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 .
Recovery and functional outcomes following olanzapine treatment for bipolar I mania.
BACKGROUND Typical experimental categorizations of treatment responses in bipolar disorder ( BPD ) patients may have limited relationship to clinical recovery or functional status , and there is inadequate research on such clinical ly important outcomes . METHODS We analyzed data from a study of open continuation of olanzapine treatment following a 3-week placebo-controlled trial involving initially hospitalized adult subjects with DSM-IV BP-I mania to estimate rates and times to symptomatic remission ( low scores on st and ardized symptomatic assessment s ) and clinical recovery ( remission sustained > or=8 weeks ) , associated clinical factors , and functional outcomes . RESULTS During treatment with olanzapine for 27.9+/-20.1 weeks , symptomatic remission was attained by 70 % of subjects , half by 8 weeks ( 95 % CI 6 - 10 ) weeks , and later lost by 82 % of remitted subjects ; remitted ( versus non-remitted ) subjects had slightly lower baseline clinical global impression scores and greater trial-completion . Sustained clinical recovery was attained by only 40 of 113 ( 35 % ) of subjects , half by 36 ( 95 % CI 20 - 40 ) weeks , and later lost by 45 % . Subjects with above-median ( > 12 ) initial  Hamilton-Depression rating scale depression scores were half as likely to recover ( p=0.016 ) and did so much later ( 36 versus 12 weeks ) than those with lower scores . At final assessment , self-rated well being ( SF-36 psychosocial functioning scores ) improved substantially more among recovered versus non-recovered subjects ( mean changes : 87 % versus 23 % ) , and two-thirds of recovered subjects remained unemployed-for-pay while half received disability-compensation . CONCLUSIONS Clinical ly meaningful symptomatic remission and recovery in relatively severely ill adult bipolar I manic patients were achieved slowly and sustained by only some patients within an average of 7 months of continuous treatment . These clinical ly relevant outcomes were worse with relatively high initial dysphoria ratings . Well-being was rated higher by recovered subjects , but their ability to work and live independently were markedly impaired . These findings underscore the emerging view that BPD can often be severe , slow to remit , and disabling , particularly in association with prominent depression-dysphoria symptoms . Improved treatments for BPD are needed , guided by longitudinal assessment s of clinical ly meaningful measures of symptomatic recovery and functional outcome
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 .