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Typical and atypical antipsychotics in bipolar disorder

Published online by Cambridge University Press:  18 September 2015

R.W. Licht
R.W. Licht*
Affiliation:
Aarhus University Psychiatric Hospital, Risskov, Denmark
*
Mood Disorders Research Unit, Aarhus University Psychiatric Hospital, DK-8240 Risskov, DenmarkTel 45-77892470, Fax 45-77892479, E-mail rl@psykiatri.aaa.dk
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Abstract

Background: In clinical practice, typical antipsychotics are widely used in the treatment of bipolar disorder, albeit in treatment guidelines often considered as adjunctive agents only. Recently, focus has shifted towards the use of atypical antipsychotics. This paper reviews the advantages and disadvantages associated with the use of antipsychotics in bipolar disorder.

Methods: Randomised controlled trials (RCTs) were selected for review. A few review articles were also cited.

Results: Typical antipsychotics, at least some of them, are powerful antimanics, beneficial for severe agitation in particular. However, in the long term treatment, typical antipsychics may precipitate depression. Among the atypical antipsychotics, both risperidone and olanzapine are clearly antimanic alternatives, although olanzapine is the best studied. Clozapine seems to be useful when other treatments fail to work.

Conclusions: Antipsychotics are beneficial for some clinical presentations of mania. To minimize side effets, atypical agents should be preferred before typical agents, unless parenteral administration is needed. Despite the lack of RCTs, antipsychotics also seem to be useful as adjunctive agents in the treatment of psychotic bipolar depression. For the long term treatment of bipolar disorder, typical antipsychotics should be used only under certain circumstances. The place of atypical antipsychotics in the long term treatment of bipolar disorder remains to be studied.

Keywords

bipolar disordermaniaantipsychotic agentstreatmentreview
Type
Articles
Information
Acta Neuropsychiatrica , Volume 12 , Issue 3 , September 2000 , pp. 115 - 119
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2000

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