In maintenance trials atypical antipsychotics had significantly fewer relapses to depression or mania than placebo or active comparator .
Conclusion Atypical antipsychotics are effective in treating both phases of bipolar disorder compared with placebo , and as effective as established drug therapies .
Atypical antipsychotics produce fewer extrapyramidal symptoms , but weight gain is more common ( with olanzapine ) .
There is insufficient data confidently to distinguish between different atypical antipsychotics
Background Atypical antipsychotics are increasingly used for treatment of mental illnesses like schizophrenia and bipolar disorder , and considered to have fewer extrapyramidal effects than older antipsychotics .
Efficacy of Quetiapine Monotherapy in Bipolar I and II Depression: A Double-blind, Placebo-controlled Study (The BOLDER II Study)
This study evaluated the efficacy and tolerability of quetiapine monotherapy for depressive episodes in patients with bipolar I or II disorder ( Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ) who were r and omized to 8 weeks of double-blind treatment with quetiapine ( 300 or 600 mg/d ; once daily , evening dosing ) or placebo .  Patients were assessed weekly using the Montgomery-Åsberg Depression Rating Scale ( MADRS ) and Hamilton Depression Rating Scale ( HAM-D ) . The primary end point was change in MADRS total score from baseline to Week 8 ( analysis of covariance/last-observation-carried-forward analysis ) . Of 509 patients r and omized , 59 % completed the study . Improvements from baseline in mean MADRS total scores were significantly greater with quetiapine 300 and 600 mg/d than with placebo from first evaluation ( Week 1 ) through Week 8 ( both P ≤ 0.001 vs. placebo ) . Therapeutic effect sizes at Week 8 were 0.61 and 0.54 for quetiapine 300 and 600 mg/d , respectively . Improvements in mean HAM-D scores were also significantly greater with both quetiapine doses than with placebo ( P < 0.001 ) as early as Week 1 and throughout the study . The MADRS response and remission rates were also significantly greater in both quetiapine dose groups compared with placebo . Improvements in primary and secondary outcomes were observed with both 300 and 600 mg/d quetiapine without major differences between the doses . Common adverse events included dry mouth , sedation , somnolence , dizziness , and constipation . The incidence of treatment-emergent mania or hypomania was lower with quetiapine treatment than placebo . This study demonstrates that quetiapine monotherapy is an effective and well-tolerated treatment for depressive episodes in bipolar disorder , confirming the results observed from a previous study ( BipOLar DEpRession [ BOLDER ] I )
In maintenance trials atypical antipsychotics had significantly fewer relapses to depression or mania than placebo or active comparator .
Conclusion Atypical antipsychotics are effective in treating both phases of bipolar disorder compared with placebo , and as effective as established drug therapies .
Atypical antipsychotics produce fewer extrapyramidal symptoms , but weight gain is more common ( with olanzapine ) .
There is insufficient data confidently to distinguish between different atypical antipsychotics
Background Atypical antipsychotics are increasingly used for treatment of mental illnesses like schizophrenia and bipolar disorder , and considered to have fewer extrapyramidal effects than older antipsychotics .