A meta-analysis of the use of typical antipsychotic agents in bipolar disorder

Background: The potential benefits of typical antipsychotic agents in bipol ar disorder are offset by serious: treatment-associated side effects. Despi te these concerns and the availability of mood stabilizing agents. the trea tment of bipolar disorder with typical antipsychotic: agents appears to be widespread. Method. A Medline search identified 16 publications that outlin ed medication use among 2378 bipolar disorder patients. Meta-analysis was u sed to estimate a weighted average of the relative proportions of the treat ment use, where the weights were the reciprocals of the estimated variances for each study. Results: Overall. 84.7% of bipolar patients received typic al antipsychotic agents. with a loading toward a greater in-patient (90.7%) relative to out-patient (65.3%) use. Monotherapy accounted for 53.8% of ty pical antipsychotic use. and typical antipsychotic/mood stabilizer combinat ion therapy accounted for 47.4%. In four studies where length of treatment data were available. the median of minimum typical antipsychotic use was 2. 5 months. with 96.0% of the patients receiving typical antipsychotic agents . Limitations: The meta-analytic technique employed in this analysis is lim ited by the possible inclusion of studies with unreliable study designs or biased treatment practices, publication bias in which some studies may not have been reported. and possible lack of identification of all relevant stu dies. Conclusions: Typical antipsychotic agents are commonly used in the tr eatment of bipolar disorder. possibly due to dissatisfaction with mood stab ilizer monotherapy especially in psychotic mania, the high prevalence of ps ychotic symptoms in acute mania, inappropriate continuation of typical anti psychotic agents after initial stabilization, and/or unavailability or unfa miliarity with new treatments. These findings also suggest that typical ant ipsychotics may have nut only antipsychotic effects in mania but perhaps al so antimanic properties. (C) 2001 Elsevier Science B.V. All tights reserved .