prophylaxis. " 06/18/2014 - "We have also demonstrated that temperamental features of hypomania (a hyperthymic temperament) and a lack of cognitive disorganization predict the best results of lithium prophylaxis. " 01/01/2008 - "In patients previously on lithium, Young Mania Rating Scale (YMRS) scores improved significantly from baseline to end point (27.4 6 SD 3.5 vs. 15.8 6 11.1; P 5 .0002). " 10/01/2005 - "Of 42 potential clinical predictors investigated, five variables were identified as possible response predictors of prophylactic lithium: [1] An episodic pattern of mania-depression-interval, and [2] a high age of illness onset were identified as potentially protective against a recurrence under lithium. "
2.	Antipsychotic Agents (Antipsychotics)IBA 12/01/2015 - "Combined antipsychotic/mood stabilizer had the highest probability of being the best treatment based on change in mania rating scales (96.1% for all mania scales; 85.5% for Young Mania Rating Scale), and 99.3% for being the best treatment for responders. " 07/01/2010 - "Most second-generation antipsychotics have demonstrated efficacy in the treatment of mania, both in monotherapy and as adjuncts to mood stabilizers. " 08/16/2007 - "With mania or mixed presentation atypical antipsychotics produced significantly better rates of response and symptomatic remission than placebo, with NNTs of about 5 up to six weeks, and 4 at 6-12 weeks, but more adverse event withdrawals (NNH of about 22) in studies of 6-12 weeks. " 09/01/2007 - "Antipsychotics and mood stabilizers are significantly more effective than placebo for the treatment of acute mania. " 09/01/2000 - "Antipsychotics are beneficial for some clinical presentations of mania. "
3.	Valproic Acid (Depakote)FDA LinkGeneric 09/01/2013 - "Sodium valproate (especially if started intravenously) is a highly efficacious, cost-effective treatment approach for acute mania. " 04/01/2010 - "The mean daily dose of divalproex ER was 2,211 mg with a mean maximum serum valproic acid concentration of 77.9 microg/mL. The results of the current study did not demonstrate statistically significant improvement in mania symptoms associated with divalproex ER treatment compared to placebo. " 01/01/2003 - "Early observations suggested antimanic actions; more than a decade later, controlled clinical trials established significant efficacy of valproate in mania. " 03/01/1989 - "The European studies, which have been both open and controlled, showed beneficial effects of valproate in acute and prophylactic treatment of bipolar illness, with particularly good results in mania. " 05/01/2005 - "Oral loading with the delayed release formulation of divalproex sodium is widely used for the treatment of patients with acute mania and produces rapid attainment of therapeutic serum levels. "
4.	Olanzapine (Zyprexa)FDA Link 05/01/2006 - "Olanzapine is most effective for avoiding acute mania episodes. " 05/01/2010 - "In a randomized, double-blind, multicentre, 3-week trial in adolescents, aged 13-17 years, with manic or mixed episodes associated with bipolar I disorder, the mean reduction from baseline to 3 weeks in the Adolescent Structured Young Mania Rating Scale (YMRS) total score (primary endpoint) was significantly greater with olanzapine than with placebo. " 07/01/2019 - "There was a significant reduction in Young Mania Rating Scale and Clinical Global Impression-Bipolar scores over time in both groups, with a significantly higher reduction in the olanzapine group as shown by the group × time interaction effect. " 07/01/2015 - "Subgroup analyses showed that cannabis use was significantly associated with lower remission rates on the Hamilton Depression Rating Scale in females (n=139) and patients prescribed mood stabilizers alone (n=151), whereas in males (n=95) and patients prescribed olanzapine and/or a mood stabilizer (n=83), cannabis use was significantly associated with lower remission rates on the Young Mania Rating Scale. " 10/01/2007 - "The mean baseline-to-endpoint change in the Young Mania Rating Scale total score was significantly greater for patients receiving olanzapine relative to patients receiving placebo, and a greater proportion of olanzapine-treated patients met response and remission criteria (44.8% versus 18.5% and 35.2% versus 11.1%, respectively). "
5.	Carbamazepine (Tegretol)FDA LinkGeneric 03/01/2005 - "Extended-release carbamazepine monotherapy had significantly greater efficacy compared with placebo in the treatment of acute mania in this large, randomized, double-blind, placebo-controlled trial." 01/01/2005 - "At study end, reductions from baseline in Young Mania Rating Scale scores were significantly greater with carbamazepine than with placebo (primary endpoint). " 02/01/2010 - "Carbamazepine is effective in treating symptoms of both mania and depression, and there are no significant differences in the relative efficacy of the IR or ERCC formulations." 04/30/2021 - "They all appear to have stronger efficacy in treating acute mania than depression, which also translates to better protection against manic than depressive relapses for carbamazepine. " 01/01/2006 - "Recently, two large, 3-week, randomised, double-blind, placebo-controlled trials using nearly identical protocols demonstrated that monotherapy with carbamazepine extended-release capsules (CBZ-ERC) was effective for the treatment of acute mania in patients with bipolar I disorder. "
