Clonidine in mania

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Abstract
Hyperactivity of central noradrenergic neurotransmission has been implicated in the pathophysiology of mania. This theory suggests that clonidine, an antihypertensive medication that decreases the activity of central noradrenergic neurons by presynaptic inhibitory effect, has antimanic properties. We administered clonidine orally in a dosage of 17 μg/kg/day to 11 hypomanic or manic patients. Biegel‐Murphy Manic‐State Rating Scale scores were significantly decreased compared to pretreatment scores at day 10 and day 25 of clonidine treatment (P < .001). Sedation, hypotension, and depression were noted but were not limiting. Though the results of this study are only preliminary, clonidine alone or in combination with lithium may have advantages over neuroleptics in the acute stages of mania, including avoidance of extrapyramidal side effects and risk of tardive dyskinesia.

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