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 of efficacy of atypical antipsychotics for mania. What Figure 1 of Dr. Keck’s article does demonstrate is that all of the atypicals tended to show faster onset of action versus placebo at the earliest timepoint at which efficacy was first measured. For the olanzapine trials, efficacy was not measured until after 7 days.2,3

J Clin Psychiatry 2005;66(10):1333-1334