What is the role of Atypical Antipsychotics in the treatment of bipolar disorder?
Although atypical antipsychotics have a lower incidence of EPS and tardive dyskinesia than typical antipsychotics, as well as better overall tolerability, they are not without side effects. Increases in weight, blood sugar, cholesterol, and triglycerides have brought new issues to light in the treatment of bipolar disorder. Nevertheless, the generally favorable side-effect profile of these agents may improve patient adherence with therapy and thus represent an advance in therapy for severe, chronic disorders, including bipolar disorder. The following atypical antipsychotics may be used in the treatment of bipolar disorder.
Olanzapine (Zyprexa®) is approved for the treatment of acute manic episodes associated with bipolar disorder. The most common side effects associated with olanzapine include somnolence, dizziness, dry mouth, and weight gain. It has a very low incidence of EPS, including tardive dyskinesia. However, there have been reports of the induction of mania.
Although clozapine (Clozaril®) has been proven to show mood-stabilizing properties in people with bipolar disorder who don’t respond to lithium or valproate, it is not considered a first-line therapy in bipolar disorder due to the risk of agranulocytosis.
Risperidone (Risperdal®) has been shown to be effective in acute mania in conjunction with lithium or valproate in some people. Unlike clozapine and olanzapine, risperidone is not associated with significant body weight gain. One difficulty with risperidone is its potent effect on prolactin. Increases in prolactin may cause sexual difficulties in both men and women. In addition, higher doses of risperidone have been associated with the development of extrapyramidal side effects. As noted in the discussion of schizophrenia, different atypical antipsychotics have different efficacy and side-effect profiles. This may result from differences in the pharmacologic properties of specific atypical agents, as well as genetically based differences among patients.
As atypical antipsychotics continue to be developed, their role in the treatment of bipolar disorder will evolve based on results of controlled clinical studies.
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