Asenapine is an atypical antipsychotic indicated for the treatment of schizophrenia and of the manic or mixed episodes in bipolar I disorder [1]. The different therapeutics option like mood stabilizers and atypical antipsychotics are used to better treat the single episode but also to stabilize manic/depressive cyclicity [2]. The aim of this case report is to underline a possible augmentation of asenapine to clozapine.

'Mrs. T.P.', is a caucasian woman aged 45 suffering from bipolar disorder type I followed by mixed depressive phases with subsequent short free period. The patient was treated with different typical and atypical antipsychotics, combined with mood stabilizers, with a partial response. With lithium 900 mg/day, valproate 1500 mg/day and clozapine 250 mg/day showed a partial improvement and remission of the symptoms. To that point we introduced asenapine 20 mg/day with rapid clinical improvement without major side effects. After 1 year the patient is still showing a good affective stability, with an improvemnt of metabolic and without cognitive side effects.

Our case report underlines the possibility of asenapine augmentation of clozapine in bipolar I disorder therapy resistant manic patients [3]. Asenapine can increase the plasmatic levels of clozapine, exhibits a unique effect and his pharmacodynamic characteristics may mediate its symptom relief in positive, negative and mood symptoms. Further research is warranted to replicate our clinical observation.