Second-generation antipsychotic medications in the treatment of mood disorders: focus on aripiprazole

Second-generation antipsychotic medications offer a broader range of therapeutic efficacies than first-generation agents. Consequently, our field has witnessed a rapid expansion of the use of second-generation antipsychotic drugs for several conditions beyond psychosis. The use of second-generation antipsychotic medications has been most pronounced in mood disorders, especially in bipolar disorders. Information about the agents clozapine, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole in terms of their efficacy and tolerability in bipolar disorder is now available. Aripiprazole, a new agent whose proposed mechanism(s) of action differs from that of other agents, has been shown in placebo-controlled comparative trials in bipolar patients to be an effective and well tolerated treatment option for this patient group. The role of second-generation antipsychotic medications in the therapeutic armamentarium for bipolar disorders will be determined by clinical experience, by additional phase IV studies and by trials that compare second-generation antipsychotics with each other and also with mood-stabilizing medications. There is also a pressing need for additional information on the long-term efficacy and safety of each second-generation antipsychotic agent during maintenance therapy for bipolar disorders.