Risks of Adding Antipsychotics to Mood Stabilizer May Outweigh Benefits After 6 Months

Following an acute manic episode, many patients with bipolar disorder are treated with a combination of a mood stabilizer and an atypical antipsychotic to reduce the risk of a manic relapse. However, due to the side effects of antipsychotics—including weight gain and metabolic syndrome—most agree that antipsychotic therapy should be maintained only if the benefits of using the medication can be shown to outweigh the risks.

A study published last month in Molecular Psychiatry suggests six months of adjunctive antipsychotic therapy is helpful in reducing mania relapse, but beyond that there is limited benefit.

Lakshmi Yatham, M.D. (pictured above), of the Department of Psychiatry at the University of British Columbia and colleagues recruited patients with bipolar I disorder who had recently remitted from a manic episode following treatment with a mood stabilizer (lithium or valproate) and antipsychotic (risperidone or olanzapine). Patients were randomly assigned to one of three conditions: discontinuation of risperidone or olanzapine and substitution with placebo at the trial’s start (“0-week group”) or 24 weeks after entry, or continuation of the antipsychotic therapy throughout the 52-week trial.

The researchers found that patients on antipsychotics and mood stabilizers for 24 weeks following remission of their manic episode had about half the risk of relapse as patients who tapered off antipsychotics following remission (the 0-week group) and the same relapse risk as patients taking antipsychotics for the full 52 weeks. The 24-week group gained an average of 0.1 kg while the 52-week group gained an average of 3.2 kg; the 0-week group lost 0.2 kg on average.

The findings suggest that when weighing the risks and benefits of risperidone or olanzapine adjunctive therapy, 24 weeks may be the best option, Yatham told Psychiatric News.

For the complete report, click here.

(Image: Martin Dee/UBC )