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Typical and atypical antipsychotics in bipolar depression
Keming Gao1, Prashant Gajwani, Omar Elhaj
1Mood Disorders Program, Department of Psychiatry, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, 11400 Euclid Avenue, Cleveland, OH 44106, USA. keming.gao@uhhs.com
The Journal of Clinical Psychiatry
|January 20, 2006
Summary
Atypical antipsychotics show promise for treating bipolar depression, with some agents demonstrating superiority over placebo. Typical antipsychotics do not appear to worsen bipolar depression based on current data.
Area of Science:
- Psychiatry and Pharmacology
- Neuroscience
- Clinical Therapeutics
Background:
- Bipolar disorder often presents with more depressive than manic symptoms.
- Research on bipolar depression treatments lags behind that for bipolar mania.
- Antipsychotic agents are being investigated for bipolar depression due to their efficacy in mania.
Purpose of the Study:
- To review the efficacy of antipsychotic agents in treating bipolar depression.
- To compare the effectiveness of atypical and typical antipsychotics for bipolar depression.
Main Methods:
- Systematic search of MEDLINE (1980-2004) for placebo-controlled clinical trials.
- Keywords included various antipsychotic classes and bipolar disorder terms.
- Inclusion criteria required depression rating scales for atypical antipsychotic studies.
Main Results:
- Quetiapine demonstrated larger effect sizes than olanzapine in acute bipolar depression.
- Both olanzapine and quetiapine were superior to placebo in acute bipolar depression treatment.
- Olanzapine also showed efficacy in delaying relapse into bipolar depression.
Conclusions:
- Atypical antipsychotic agents show potential for both acute and long-term management of bipolar depression.
- Current evidence does not support the notion that typical antipsychotics exacerbate bipolar depression.