Is There a Real Difference Between the First Onset of Efficacy for Atypical Antipsychotic Monotherapies in Acute Bipolar Mania?

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Sir: Several points beyond those mentioned in Dr. Keck’s recent article¹ are relevant to the appraisal of relative onset ofefficacy of atypical antipsychotics for mania. What Figure 1 ofDr. Keck’s article does demonstrate is that all of the atypicalstended to show faster onset of action versus placebo at the earliesttimepoint at which efficacy was first measured. For the olanzapinetrials, efficacy was not measured until after 7 days.^2,3‘ ‹