New Treatments for Bipolar Disorder: The Role of Atypical Neuroleptic Agents
J Clin Psychiatry 2000;61(suppl 14):33-42
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Atypical neuroleptic agents are an excellent, safer, and more effective alternative to the widespread
practice of maintenance adjunctive treatment with traditional neuroleptic agents in patients
with bipolar disorder. Currently, a number of prospective studies are available with clozapine, risperidone,
olanzapine, and quetiapine in the treatment of bipolar disorder. Most are short-term studies,
although longer-term data are becoming available. Four double-blind studies of acute mania have
been conducted with risperidone and olanzapine, leading to recent Food and Drug Administration
approval for olanzapine in the indication of acute mania. Given the limited longer-term data, and the
evidence for mostly adjunctive benefits with these agents, it seems unlikely that these agents will
prove to be primary mood stabilizers in their own right. Nonetheless, they serve an important role as
adjunctive treatments along with standard mood stabilizers in the rational polypharmacy of bipolar
disorder. To date, differences in efficacy have not been established. However, differences in the side
effect of weight gain may be even more relevant in bipolar disorder than in schizophrenia due to the
need to use standard mood stabilizers that often potentiate such weight gain.