First-generation, or typical, antipsychotic
Second-generation, or atypical, antipsychotic
|olanzapine and fluoxetine
These medicines are available in liquid, tablet, or
How It Works
These medicines balance certain chemicals
in the brain (neurotransmitters). It is not clear exactly how these
medicines work for the treatment of bipolar disorder. But they quickly improve
Why It Is Used
Each of these medicines has been
approved by the U.S. Food and Drug Administration (FDA) to treat bipolar
disorder. Some medicines work better for some people than for others.
Second-generation antipsychotic medicines may have fewer side effects than
first-generation antipsychotic medicines. Be sure to talk with your doctor
about how the medicine is working for you. Sometimes you might need to try more
than one type of medicine before you find one that works best for you.
These medicines have all been found to be an effective treatment of manic
episodes. Quetiapine has been approved by the FDA to treat both mania and
depression. Other antipsychotic medicines, such as olanzapine, are also being
studied for the treatment of depression in bipolar disorder. The single
medicine combining olanzapine and fluoxetine (Symbyax) is also used to treat
depressive episodes associated with bipolar disorder. Fluoxetine is a selective
serotonin reuptake inhibitor (SSRI), which is used to balance certain brain
chemicals (neurotransmitters) that are thought to cause
How Well It Works
Drugs in this classification work
quickly in the treatment of bipolar disorder, especially in older adults. These
medicines have all been found to be an effective treatment of manic episodes.
Some studies show the combination of an antipsychotic and a mood stabilizer may
be more effective than a mood stabilizer alone.1
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call911or other emergency services right away if you have:
Call your doctor if you have:
Neuroleptic malignant syndrome (NMS) is an extremely rare but serious side effect
that has been reported by people who take antipsychotic medicines. NMS causes
life-threatening problems with your body's ability to regulate its temperatures.
Call911or other emergency services right away if you have a fever and:
Other side effects of antipsychotic medicines include:
Managing side effects
It may take several
attempts to find the right dose and medicine to treat your bipolar
symptoms. Effectiveness and side effects for each medicine vary from person to
Some side effects are minor. You can manage these
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
Before you take an antipsychotic medicine, be sure to tell your
doctor if you have:
- A heart condition.
- A seizure
- Problems with liver function.
- Problems with
- Diabetes or high blood
- A history of breast
- Problems with swallowing.
- Problems with
These medicines should be started in low doses. Talk
with your doctor about any other medicines you may be taking to make
sure there are no negative drug interactions.
need regular liver tests, blood tests, and blood pressure monitoring while
taking an antipsychotic medicine. Your doctor may also monitor your weight and blood sugar.
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 taking an antipsychotic medicine. Grapefruit juice can increase the
level of these medicines in your blood. Having too much medicine in your blood
increases the chances of having serious side effects.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
Women who use this medicine during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Scherk H, et al. (2007). Second-generation
antipsychotic agents in the treatment of acute mania: A systematic review and
meta-analysis of randomized controlled trials. Archives of General Psychiatry, 64(4): 442–455.
Primary Medical Reviewer
||Patrice Burgess, MD - Family Medicine
Specialist Medical Reviewer
||Lisa S. Weinstock, MD - Psychiatry
Current as of
||May 14, 2012