CLOZAPINE IN BIPOLAR DISORDER - TREATMENT IMPLICATIONS FOR OTHER ATYPICAL ANTIPSYCHOTICS

Traditional neuroleptics are often utilized clinically for the managem ent of bipolar disorder. Although effective as antimanic agents, their mood stabilizing properties are less clear. Additionally, their acute clinical side effect profile and long term risk of tardive dyskinesia , particularly in mood disorder patients, portend significant liabilit y. This review focuses on the use of atypical antipsychotics in the tr eatment of bipolar disorder focusing on clozapine as the prototypical agent. Although, preclinical research and clinical experience suggest that the atypical antipsychotics are distinctly different from typical antipsychotics, they themselves are heterogeneous in profiles of neur opharmacology, clinical efficacy, and tolerability. The early clinical experience of clozapine as a potential mood stabilizer suggests great er antimanic than antidepressant properties. Conversely, very prelimin ary clinical experience with risperidone suggests greater antidepressa nt than antimanic properties and some liability for triggering or exac erbating mania. Olanzapine and sertindole are under investigation in p sychotic mood disorders. The foregoing agents and future drugs with at ypical neuroleptic properties should come to play an increasingly impo rtant role, compared to the older classical neuroleptics, in the acute and long term management of bipolar disorder. (C) 1998 Elsevier Scien ce B.V.