Neuroleptic trials Compared with other drug

The next important question is whether the short-term improvement produced by neuroleptics is better than that obtained with other sorts of drugs. Table 6.1 shows that studies have found that a variety of drugs have comparable effects to neuroleptics in the treatment of psychosis or schizophrenia. Two early randomised trials concluded that barbiturates were inferior to neuroleptics, but these may have been influenced by negative expectations of barbiturates, which were part of the old generation of disregarded drugs and are referred to in the studies as the control medication (Casey et al. 1960, p. 98). 

Lithium is rarely used as the only treatment for acute mania, a practical acknowledgment of its limitations. If it is used at all it is combined with a neuroleptic and other sedatives are frequently prescribed as well. Trials comparing effects of lithium and carbamazepine in acute mania reveal that substantial doses of benzodiazepines or barbiturates were used in addition to the study drugs (Freeman et al. 1992 Small et al. 1991). However the belief in lithium s specificity for manic depression means it is still deemed an effective treatment and it is still recommended for mild to moderate cases of mania (National Institute for Clinical Excellence 2006). 

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