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 olanzapine in acute bipolar mania: a double-blind, placebo-controlled study. The Olanzipine HGGW Study Group.
BACKGROUND We compared the efficacy and safety of olanzapine vs placebo for the treatment of acute bipolar mania . METHODS Four-week , r and omized , double-blind , parallel study . A total of 115 patients with a DSM-IV diagnosis of bipolar disorder , manic or mixed , were r and omized to  olanzapine , 5 to 20 mg/d ( n = 55 ) , or placebo ( n = 60 ) . The primary efficacy measure was the Young-Mania Rating Scale ( Y-MRS ) total score . Response and euthymia were defined , a priori , as at least a 50 % improvement from baseline to end point and as a score of no less than 12 at end point in the Y-MRS total score , respectively . Safety was assessed using adverse events , Extrapyramidal Symptom ( EPS ) rating scales , laboratory values , electrocardiograms , vital signs , and weight change . RESULTS Olanzapine-treated patients demonstrated a statistically significant greater mean ( + /- SD ) improvement in Y-MRS total score than placebo-treated patients ( -14.8 + /- 12.5 and -8.1 + /- 12.7 , respectively ; P<.001 ) , which was evident at the first postbaseline observation 1 week after r and omization and was maintained throughout the study ( last observation carried forward ) . Olanzapine-treated patients demonstrated a higher rate of response ( 65 % vs 43 % , respectively ; P = .02 ) and euthymia ( 61 % vs 36 % , respectively ; P = . 01 ) than placebo-treated patients . There were no statistically significant differences in EPSs between groups . However , olanzapine-treated patients had a statistically significant greater mean ( + /- SD ) weight gain than placebo-treated patients ( 2.1 + /- 2.8 vs 0.45 + /- 2.3 kg , respectively ) and also experienced more treatment-emergent somnolence ( 21 patients [ 38.2 % ] vs 5 [ 8.3 % ] , respectively ) . CONCLUSION Olanzapine demonstrated greater efficacy than placebo in the treatment of acute bipolar mania and was generally well tolerated
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 .