The Position of Neuroleptics inthe Treatment of Bipolar Disorder

Overview

Before the era of atypical neuroleptics there was a relatively clear consensushow to use neuroleptics in the treatment of bipolar disorder (BD): they wereconsidered one of the main choices in the treatment of the manic phase,while in depression they were recommended only of psychotic depth. Theauthors submit a review of investigations of typical neuroleptics in BD andsuggest possible advantages of the use of atypical neuroleptics in this indica-tion. They submit also a review of investigations of atypical neuroleptics inBD. So far in the treatment of BD clozapine, risperidone and olanzapine wereused. Clozapine was sporadically used in the treatment of BD since the mid-seventies with a considerable increase of its use from the end of the eighties.It proved useful in the treatment of manic and depressive phases, wherebya considerable part of the treated patients was pharmacoresistent. The effec-tiveness of clozapine in mania seems to be greater than in depression. Therewere also publications on the effectiveness of clozapine in the treatment ofrapid cycling and as a thymostabilizing agent. Risperidone has been tested inBD since 1992. It has a good antidepressive effect. Some authors describedafter monotherapy with risperidone deterioration of the manic syndrome,while in combination with a thymostabilizing agent the antimanic effect ofrisperidone was evaluated as convincing. In olazapine initial favourable experience with the treatment of BD is available, in manic as well as in depres-sive symptoms.

Key words:
bipolar disorder, mania, depression, typical neuroleptics, atypi-cal neuroleptics, clozapine, risperidone, olanzapine.