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 .
Ziprasidone in Acute Bipolar Mania: A 21-Day Randomized, Double-Blind, Placebo-Controlled Replication Trial
Background : In an earlier 21-day , placebo-controlled trial , ziprasidone was efficacious in improving symptoms of mania and was well tolerated . To confirm these results , a similarly design ed 21-day trial was conducted . Methods : In patients with bipolar I disorder , manic or mixed , were r and omized to ziprasidone ( 40 to 80 mg BID ) or placebo . Efficacy rating scales were derived from the Schedule for Affective Disorders and Schizophrenia-Change Bipolar Scale ( SADS-CB ) . SADS-CB-derived Mania Rating Scale ( MRS ) total score was the primary efficacy parameter . Secondary SADS-CB-derived efficacy parameters included Manic Syndrome and Behavior and Ideation Subscales , Hamilton Depression Rating Scale ( HAM-D ) , and the Montgomery Asberg Depression Rating Scale ( MADRS ) . The Clinical Global Impression-Severity Scale ( CGI-S ) , the Global Assessment of Functioning ( GAF ) , and the Positive and Negative Syndrome Scale ( PANSS ) were also assessed . Results : Sixty-five placebo and 137 ziprasidone patients were evaluable for efficacy . Baseline-to-endpoint mean changes in MRS scores were −11.1 for ziprasidone and −5.6 for placebo ( all patients , last observation carried forward [ LOCF ] ; P < 0.01 ) . Ziprasidone produced significantly greater improvements in Manic Syndrome ( P ≤ 0.01 ) and Behavior and Ideation Subscales ( P ≤ 0.001 ) , CGI-S score , ( P ≤ 0.001 ) , PANSS Total ( P ≤ 0.01 ) and Positive Subscale ( P ≤ 0.001 ) scores , and GAF ( P ≤ 0.001 ) . With ziprasidone , significant improvements were observed from Day 2 onward for MRS and CGI-S at all time points except Day 4 for MRS . Treatment-related discontinuations due to adverse events were 5.8 % for ziprasidone and 1.5 % for placebo ( P = 0.20 ) . Conclusions : Ziprasidone was well tolerated , rapidly efficacious , and superior to placebo in improving symptoms and global illness severity in these in patients with acute bipolar mania , both manic and mixed episodes
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 .