Psychopharmacology and Psychiatry Updates Beyond Lithium Monotherapy: Evidence-Based Augmentation in Acute Mania
Nov 22, 2025
David Osser, an associate professor of psychiatry at Harvard Medical School and psychopharmacology expert, shares his insights on treating acute mania. He discusses effective strategies for augmenting lithium, highlighting quetiapine as the preferred add-on due to its mood-stabilizing effects. Osser critiques the overuse of valproate and explains the minimal benefits from combining it with lithium based on the BALANCE study. He also warns of metabolic risks associated with drug combinations, providing vital considerations for patient care.
AI Snips
Chapters
Transcript
Episode notes
Weekend ED Mania Case
- A 23-year-old woman presents manic, awake for days, with pressured speech and grandiose scribbling.
- She started lithium but remained symptomatic after one week, prompting the augmentation question.
Add An SGA To Lithium Quickly
- Add a second-generation antipsychotic when lithium monotherapy fails for acute classic mania.
- Prioritize quetiapine as the first add-on because it acts as a broad-spectrum mood stabilizer and is FDA-approved adjunctively.
Give Lithium Time; Use Benzodiazepines For Agitation
- Allow adequate time for the first medication and use benzodiazepines for sedation before hastily adding agents.
- If rapid augmentation is needed, adding an SGA can be done quickly but prioritize safety.