CONCLUSIONS
manic, bipolar disorder
TREATMENT COMPLICATIONS, OXIDATIVE STRESS, RECURRENCE, DISORDER
The treatment complications of bipolar disorder in manic episodes and the lack of satisfactory responses to usual pharmacological and non‐pharmacological treatments to control the episode and prevent the recurrence of symptoms emphasize the need to pay attention to the use of additional treatments. The use of spironolactone add‐on treatment as a mineralocorticoid receptor antagonist to sodium valproate in the manic episode of bipolar disorder among a group of hospitalized patients in this clinical trial was associated with an improvement in the cognitive status of these patients compared to placebo.The multiplicity of different possible mechanisms influencing the improvement of the cognitive status of these patients (systemic effects on fluid and electrolyte regulation, control of inflammatory status and oxidative stress, and regulation of the HPA axis and circadian rhythm) emphasizes the necessity of designing related studies focusing on each of the possible influencing paths to achieve new methods of treating this disorder.In this study, the usefulness of spironolactone‐added treatment to control mood symptoms, improve sleep quality, control appetite, and reduce mass index was not obtained. The need to pay attention to conducting similar studies using spironolactone as adjunctive therapy in the treatment of manic episodes of bipolar disorder using a larger sample size, multicenter setting, longer follow‐ups, and other possible doses of spironolactone is suggested.