Which medications in the drug class Antipsychotics, 2nd Generation are used in the treatment of Bipolar Disorder?

Updated: May 06, 2018
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Answer

Antipsychotics, 2nd Generation

Second-generation, or atypical, antipsychotics are increasingly being used for treatment of both acute mania and mood stabilization in patients with bipolar I disease.

Asenapine (Saphris)

Asenapine is indicated as monotherapy for the acute treatment of manic or mixed episodes that are associated with bipolar I disorder. It is also indicated as adjunctive therapy with lithium or valproate for the acute treatment of manic or mixed episodes associated with bipolar I disease. The efficacy of asenapine is thought to be mediated through a combination of antagonist activity at dopamine 2 and serotonin (5-HT2) receptors.

Ziprasidone (Geodon)

Ziprasidone is approved for the treatment of acute or mixed episodes that are associated with bipolar disorder. It can be used as maintenance treatment or as an adjunct to lithium or valproate.

Quetiapine (Seroquel, Seroquel XR)

Quetiapine is indicated for acute treatment of manic (immediate release and extended release [XR]) or mixed (XR) episodes that are associated with bipolar I disorder. It can be used as monotherapy or adjunctively with agents such as lithium or divalproex.

Risperidone (Risperdal, Risperdal Consta, Risperdal M-Tab)

Risperidone is indicated for short-term treatment of acute manic or mixed episodes that are associated with bipolar I disorder. It can be used alone or in combination with lithium or valproate. Risperidone can be used in adults and adolescents aged 10-17 years with bipolar I disorder.

Aripiprazole (Abilify, Abilify Maintena, Aristada)

Aripiprazole is indicated for the acute and maintenance treatment of manic or mixed episodes associated with bipolar I disorder. It can be used alone or in combination with lithium or valproate. Aripiprazole may be mediated through a combination of partial agonist activity at D2 and 5-HT1A receptors and antagonist activity at 5-HT2A receptors.

Olanzapine (Zyprexa, Zyprexa Zydis)

Olanzapine is used for the acute and maintenance treatment of manic or mixed episodes associated with bipolar I disorder. It can be used alone or in combination with lithium or valproate. Olanzapine can be used in adults and adolescents aged 13-17 years with bipolar I disorder.

Olanzapine and fluoxetine (Symbyax)

The drug combination includes olanzapine, a second-generation antipsychotic, and fluoxetine, a selective serotonin reuptake inhibitor. This drug is indicated for the acute treatment of depressive episodes associated with bipolar I disorder in adults. The clinical effects of this agent have not been studied in patients younger than 18 years.

Clozapine (Clozaril, FazaClo ODT, Versacloz)

Clozapine has an off-label indication for treatment of acute manic episodes associated with bipolar disorder and treatment of refractory bipolar mania. This agent demonstrates weak D2 receptor and D1 receptor blocking activity. Clozapine also acts as an antagonist at adrenergic, cholinergic, histaminergic, and serotonergic receptors.

Paliperidone (Invegaj, Invega Sustenna, Invega Trinza)

Paliperidone may be used for refractory, moderate to severe mania alone or in combination with lithium or valproate. This agent is typically reserved for patients who decline electroconvulsive therapy (ECT) and who do not respond to medication combinations involving lithium or valproate plus aripiprazole, haloperidol, or another first-generation antipsychotic.

Cariprazine (Vraylar)

Precise mechanism by which cariprazine works for bipolar disorder is unknown. Efficacy could be mediated through a combination of partial agonist activity at central dopamine (D2) and serotonin 5-HT1A receptors. It is indicated for manic or mixed episodes associated with bipolar 1 disorder.

Lurasidone (Latuda)

Lurasidone’s mechanism of action for treating bipolar depression is unknown. However, its efficacy could be mediated through a combination of central dopamine D2 and serotonin Type 2 (5HT2A) receptor antagonism. It is indicated for treatment of adults with major depressive episodes associated with bipolar I disorder as either monotherapy or as adjunctive treatment with lithium or valproate.


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