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 sodium for the treatment of acute mania and maintenance of remission: A 47-week study
OBJECTIVE Few double-blind trials have compared longer-term efficacy and safety of medications for bipolar disorder . The authors report a 47-week comparison of olanzapine and divalproex . METHOD This 47-week , r and omized , double-blind study compared flexibly dosed olanzapine ( 5 - 20 mg/day ) to divalproex ( 500 - 2500 mg/day ) for manic or mixed episodes of bipolar disorder ( N=251 ) . The only other psychoactive medication allowed was lorazepam for agitation . The primary efficacy instrument was the Young Mania Rating Scale ; a priori protocol -defined threshold scores were > or = 20 for inclusion , < or = 12 for remission , and > or = 15 for relapse . Analytical techniques included mixed model repeated- measures analysis of variance for change from baseline , Fisher 's exact test ( two-tailed ) for categorical comparisons , and Kaplan-Meier estimates of time to events of interest . RESULTS Over 47 weeks , mean improvement in Young Mania Rating Scale score was significantly greater for the  olanzapine group .  Median time to symptomatic mania remission was significantly shorter for olanzapine , 14 days , than for divalproex , 62 days . There were no significant differences between treatments in the rates of symptomatic mania remission over the 47 weeks ( 56.8 % and 45.5 % , respectively ) and subsequent relapse into mania or depression ( 42.3 % and 56.5 % ) . Treatment-emergent adverse events occurring significantly more frequently during olanzapine treatment were somnolence , dry mouth , increased appetite , weight gain , akathisia , and high alanine aminotransferase levels ; those for divalproex were nausea and nervousness . CONCLUSIONS In this 47-week study of acute bipolar mania , symptomatic remission occurred sooner and overall mania improvement was greater for olanzapine than for divalproex , but rates of bipolar relapse did not differ
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 .