A key goal of the pharmacologic treatment of acute bipolar mania is rapid symptom improvement.Medications commonly used to attain this goal include lithium, several anticonvulsants, and bothfirst- and second-generation antipsychotics. Second-generation antipsychotics, which are associatedwith substantially lower rates of extrapyramidal side effects than first-generation agents, are becominga mainstay in the treatment of acute mania. Although their efficacy appears to be comparable,second-generation antipsychotics may differ in time to onset and in their side effect profiles. Therefore,selecting a second-generation antipsychotic requires consideration of how an agent’s efficacy,onset of action, and adverse events profile influence its appropriateness for each patient.
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