Examples

Generic Name	Brand Name
aripiprazole	Abilify
olanzapine	Zyprexa
quetiapine fumarate	Seroquel
risperidone	Risperdal
ziprasidone	Geodon

These medicines are available in liquid or tablet form.

How It Works

These medicines balance certain brain chemicals (neurotransmitters) that help regulate mood and control symptoms of bipolar disorder. They quickly improve manic episodes.

Why It Is Used

Olanzapine

Olanzapine acts as a mood stabilizer. It can help prevent the reckless and impulsive behaviors associated with mania and may help treat the "losing touch with reality" that can occur with mania. Olanzapine is often used in combination with other medicines (such as mood stabilizers like lithium or valproate) to effectively treat the manic phase of bipolar disorder. ¹

Risperidone

Risperidone can help restore more normal thinking and a more normal mood. Preliminary studies show it to be helpful when combined with other medicines (such as mood stabilizers) for adults who experience "breakthrough" episodes of depression and mania (mood disruption that occurs while taking maintenance medicines to control these episodes). ² Risperidone may be effective in the treatment of mania in young people, although research continues in this area.

Quetiapine

Quetiapine is being studied for effectiveness and safety for the treatment of mania associated with child and teen bipolar disorder. Doctors have used quetiapine to treat the "losing touch with reality" (psychosis) that is associated with schizophrenia.

Ziprasidone

Ziprasidone has been used to treat schizophrenia and was recently approved for the treatment of adult bipolar disorder and mania. Research in children is limited, but preliminary studies show ziprasidone may help reduce hypomania (a less severe form of mania), hallucinations, aggression, irritability, depression, and insomnia. It may cause less weight gain than other antipsychotic medicines.

Aripiprazole

Aripiprazole is a drug that is being studied for its effectiveness in treating bipolar disorder, both on its own and when combined with other medicines (such as mood stabilizers). It is also used to treat schizophrenia.

How Well It Works

Olanzapine

Olanzapine has been shown to be safe and effective in adults for the short-term treatment of acute mania due to bipolar disorder.

Risperidone

Initial studies show risperidone is effective and safe for treating mania in children and teens who have bipolar disorder. ³ Preliminary studies show risperidone to be helpful when combined with other medicines (such as mood stabilizers) for those who experience "breakthrough" episodes of depression and mania (mood disruption that occurs while taking maintenance medicines to control these episodes). ² Risperidone is often used successfully to treat symptoms of psychosis associated with bipolar disorder in adults.

Quetiapine

Initial tests indicate that quetiapine effectively reduces mania in adolescents with bipolar disorder when combined with the mood stabilizer divalproex. ⁴

Aripiprazole

Initial research shows that aripiprazole works especially well in treating mania. It is also effective in treating schizophrenia. Long-term studies on its safety and effectiveness are still under way.

Side Effects

Olanzapine

Olanzapine can cause side effects such as dry mouth, constipation, weight gain, drowsiness, increased appetite, shakiness or tremors, slurred speech, low blood pressure that makes you feel dizzy when you stand up, and sudden and sustained stiffness or muscle spasm (dystonic reaction). Unusual side effects can include headaches or a skin rash from an allergic reaction to the medicine.

Risperidone

Risperidone may cause sleepiness, dystonic reaction, weight gain, menstrual irregularity, and breast tenderness. Unusual side effects include an allergic reaction (skin rash), headaches, constipation, decreased sexual desire and function, and increased heart palpitations.

Quetiapine

Quetiapine can cause side effects such as headaches, dizziness, rash, fever, weight gain, dry mouth, and other flu-like symptoms.

Ziprasidone

Ziprasidone can cause side effects such as tiredness, nausea, hard stools, dizziness, uncontrollable muscle movements, diarrhea, rash, restlessness, and increased cough or runny nose. It may also cause changes in transmission of electrical signals in the heart (EKG abnormalities).

Aripiprazole

Aripiprazole can cause side effects such as headache, anxiety, insomnia, nausea, vomiting, sleepiness or drowsiness, lightheadedness, muscle twitching, restlessness, and constipation.

Other side effects of antipsychotic medicines

Other possible side effects of antipsychotic medicines include:

• Blood sugar problems. The U.S. Food and Drug Administration (FDA) requested that a warning be added to the prescribing information for all atypical antipsychotics indicating an increased risk of hyperglycemia (high blood sugar) and type 2 diabetes for people taking these medicines. The FDA recommends blood sugar monitoring of patients taking atypical antipsychotics, especially those who are at risk for obesity or who have diabetes or a family history of diabetes.
• Weight gain. But some antipsychotic medicines appear less likely to cause weight gain. Talk to your doctor if this is a concern.
• Hyperlipidemia (abnormalities in cholesterol levels).
• Hyperprolactinemia, which is high levels of certain hormones that can lead to breast enlargement in boys and girls and to abnormal menstrual cycles in girls.
• Problems in children who have a history of seizures or with conditions that make seizures more likely.

There are other extremely rare but serious side effects that are possible with these medicines:

Neuroleptic malignant syndrome (NMS), which causes life-threatening problems with your body's ability to regulate its temperature, has been reported with antipsychotic medicines.

Tardive dyskinesia (TD) is a drug-induced movement disorder that can cause uncontrollable body movements. Newer medicines are much less likely than older antipsychotics to cause the disorder.

Managing side effects

It may take several attempts to find the right dose and medicine to treat your child's bipolar symptoms. Effectiveness and side effects for each medicine vary from person to person.

Some side effects are minor, and you can manage them through lifestyle changes such as exercise, relaxation techniques, and diet changes. Other side effects can be more serious and require changes to the dose or type of medicine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

While these medicines have been well studied for use in adults, there are few long-term studies that confirm the effectiveness and safety of antipsychotics in children and teens who have bipolar disorder. Be sure to use these medicines exactly as your doctor prescribes them. If your child develops intolerable side effects to any of these medicines, call your doctor immediately.

Before your child takes an antipsychotic medicine, be sure to tell your doctor if your child has:

• A heart condition.
• A seizure disorder.
• Problems with liver function.
• Problems with blood pressure.
• Diabetes or high blood sugar.
• Constipation.
• A history of breast cancer.
• Problems with swallowing.
• Problems with fainting.

Adolescents who could be pregnant or have had neuroleptic malignant syndrome should not take these medicines.

These medicines should be started in low doses. Talk with your doctor about any other medicines your child may be taking to make sure there are no negative drug interactions.

Your child may require regular liver tests, blood tests, and blood pressure monitoring while taking an antipsychotic medicine.

Avoid herbal stimulants (such as ma huang, ginseng, or kola) while taking an antipsychotic medicine.

Talk to your doctor or pharmacist about drinking grapefruit juice while you are taking an antipsychotic medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases your chances of having serious side effects.

Newer antipsychotics should be used with caution in people who drink alcohol or take other medicines.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. Tohen M, et al. (2002). Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy. Archives of General Psychiatry, 59(1): 62-69.

2. American Psychiatric Association (2002). Practice guideline for the treatment of patients with bipolar disorder (revision). American Journal of Psychiatry, 159(4, Suppl):1-50.

3. Geddes J, Briess D (2008). Bipolar disorder, search date July 2006. Online version of Clinical Evidence: www.clinicalevidence.com.

4. DeBello MP, et al. (2002). A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. Journal of the American Academy of Child and Adolescent Psychiatry, 41(10): 1216-1223.