Olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: A randomized, 12-week, double-blind study

Mauricio Tohen, Eduard Vieta, Guy M. Goodwin, Bin Sun, Jay D. Amsterdam, Michael Banov, Anantha Shekhar, Scott T. Aaronson, Leonid Bardenstein, Iosif Grecu-Gaboş, Vladimir Tochilov, Dan Prelipceanu, Heather S. Oliff, Ludmila Kryzhanovskaya, Charles Bowden

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Abstract

Objective: To evaluate the efficacy and safety of olanzapine, divalproex, and placebo in a randomized, double-blind trial in mild to moderate mania (DSM-IV-TR criteria). Method: The study was conducted from October 2004 to December 2006. A total of 521 patients from private practices, hospitals, and university clinics were randomly assigned to olanzapine (5-20 mg/day), divalproex (500-2500 mg/day), or placebo for 3 weeks; those completing continued with a 9-week double-blind extension. Efficacy (mean change in Young Mania Rating Scale [YMRS] total score was the primary outcome) and safety were assessed. Results: After 3 weeks of treatment, olanzapine-treated (N = 215) and placebo-treated (N = 105) patients significantly differed in YMRS baseline-to-endpoint total score change (p = .034; least squares [LS] mean: -9.4 and -7.4, respectively). Such changes were not significantly different between olanzapine vs. divalproex (N = 201) or divalproex vs. placebo. After 12 weeks of treatment, olanzapine-and divalproex-treated patients significantly differed in YMRS baseline-to-endpoint changes (p = .004; LS mean: -13.3 and -10.7, respectively). Of observed cases, 35.4% (35/99; 3 weeks) to 57.1% (28/49; 12 weeks) had valproate plasma concentrations lower than the recommended valproate therapeutic range, but these patients' YMRS scores were lower than those of patients with valproate concentrations above/within range. Compared with divalproex, after 12 weeks, olanzapine-treated patients had significant increases in weight (p < .001) and in glucose (p < .001), triglyceride (p = .003), cholesterol (p = .024), uric acid (p = .027), and prolactin (p < .001) levels. Divalproex-treated patients had significant decreases in leukocytes (p = .044) and platelets (p < .001) compared with olanzapine after 12 weeks of treatment. The incidence of potentially clinically significant weight gain (≥ 7% from baseline) was higher with olanzapine than with divalproex (3-week: p = .064, 6.4% vs. 2.7%; 12-week: p = .002, 18.8% vs. 8.5%; respectively). Conclusion: Olanzapine was significantly more efficacious than placebo but not divalproex at 3 weeks and significantly more efficacious than divalproex at 12 weeks. Olanzapine-treated patients had significantly greater increases in weight and in glucose, cholesterol, triglyceride, uric acid, and prolactin levels than divalproex-treated patients. Trial Registration: clinicaltrials.gov Identifier: NCT00094549.

Original languageEnglish (US)
Pages (from-to)1776-1789
Number of pages14
JournalJournal of Clinical Psychiatry
Volume69
Issue number11
DOIs
StatePublished - Nov 2008

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ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Tohen, M., Vieta, E., Goodwin, G. M., Sun, B., Amsterdam, J. D., Banov, M., Shekhar, A., Aaronson, S. T., Bardenstein, L., Grecu-Gaboş, I., Tochilov, V., Prelipceanu, D., Oliff, H. S., Kryzhanovskaya, L., & Bowden, C. (2008). Olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: A randomized, 12-week, double-blind study. Journal of Clinical Psychiatry, 69(11), 1776-1789. https://doi.org/10.4088/JCP.v69n1113