Bipolar Today

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In today’s edition of the major medical journal, The Lancet, a new meta-analysis appeared arguing that three antipsychotic drugs, specifically haloperidol, risperidone (Risperdal) and olanzopine (Zyprexa) were more effective than the old stalwarts, lithium and valproate, at treating the manic side of mental illness. In addition, two anti-psychotics were tied with lithium and valproate, quetiapine (Seroquel) and aripiprazole (Abilify). You can find a link to the abstract of the meta-analysis here.

Commentary

Doctors Lounge provides an interesting analysis of the article on their website here. They note two things about the study. First, they note that it is not surprising that antipsychotics are better for acute manic episodes than mood stabilizers. Many psychiatrists had surmised this for years. Second, they note that, despite being more effective than mood stabilizers at controlling acute mania, antipsychotic drugs do nothing to control depression, which means that bipolar patients would need to have anti-depressants in addition to antipsychotic drugs, while lithium and valproate could, in principle, work on their own.

What does all of this mean for us? Fortunately, all three of the antipsychotics that did better than mood stabilizers are now available generically (the patent on Zyprexa runs out this year), so they will be reasonably affordable. For those with acute mania who can also tolerate antidepressants, this gives more information that can be useful in deciding which medications to take. In addition, it opens up what might have seemed like a strange combination before: taking antipsychotics for mania and mood stabilizers for depression.

On a side note, the study’s abstract says something really ambiguous and potentially misleading: “Overall, antipsychotic drugs were significantly more effective than mood stabilisers.” Without clarification, it is unclear whether this means “all” or “some” antipsychotic drugs (it means “some” based on the data). Ambiguous statements like this should not be used in medical abstracts, and this statement has the potential to be misquoted or misunderstood (look, for example, at the Doctors Lounge title that repeats the mistake).

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4. Antidepressant-Induced Mania Signals Bipolar Disorder: JAD
5. Antipsychotic Prescriptions Higher in Foster Care