MT is a former employee of Eli Lilly & Co. (2008) and his spouse is a current Eli Lilly & Co. employee and stockholder; and he has been a consultant to or received honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., GlaxoSmithKline, Johnson & Johnson and Wyeth. EV has received grants or honoraria as a consultant from Almirall, AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., Esteve, Forest, GlaxoSmithKline, Janssen-Cilag, Jazz, Lundbeck, Novartis, Pfizer, Sanofi, Servier, Shering-Plough, and UBC; and is supported in part by grants from the Instituto Carlos III (Fondos de Investigacion Sanitaria and CIBER-SAM), and by the EU 7th Framework Programme (ENBREC).
Antipsychotic agents in the treatment of bipolar mania
Article first published online: 1 JUN 2009
© 2009 John Wiley & Sons A/S
Special Issue: Lithium and the Modern Management of Bipolar Disorder
Volume 11, Issue Supplement s2, pages 45–54, June 2009
How to Cite
Tohen, M. and Vieta, E. (2009), Antipsychotic agents in the treatment of bipolar mania. Bipolar Disorders, 11: 45–54. doi: 10.1111/j.1399-5618.2009.00710.x
- Issue published online: 1 JUN 2009
- Article first published online: 1 JUN 2009
- Received 3 December 2008, revised and accepted for publication 9 March 2009
- acute mania;
- atypical antipsychotics;
- bipolar mania;
- typical antipsychotics
Objectives: Antipsychotics have been widely used in the treatment of bipolar mania. The purpose of this manuscript was to briefly review the evidence of typical and atypical antipsychotics for the treatment of bipolar mania.
Methods: A detailed literature review was conducted on the use of typical and atypical antipsychotics in the treatment of bipolar mania using standard search engines. A summary of the published literature on each agent is described followed by a discussion on the overall comparison of the different agents.
Results: For typical antipsychotics, up until recently, there was a paucity of published evidence on their strengths and limitations in the treatment of bipolar mania. Recent studies have demonstrated clear evidence on the efficacy of haloperidol on the treatment of acute mania. The literature suggests a faster onset of action of haloperidol as compared to either lithium or atypical antipsychotics. A limitation of typical antipsychotics however, is the risk of tardive dyskinesia, extrapyramidal side effects and a possible increased risk of non-adherence. Evidence on the efficacy for atypical antipsychotics has been demonstrated for aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone. Limitations as regards the use of atypical antipsychotics include the risk of weight gain and dyslipidemia. Comparison among different atypical antipsychotics agents are difficult to determine as there are no conclusive head to head studies. There is also a paucity of studies comparing atypical antipsychotics with lithium.
Conclusions: Evidence exists on the efficacy of both typical and atypical antipsychotics on the treatment of acute mania such that they are now clearly first-line along with lithium. An important limitation of the published literature is that most of the studies were designed to obtain regulatory approval for the different agents therefore the generalizability of the findings to clinical practice remains unclear.