Comparison of the antimanic efficacy of carbamazepine and chlorpromazine: A double-blind controlled study

A multiinstitutional cooperative study comparing carbamazepine (Tegretol) with chlorpromazine was performed using a controlled, double-blind trial design. In a series of 63 cases of endogenous manic psychosis, carbamazepine's clinical utility and efficacy, characteristics of therapeutic effect, and side effects were evaluated. Carbamazepine and chlorpromazine were given by a fixed, but flexible, method at an equipotent ratio of 2∶1, starting from the initial dosages of 300 and 150 mg, respectively. The overall improvement rate, based on the number of cases showing moderate to marked amelioration of manic symptoms, was 70% in the carbamazepine group and 60% in the chlorpromazine group. No significant differences were found between the two groups. Improvements in basic mood, insomnia, headache and lassitude, and diurnal fluctuations of mood tended to be characteristic of carbamazepine efficacy for mania compared with the effects of chlorpromazine. The onset of therapeutic effect was within 10 days of treatment in 65.7% of the patients receiving carbamazepine and 50% receiving chlorpromazine. The incidence of side effects was significantly lower in the carbamazepine group than in the chlorpromazine group. It was suggested that carbamazepine is potentially useful drug for the treatment of the manic state.