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 .
A comparison of the efficacy, safety, and tolerability of divalproex sodium and olanzapine in the treatment of bipolar disorder.
BACKGROUND This study compared the efficacy , safety , and tolerability of divalproex and olanzapine in the treatment of acute mania associated with bipolar disorder . METHOD This r and omized , 12-week , double-blind , parallel-group , multicenter study included DSM-IV-defined bipolar disorder type I patients hospitalized for acute mania and r and omly assigned to treatment with divalproex or olanzapine .  After an inpatient period of up to 21 days , subjects were followed as out patients . Dose adjustment was permitted during the inpatient period . Efficacy was assessed using change from baseline in Mania Rating Scale ( MRS ) score to day 21 ; other efficacy measures included the Brief Psychiatric Rating Scale , the Hamilton Rating Scale for Depression , and the Clinical Global Impressions-Part I , Severity of Illness scale . The primary safety endpoint was change from baseline in weight . Other safety and tolerability endpoints included spontaneous adverse event reporting and changes from baseline in laboratory measures and vital signs . RESULTS 120 subjects ( N = 63 divalproex , N = 57 olanzapine ) were r and omly assigned to treatment . No significant differences between groups were found for any efficacy variable for change from baseline to day 21 . Mean MRS score changes from baseline to day 21 were -14.8 for divalproex and -17.2 for olanzapine ( p = .210 ) . A significantly ( p < .05 ) greater proportion of olanzapine-treated subjects experienced somnolence , weight gain , edema , rhinitis , and speech disorder ( slurred speech ) ; no adverse events were significantly greater in the divalproex group . A number of laboratory measures also demonstrated significant treatment differences , but the clinical significance of many of these is uncertain . Mean body weight changes were significantly greater in the olanzapine group ( + 8.8 lb [ + 4.0 kg ] ) than the divalproex group ( + 5.5 lb [ + 2.5 kg ] , p < .050 ) . One death occurred during the study ( olanzapine group , diabetic ketoacidosis ) . CONCLUSION No significant difference in efficacy was found between treatment groups . Divalproex was associated with a more favorable adverse event profile and significantly less weight gain than olanzapine
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 .