Table of Contents
Atypical antipsychotics include clozapine (Clozaril, generic), olanzapine (Zyprexa), risperidone (Risperdal, generic), paliperidone (Invega), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), and asenapine (Saphis).
- Olanzapine was the first atypical antipsychotic approved for treatment and longterm maintenance of bipolar disorder. It is FDA-approved to treat bipolar mania and mixed states.
- Symbyax, a drug that combines olanzapine and the antidepressant fluoxetine is approved for treatment of bipolar depression.
- Risperidone, ziprasidone, ariprazole, and asenapine are approved for treatment of bipolar mania and mixed states in adults. Ariprazole and risperidone are also approved for the acute treatment of mania and mixed episodes in children ages 10 - 17 with bipolar I disorder.
- Quetiapine is approved for treatment of bipolar mania and bipolar depression, making it the only drug approved for treating both manic and depressive states.
- Clozapine is an older atypical antipsychotic. It has not been approved for treatment of bipolar disorder, but has shown promise in investigational studies. However, this drug has more significant side effects than other atypical antipsychotics. It poses a risk of white blood cell reduction (agranulocytosis).
Side Effects. Although atypical antipsychotics have fewer severe side effects than standard antipsychotics, many patients fail to comply with regimens containing them. Common side effects include:
- Nasal congestion or runny nose
- Drooling
- Dizziness
- Headache
- Drowsiness -- however, these drugs may also cause restlessness and insomnia.
- Constipation
- Rapid heart beat
- Difficulty urinating
- Skin rash
- Increased body temperature
- Confusion, short-term memory problems, disorientation, and impaired attention
More serious risks include:
- Diabetes
- Weight gain and unhealthy cholesterol levels. The risk is highest for olanzapine and clozapine.
- Seizures
- Extreme and very serious increases in body temperature
- Sudden drop in blood pressure (hypotension)
- Extrapyramidal side effects, which are lack of motor coordination and involuntary movements
- Cataracts and worsening of any existing glaucoma
- Increased prolactin levels -- prolactin is a hormone associated with infertility and erectile dysfunction. High levels can cause menstrual abnormalities and may increase the risk for osteoporosis and possibly breast cancer.
- Heart problems, including sudden death
Diabetes Risk and Atypical Antipsychotics. All atypical antipsychotics can increase the risk of high blood sugar (hyperglycemia) and diabetes. (Olanzapine is more likely to cause high blood sugar levels than other atypical antipsychotic medicines.) The FDA recommends that:
- Patients with an established diagnosis of diabetes who begin atypical antipsychotic treatment should be regularly monitored for worsening of blood sugar control.
- Patients with risk factors for diabetes (obesity, family history of diabetes) should undergo fasting blood sugar testing at the beginning of atypical antipsychotic treatment and periodically during treatment.
- All patients treated with atypical antipsychotics should be monitored for high blood sugar (hyperglycemia) symptoms.
- Patients who develop hyperglycemia symptoms should undergo fasting blood sugar testing.
Antidepressants
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Review Date: 01/28/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
