Novel antipsychotics in bipolar and schizoaffective mania


  • The novel antipsychotics clozapine (Clozaril, Leponex), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) have all been registered for the indication of schizophrenia. Ziprasidone (Geodon) has been registered for this indication only in the USA. Only olanzapine has been registered for the indication of acute bipolar mania and that too only in the USA.

C. J. Slooff MD PhD, Department of Psychotic Disorders, Flat 10, Mental Health Centre Drenthe, PO Box 30007, 9400 RA Assen, The Netherlands


Objective:  Novel antipsychotics are increasingly used in the treatment of bipolar and schizoaffective mania. This paper presents an overview of the controlled studies in this field.

Method:  Using cross-references, a computerized search was performed on MEDLINE and EMBASE psychiatry covering the period 1990–2002.

Results:  Olanzapine and risperidone, added to mood stabilizers, and olanzapine as monotherapy enjoy the most evidential support in terms of efficacy and side-effect profile for their use in acute bipolar mania. The use of modern antipsychotics in bipolar prophylaxis and in both the short- and long-term treatment of schizomania has not been widely studied yet.

Conclusion:  More controlled trials are still needed comparing modern antipsychotics as monotherapy and adjunctive to mood stabilizers with conventional antipsychotics, lithium, anticonvulsants and with each other in short-term and, especially, maintenance treatment of (schizo)mania. Partly based on controlled studies, olanzapine, risperidone and other modern antipsychotics could become preferable for these indications.