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Atypical antipsychotic medication in the treatment of bipolar affective disorders

Several mood stabilizers, such as lithium, valproic acid and carbamazepine are widely used for the prevention and treatment of bipolar disorders. However, there is number of patients unresponsive to either monotherapy or combination treatment. This proportion may be even higher in patients with mixed episodes or rapid cycling. Conventional antipsychotics have been used over four decades to treat bipolar disorders, especially those with psychotic features. It has been reported that they may induce or exacerbate major depressive episodes, while high incidence of extrapyramidal side effects has also been noted. Furthermore, literature review suggests that their long-term use may be related to poor functioning. Atypical antipsychotics characterized by a much-improved tolerability and safety profile can be used as an adjunctive therapy for psychotic bipolar patients or as alternatives for the treatment of bipolar patients with mania who have not responded to lithium or other mood stabilizers. It has been demonstrated that olanzapine monotherapy is efficacious in the treatment of acute mania. Certain atypical antipsychotics may possess antidepressant effects as add-on therapy in patients with mood disorders. The existing literature suggests their long-term use in low doses as adjunctive treatments of mood stabilizing agents in severe refractory patients. The issue of efficacy and tolerability of atypical antipsychotics alone or in combination with mood stabilizers in bipolar disorders is critical, challenging and warrants further exploration in the context of larger controlled studies.

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Psarros, C. Atypical antipsychotic medication in the treatment of bipolar affective disorders. Ann Gen Hosp Psychiatry 2 (Suppl 1), S10 (2003).

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