Pharmacologic loading in the treatment of acute mania


Corresponding author: Dr Paul Keck, Jr, Biological Psychiatry Program, Department of Psychiatry, University of Cincinnati College of Medicine, PO Box 670559, 231 Bethesda Avenue, Cincinnati, OH 45267-0559, USA. Fax: +1 513 5582882; e-mail:


The rapid and safe reduction of manic symptoms is an important initial goal of the pharmacologic treatment of acute mania. The pharmacokinetics and studies of pharmacologic loading of lithium, valproate, and carbamazepine were reviewed. In addition, the feasibility of administering other agents with potential efficacy in mania, e.g., atypical antipsychotics and new anticonvulsants, was discussed. Further double-blind, controlled studies with adequate sample sizes comparing loading strategies with more gradual titration schedules of candidate antimanic agents are needed.