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 different people than 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
The use of antipsychotics
has also been linked to the risk of movement disorders. The risk of developing
a movement disorder is less for newer antipsychotics such as aripiprazole,
olanzapine, risperidone, and quetiapine. But it is important to tell your
doctor about any abnormal muscle movements.
Also, second-generation antipsychotics may raise the risk of
diabetes and/or abnormalities in cholesterol levels.
The most common side effects of
olanzapine include dry mouth, constipation, weight gain, drowsiness, and
increased appetite.2 Other common side effects are
shakiness or tremors, slurred speech, and low blood pressure that makes you
feel dizzy when you stand up.
Risperidone may cause sleepiness, weight gain,
abnormal cholesterol levels, and breast tenderness. Side effects include a
rash, headaches, constipation, decreased sexual desire and function, or
increased heart palpitations. Risperidone may be linked to an increased
risk of stroke in older adults. It also may increase levels of the hormone prolactin. This can lead to larger breasts in both men and women.
Ziprasidone may make you sleepy or
cause nausea, dizziness, restlessness, diarrhea, coughing, or a rash.
Ziprasidone may also cause abnormal muscle movements such as tremors or
shuffling. Ziprasidone can sometimes affect the heart rate. It should not be used by people who have a history of cardiac arrhythmia.
Quetiapine can cause side effects such as sleepiness,
headaches, dizziness, rash, fever, weight gain, abnormal cholesterol levels,
dry mouth, and other flu-like symptoms.
See Drug Reference for
a full list of side effects. (Drug Reference is not available in all
What To Think About
Before taking olanzapine,
risperidone, ziprasidone, or quetiapine, be sure to tell your doctor if you
- A heart condition.
- A seizure
- Problems with liver function.
- Problems with
- Diabetes or high blood
- A history of breast
- Problems with swallowing.
- Problems with
You should not take ziprasidone if you have long QT
syndrome (a specific heart-rhythm problem) or severe
heart failure or you have had a recent
heart attack. Ziprasidone should not be taken with
certain medicines used to treat abnormal heartbeats.
has been linked to a rare risk for neuroleptic syndrome. Neuroleptic syndrome
is a life-threatening reaction that begins with a high fever along with changes
in heart rate and breathing patterns.
These medicines should be
started in low doses, especially in the elderly. Talk with your doctor about
any other medicines you may be taking to make sure there are no negative drug
You may need regular blood tests and blood pressure
monitoring while taking these medicines.
Avoid herbal stimulants
(such as ma huang, ginseng, or kola), which may increase your chances of having
serious side effects.
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
Taking medicines during pregnancy for bipolar
disorder may increase the risk of birth defects. If you are pregnant, or
thinking of becoming pregnant, talk to your doctor. Medicines may need to be
continued if your bipolar disorder is severe. Your doctor can help weigh the
risks of treatment against the risk of harm to your pregnancy.
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.
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.