Antipsychotics for the treatment of bipolar disorder

Examples

Generic Name	Brand Name
aripiprazole	Abilify

The above medication is taken as a tablet or capsule (orally).

Generic Name	Brand Name
haloperidol	Haldol
olanzapine	Zyprexa
olanzapine and fluoxetine hydrochloride	Symbyax
quetiapine fumarate	Seroquel
risperidone	Risperdal
ziprasidone hydrochloride	Geodon

These medications are available in liquid, tablet, or injectable form.

How It Works

These medications balance certain chemicals in the brain (neurotransmitters). It is not clear exactly how these medications work for the treatment of bipolar disorder. But they quickly improve manic episodes.

Why It Is Used

Each of these medicines has been approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder. Some medicines work better for different people than others. Be sure to talk with your doctor about how the medicine is working for you. Sometimes you might need to try more than one type of medicine before you find one that works best for you.

Olanzapine acts as a mood stabilizer to manage the manic phase of bipolar disorder. It can help you avoid the reckless and impulsive behaviors associated with mania. Olanzapine is often used in combination with other medicines (such as mood stabilizers like lithium or valproate) to effectively treat the manic phase of bipolar disorder.¹

The single medication combining olanzapine and fluoxetine (Symbyax) is used to treat depressive episodes associated with bipolar disorder. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), which is used to balance certain brain chemicals (neurotransmitters) that are thought to cause depression.

Risperidone can help restore more normal thinking and a more normal mood. Preliminary studies show it to be helpful when combined with other medicines (such as mood stabilizers) for those who experience “breakthrough” episodes of depression and mania. A breakthrough episode is a mood disruption that occurs while taking maintenance medications to control these episodes.² Risperidone may be effective in the treatment of mania in young people, although research continues in this area.

Ziprasidone is used to treat acute episodes of mania and mixed bipolar episodes of mania and depression.

Quetiapine is used to treat manic episodes associated with bipolar disorder in adults. Quetiapine is currently being studied for effectiveness and safety when combined with other medications (such as the mood stabilizers lithium and divalproex) for the treatment of mania. Quetiapine has been used to treat the loss of touch with reality (psychosis).

How Well It Works

Drugs in this classification work quickly in the treatment of bipolar disorder, especially in older adults.

Olanzapine is easy to take, and it has been shown to be safe and effective for the short-term treatment of acute mania caused by bipolar disorder. It usually eases manic symptoms after only 1 week of treatment.

Risperidone is often used in individuals who are resistant to treatment with other medications. It has fewer side effects compared with older antipsychotic medications, such as Haldol. It is often used successfully to treat symptoms of psychosis.

Side Effects

The most common side effects of olanzapine include:¹

• Dry mouth.
• Constipation.
• Weight gain.
• Drowsiness.
• Increased appetite.
• Shakiness or tremors.
• Slurred speech.
• Low blood pressure that makes you feel dizzy when you stand up.
• Risk of developing diabetes and abnormalities in blood cholesterol levels. Abnormalities in blood glucose levels have been reported less for people who use risperidone or quetiapine.

Risperidone may cause sleepiness, weight gain, and breast tenderness. Side effects include a rash, headaches, constipation, decreased sexual desire and function, or increased heart palpitations. Risperidone may also be linked to an increased risk of stroke in older adults.

Ziprasidone may make you sleepy or cause nausea, dizziness, restlessness, diarrhea, coughing, or a rash. Ziprasidone may also cause abnormal muscle movements such as tremors or shuffling.

Quetiapine can cause side effects such as sleepiness, headaches, dizziness, rash, fever, weight gain, dry mouth, and other flu-like symptoms.

The use of antipsychotics has also been linked to the risk of movement disorders. The risk of developing a movement disorder is less for newer antipsychotics such as aripiprazole, olanzapine, risperidone, and quetiapine. But it is important to tell your doctor about any abnormal muscle movements.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Before taking olanzapine, risperidone, ziprasidone, or quetiapine, be sure to tell your doctor if you have:

• A heart condition.
• A seizure disorder.
• Problems with liver function.
• Problems with blood pressure.
• Diabetes or high blood sugar.
• Constipation.
• A history of breast cancer.
• Problems with swallowing.
• Problems with fainting.

You should not take ziprasidone if you have long QT syndrome (a specific heart-rhythm problem) or severe heart failure or you have had a recent heart attack. Ziprasidone should not be taken with certain medications used to treat abnormal heartbeats.

These medications should not be taken if you are pregnant or breast-feeding or have had a condition called neuroleptic malignant syndrome.

These medications should be started in low doses, especially in the elderly. Talk with your doctor about any other medications you may be taking to make sure there are no negative drug interactions.

You may need regular blood tests and blood pressure monitoring while taking these medications.

Avoid herbal stimulants (such as ma huang, ginseng, or kola), which may increase your chances of having serious side effects.

Talk to your doctor or pharmacist about drinking grapefruit juice while you are taking an antipsychotic medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases your chances of having serious side effects.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Author:	Sabra L. Katz-Wise Cynthia Tank	Last Updated April 18, 2006
Medical Review:	Adam Husney, MD - Family Medicine Lisa S. Weinstock, MD - Psychiatry
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