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 .
Olanzapine versus divalproex in the treatment of acute mania.
OBJECTIVE The effects of olanzapine and divalproex for the treatment of mania were compared in a large r and omized clinical trial . METHOD A 3-week , r and omized , double-blind trial compared flexibly dosed olanzapine ( 5 - 20 mg/day ) to divalproex ( 500 - 2500 mg/day in divided doses ) for the treatment of patients hospitalized for acute bipolar manic or mixed episodes . The Young Mania Rating Scale and the Hamilton Depression Rating Scale were used to quantify manic and depressive symptoms , respectively . Safety was assessed with several measures . RESULTS The protocol defined baseline-to-endpoint improvement in the mean total score on the Young Mania Rating Scale as the primary outcome variable . The mean Young Mania Rating Scale score decreased by 13.4 for patients treated with olanzapine ( N=125 ) and 10.4 for those treated with divalproex ( N=123 ) . A priori categorizations defined response and remission rates : 54.4 % of olanzapine-treated patients responded ( > or = 50 % reduction in Young Mania Rating Scale score ) , compared to 42.3 % of divalproex-treated patients ; 47.2 % of olanzapine-treated patients had remission of mania symptoms ( endpoint Young Mania Rating Scale < or = 12 ) , compared to 34.1 % of divalproex-treated patients . The decrease in Hamilton depression scale score was similar in the two treatment groups . Completion rates for the 3-week study were similar in both groups . The most common treatment-emergent adverse events ( incidence > 10 % ) occurring more frequently during treatment with olanzapine were dry mouth , increased appetite , and somnolence . For divalproex , nausea was more frequently observed . The average weight gain with olanzapine treatment was 2.5 kg , compared to 0.9 kg with divalproex treatment . CONCLUSIONS The olanzapine treatment group had significantly greater mean improvement of mania ratings and a significantly greater proportion of patients achieving protocol -defined remission , compared with the divalproex treatment group . Significantly more weight gain and cases of dry mouth , increased appetite , and somnolence were reported with olanzapine , while more cases of nausea were reported with divalproex
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 .