Atypical Antipsychotic Augmentation of Mood Stabilizer Therapy in Bipolar Disorder
J Clin Psychiatry 2005;66(suppl 3):12-19
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Although monotherapy with lithium or divalproex is the recommended initial therapy for bipolar
disorder, these agents are associated with prolonged favorable outcomes in only 30% of patients. Increasingly,
the medical literature is demonstrating that augmentation of mood stabilizers with atypical
antipsychotics is a more effective therapy. This form of combination therapy is recommended as firstline
treatment for severe bipolar mania. Recent clinical studies have shown that augmentation therapy
with the atypical antipsychotics risperidone, olanzapine, quetiapine, and ziprasidone is effective in
long-term maintenance treatment, and preliminary evidence is emerging that use of atypicals with
mood stabilizers can help control the depressive phase of bipolar disorder. The atypical antipsychotics
also have relatively mild side effect profiles, although augmentation therapy with some antipsychotics
and mood stabilizers has been associated with excessive weight gain.