What is the role of Typical Antipsychotics in the treatment of bipolar disorder?
Like anxiolytics, antipsychotics are used as adjuvant therapy in the treatment of mania with psychomotor agitation or psychotic features. For example, typical antipsychotic agents may be used to treat the psychosis, aggression, and agitation associated with bipolar disorder. In addition, antipsychotics are often used as first-line agents for these conditions because of their relatively rapid onset of action.
Antipsychotics have been successfully used as an adjunct to lithium and anticonvulsant medications for the treatment of bipolar mania. Current treatment practices for acute mania may include the use of an antipsychotic to quickly manage symptoms. Lithium or anticonvulsants (as mood stabilizers) are added initially or shortly after the symptoms are managed by the antipsychotic. After the acute phase, the antipsychotic is tapered off and the patient is generally maintained on the mood stabilizer.
It is important to remember that Bipolar patients may be at an increased risk for tardive dyskinesia.
As you know, typical antipsychotics are associated with side effects, such as extrapyramidal symptoms (EPS) and the potential for tardive dyskinesia. Other side effects associated with typical antipsychotics include orthostatic hypotension, sedation, anticholinergic and antiadrenergic side effects, sexual dysfunction, and weight gain. One serious adverse reaction is neuroleptic malignant syndrome (NMS). Compared with patients with schizophrenia, patients with bipolar disorder are more sensitive to side effects associated with antipsychotics.
Several controlled studies have shown that haloperidol and chlorpromazine (typical antipsychotics) have efficacy similar to lithium in the treatment of acute mania. However, the side-effect profile of typical antipsychotics, especially EPS, is also a concern if these agents are to be used for long-term treatment of bipolar disorder. With typical antipsychotic agents, there may be a greater potential for tardive dyskinesia in people with affective disorders as compared to those with psychotic disorders.
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