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Efficacy of Atypical Antipsychotics in Bipolar Disorder

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Abstract

Bipolar disorder is a severe and recurrent disorder. Atypical antipsychotics have emerged as both an alternative and adjunct to conventional mood stabilisers. The manic phase of the illness is the best studied, and it appears that a class effect with regards to efficacy is present in both monotherapy and augmentation studies.

Evidence for efficacy of atypical antipsychotics in depression is emerging. At this stage controlled data are available for both olanzapine and quetiapine. Maintenance data demonstrating efficacy are available for olanzapine. Atypical antipsychotics have utility in treating acute agitation and aggression in manic episodes of bipolar disorder. Subgroup analyses from trials treating manic phase bipolar disorder, and an open-label study of rapid cycling, have suggested that atypical antipsychotics may be useful for the treatment of mixed states and rapid cycling. Several studies have suggested that atypical antipsychotics may be useful in treatment-refractory episodes of bipolar disorder.

The current available data suggest greater efficacy of the atypical antipsychotics in mania than in depression, although the data are fairly clear that induction of depression is not an issue with the atypical antipsychotics. A number of trials are underway that will hopefully address many of the questions still pending.

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Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript.

Dr Berk has received grants from Organon, Eli Lilly, Bristol-Myers Squibb, Novartis and Mayne Pharma and has acted as a consultant for GlaxoSmithKline, Janssen Cilag, Bristol-Myers Squibb, Eli Lilly, Lundbeck and Astra Zeneca. He is on the Speakers Bureau for GlaxoSmithKline, Janssen Cilag, Bristol-Myers Squibb, Eli Lilly, Wyeth, Pfizer, Sanofi Synthelabo, Lundbeck, Astra Zeneca, Solvay and Organon.

Dr Dodd has received grants from Organon, Eli Lilly, Bristol-Myers Squibb, Novartis and Mayne Pharma.

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  1. Department of Clinical and Biomedical Sciences, The University of Melbourne, Swanston Centre, PO Box 281, Geelong, Victoria, 3220, Australia

    Michael Berk & Seetal Dodd

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Berk, M., Dodd, S. Efficacy of Atypical Antipsychotics in Bipolar Disorder. Drugs 65, 257–269 (2005). https://doi.org/10.2165/00003495-200565020-00006

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