6.	Risperidone (Risperdal Consta)FDA LinkGeneric 01/01/2020 - "A significant improvement in his symptoms was observed after administration of oral risperidone, with his scores on the Young Mania Rating Scale and Brief Psychiatric Rating Scale also showing improvement. " 01/01/2020 - "A significant improvement in his symptoms was observed after administration of oral risperidone, with his scores on the Young Mania Rating Scale and Brief Psychiatric Rating Scale also showing improvement. " 02/01/2010 - "The combination of risperidone with mood stabilizers significantly improved the scores on the Young Mania Rating Scale (YMRS), 17-item Hamilton Rating Scale for Depression (HAMD), 18-item Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), and Clinical Global Impression Scale for use in bipolar illness Severity (CGI-BP) at 24 weeks (P < 0.0001). " 01/01/2005 - "At week 3, mean Young Mania Rating Scale (YMRS) score reductions from baseline were significantly greater in patients receiving risperidone than placebo (p<0.001). " 06/01/2004 - "Improvement in mean Young Mania Rating Scale total score (adjusted for covariates) was significantly greater in the risperidone than in the placebo group at endpoint (mean change=-10.6 [SD=9.5] versus -4.8 [SD=9.5], respectively), with significant between-group differences seen as early as 3 days after start of treatment (change with risperidone: mean=-6.8 [SD=5.8]; change with placebo: mean=-4.0 [SD=5.8]) and continuing throughout all time points. "
7.	Antidepressive Agents (Antidepressants)IBA 01/01/2008 - "Most of the standard randomized controlled trials report the efficacy of antidepressants in the acute phase of BPD, but the data also indicate higher switch rates to mania and acceleration of mood cycle with their use. " 01/01/2017 - "The reviewed articles showed that an adequate psychiatric screening for BD is recommended in FM patients with depressive symptoms, in order to decrease administration of antidepressants for BD, due to the lack of proven efficacy, and to limit antidepressant-induced mania. " 05/01/2010 - "The correct diagnosis at the first presentation could help to find an effective medication regimen, to prevent antidepressant-induced rapid cycling and to reduce antidepressant-induced manic episodes, e.g. " 02/01/1999 - "Currently available antidepressants may increase the risk of mania and rapid cycling, and mood stabilizers appear to be less effective in treating depression than mania. " 03/01/1992 - "Antidepressant drugs are effective in the acute treatment and prevention of depression only, and can even precipitate hypomanic or manic "switches," or "rapid cycling" between mania and depression. "
8.	Quetiapine Fumarate (Seroquel)FDA Link 01/01/2007 - "Quetiapine as monotherapy, or in combination with Li or DVP, was a highly effective treatment for acute mania, as shown by overall change scores in the total YMRS. " 01/01/2007 - "Quetiapine was associated with significantly higher response and remission/euthymia rates compared with placebo with most criteria used, in patients with acute mania at the end of both 3 and 12 weeks." 06/01/2009 - "Safety, tolerability and efficacy of a rapid dose escalation of quetiapine in bipolar I mania: the FATIMA study." 06/01/2009 - "Rapid dose escalation of quetiapine to 800 mg/day over 4 days was well tolerated and effective in reducing symptoms within 5 days in acutely ill bipolar I patients with a manic episode." 01/01/2007 - "At Days 21 and 42, quetiapine combined with Li/DVP compared to Li/DVP monotherapy yielded significant, sustained improvements in the rate of clinical remission/euthymia in patients with bipolar mania. "
9.	Aripiprazole (Abilify)FDA Link 01/01/2015 - "Factors most predictive of endpoint efficacy for aripiprazole were judgment/impulsivity at day 4 and mania at week 1. Optimal factor score improvement for outcome prediction was approximately 40% to 50%. " 09/01/2007 - "Aripiprazole was superior to placebo in reducing the severity of both mania and agitation in highly agitated patients with bipolar I disorder and showed significant antimanic activity in patients with low levels of agitation without increasing agitation. " 02/01/2014 - "Using trial data together with ancillary analyses, the European Medicines Agency concluded that aripiprazole 10 mg once daily for 12 weeks was effective in reducing symptoms of mania, but because of the high drop-out rate, efficacy over 30 weeks of treatment was not proven. " 01/01/2016 - "At 24 weeks after switching to aripiprazole, the remission rates on the Montgomery-Åsberg Depression Rating Scale (MADRS) and on both the MADRS and the Young Mania Rating Scale were increased significantly in the full sample and in the inefficacy subgroup. " 11/01/2010 - "Aripiprazole 15 or 30 mg/day was not significantly more effective than placebo in the treatment of bipolar I disorder acute mania at endpoint (Week 3). "
10.	Anticonvulsants (Antiepileptic Drugs)IBA 06/01/2011 - "Data from 35 randomized clinical trials suggested that not all anticonvulsants are efficacious for the treatment of acute mania. " 06/01/2011 - "We conducted a systematic review of randomized controlled trials (RCTs) with placebo or active comparator, in acute bipolar mania in order to summarize available data on anticonvulsant treatment of mania/mixed episodes. " 10/01/2001 - "Future studies of newer anticonvulsants should include dimensional perspectives and soft bipolar presentations, as the greatest contribution of the newer anticonvulsants may be in treatment of mood conditions other than acute mania." 11/01/1996 - "A new series of anticonvulsants has just been FDA-approved and warrant clinical trials to determine their efficacy in acute and long-term treatment of mania and depression. " 01/01/1995 - "Controlled clinical trials are necessary to confirm the efficacy and tolerability of mood-stabilizing anticonvulsants in the treatment of secondary mania."

