Atypical Antipsychotic Augmentation of Mood Stabilizer Therapy in Bipolar Disorder

Although monotherapy with lithium or divalproex is the recommended initial therapy for bipolardisorder, these agents are associated with prolonged favorable outcomes in only 30% of patients. Increasingly,the medical literature is demonstrating that augmentation of mood stabilizers with atypicalantipsychotics is a more effective therapy. This form of combination therapy is recommended as firstlinetreatment for severe bipolar mania. Recent clinical studies have shown that augmentation therapywith the atypical antipsychotics risperidone, olanzapine, quetiapine, and ziprasidone is effective inlong-term maintenance treatment, and preliminary evidence is emerging that use of atypicals withmood stabilizers can help control the depressive phase of bipolar disorder. The atypical antipsychoticsalso have relatively mild side effect profiles, although augmentation therapy with some antipsychoticsand mood stabilizers has been associated with excessive weight gain.