BENZODIAZEPINES

There is evidence for both Lorazepam and Clonazepam being effective as primary antimanic agents, although Lorazepam may be superior in this respect (Bradwejn et al, 1990). However, concerns about provoking disinhibition, the risk of dependence and the lack of efficacy of Benzodiazepines in the prophylaxis of bipolar disorder have limited the use of these medications.

There is growing and robust evidence for the use of Benzodiazepines as an adjunctive treatment with mood stabilizers in acute mania. Lorazepam (Bowden et al, 1994) and Clonazepam have been used successfully as adjunctive treatments in acute mania instead of neuroleptics. Lorazepam has the advantage of being available for parenteral use. Benzodiazepines are useful in the first few hours and days of the treatment of acute mania to suppress behaviour disturbance and tackle insomnia. It is becoming common practice to taper down and discontinue benzodiapines within 2-3 weeks of achieving adequate symptom control in mania.

References
Bowden CL, Brugger AM, Swann AC, Calabrese JR et al. 1994. Efficacy of Divalproex vs Lithium and Placebo in the Treatment of Mania. JAMA. 271:12. 918-924.

Bradjewn J, Shriqui C, Koszycki D et al. 1990. Double-blind comparison of the effects of Clonazepam and Lorazepam in acute mania. J Clin Psychopharm. 10. 403-408.