Vieta E, Goikolea JM. Atypical
antipsychotics: newer options for
mania and maintenance
therapy. Bipolar Disord 2005: 7 (Suppl. 4): 21-33. (c) Blackwell Munksgaard, 2005Atypical
antipsychotics have been used to treat patients with
schizophrenia for many years, but now there is increasing evidence of their utility in the treatment of
bipolar disorder. In the past few years several atypical agents have received regulatory approval for use in bipolar
mania. Through a review of randomized controlled trials for five commonly used atypical drugs,
olanzapine,
risperidone,
quetiapine,
ziprasidone and
aripiprazole, this article evaluates their efficacy in the acute and maintenance phases of
bipolar disorder. The evidence shows that atypical
antipsychotics are effective in the treatment of manic symptoms, either alone or in combination with traditional mood stabilizers such as
lithium and
divalproex. Although emerging data indicate that atypical
antipsychotics will be a promising addition to those
therapies that are currently available for managing patients during the maintenance phase of bipolar illness, their potential in the long-term management of
bipolar disorder remains to be fully explored. Atypical
antipsychotics appear to have broadly similar efficacy against manic symptoms of
bipolar disorder, but there are important differences in their tolerability profiles, which are likely to be of particular relevance during long-term treatment. A brief assessment of tolerability issues surrounding the use of atypical agents in
bipolar disorder and other aspects of treatment that have impact on the clinical effectiveness of the
therapy are considered.