Therapies and Procedures

1.	Therapeutics 03/01/2006 - "A systematic review of the most recent treatment outcome studies suggest that adjunctive psychological therapies reduce overall rates of relapse, but are more effective for depression than for mania. " 07/01/2001 - "The study by Bowden et al. (2000) shows that good efficacy of divalproate in acute manic episodes in a given patient may be predictive of efficacy of the drug in maintenance therapy. " 11/01/2023 - "Psychological therapy might be more beneficial for depressive symptoms and have long-term benefits for hypomania. " 05/01/2014 - "Adjunctive therapy with MPA may be a potentially useful new treatment for persistent mania, leading to a greater and more rapid resolution of symptoms compared with mood stabiliser treatment alone. " 01/01/2019 - "In conclusion, our results support experimental findings, suggesting that combination therapy is more effective than monotherapy after a manic episode."
2.	Drug Therapy (Chemotherapy) 02/01/1994 - "The evidence indicates that ECT is associated with remission or marked clinical improvement in 80% of manic patients and that it is an effective treatment for patients whose manic episodes have responded poorly to pharmacotherapy. " 10/01/2009 - "High-frequency supra-threshold right prefrontal rTMS in bipolar, mania patients was well tolerated and found to be effective as add-on to standard pharmacotherapy." 01/01/2019 - "DBT has been effective in decreasing the intensity of mania, but, it cannot be used to reduce the emotional instability and impulsivity of these patients along with drug therapy although it has improved the executive functions and depression of the patients." 11/01/2023 - "For single-arm trials, both pharmacotherapy and psychotherapy showed efficacy for depressive symptoms, while pharmacotherapy only showed efficacy for hypomania symptoms (effect size (ES) = -9.16, 95 % CI:-11.29, -7.04). " 10/01/2022 - "A cumulative Bayesian network meta-analysis on the comparative efficacy of pharmacotherapies for mania over the last 40 years."
3.	Aftercare (After-Treatment) 09/18/2023 - "The aim of this study was to compare Vit D and related metabolites of bipolar manic episodes prior to treatment, bipolar remission after treatment, and healthy control groups. " 05/01/2023 - "Subjective Improvement in Hearing After Treatment With a Manic Episode in an Elderly Patient." 06/01/2022 - "[Variations in immunological parameters after treatment of a manic episode]." 01/01/2020 - "The enrolled patients were rated using the Bech-Rafaelsen Mania Rating Scale (BRMS) before and after treatment, and relevant adverse effects were monitored. " 12/01/2016 - "We did three between-group meta-analyses comparing CRP concentrations in patients in mania, depression, or euthymia, with those in healthy controls (cross-sectional studies), and two within-group meta-analyses comparing changes in CRP concentrations before and after treatment of an index manic or depressive episode (longitudinal studies). "
4.	Transcranial Magnetic Stimulation 01/01/2019 - "Elevated mirror neuron system activity in bipolar mania: Evidence from a transcranial magnetic stimulation study." 09/01/2014 - "Mirror neuron activity and symptom severity in drug-naïve mania - a transcranial magnetic stimulation study." 02/01/2003 - "Left prefrontal transcranial magnetic stimulation (TMS) has been reported to have ECT-like effects in depression and we therefore planned a study of TMS in mania. " 11/01/1998 - "Left prefrontal transcranial magnetic stimulation has been reported to have ECT-like effects in depression; therefore, the authors planned a study of transcranial magnetic stimulation in mania. " 11/01/1998 - "Transcranial magnetic stimulation in mania: a controlled study."
5.	Secondary Prevention 10/01/2011 - "We found that the relapse prevention design fails to prove that these agents are mood stabilizers because patients are pre-selected to respond to the study drug for an acute mood episode (mania) and when they relapse, they do so into an episode of the same polarity (i.e. " 12/01/2014 - "Aims and method To assess whether a home treatment team acute relapse prevention (ARP) strategy reduces admissions to hospital with mania. " 12/01/2010 - "Because prodromal mood symptoms precede the onset of mania by an average of 10 years, and there is low specificity of risk factors and prodromal features for mania, interventions initiated prior to onset of the disorder (primary prevention) or early in the course of the disorder (early or secondary prevention) must be safe and well tolerated upon long-term exposure. " 01/01/2017 - "Although sample sizes were limited, the findings suggest that the lifetime definition of rapid cycling may identify individuals with a chronic rapid-cycling course and may also be slightly superior to the DSM-IV definition in identifying individuals with hypomania during relapse-prevention therapy. " 11/01/2007 - "Recently, a large number of studies have provided evidence for the efficacy of new compounds in the treatment of both mania and bipolar depression, but also in long-term relapse prevention. "