The place of atypical antipsychotics in the therapy of bipolar disorder – the current state of knowledge
Łukasz Święcicki, Bogdan Stefanowski

The purely academic division into antidepressants, antipsychotics and mood stabilisers is misleading. In clinical practice, certainly not all types of depression can be treated with antidepressants, while the activity of antipsychotics is not limited to the treatment of psychoses (understood as mental disorders with positive symptoms). The therapy of bipolar disorder is a very good example in this regard. Antidepressants are not recommended in bipolar I disorder (also in the periods of depression), while they are usually considered as “of limited use” in bipolar II disorder. Their use is associated with the risk of transition from depressive to hypomanic phase on one hand, and the risk of drug resistance, on the other. Therefore, a question should be asked about the place of atypical antipsychotics in the treatment of bipolar disorder. The paper presents the current research findings on the use of olanzapine, quetiapine and amisulpride in the treatment of depressive and manic episodes in bipolar disorder. The role of agents from the discussed class in preventative therapy (mood stabilising) is also mentioned. A number of methodologically adequate double blind and placebo-controlled trials have demonstrated the efficacy of olanzapine in the treatment of both depressive and manic episodes in bipolar disorder. Olanzapine can be also used as a mood stabiliser, although usually in combination therapy. High risk of metabolic syndrome is the primary problem associated with this medication. Quetiapine may also be used in the treatment of depressive and manic episodes, as confirmed by the available data. The authors of studies on quetiapine point out that its effects are dosedependent. Doses of up to 300 mg per day show mainly antidepressant activity. Higher doses are needed in the treatment of manic episodes – usually above 500 mg per day. Excessive sedation is the major problem associated with this medication. In the case of amisulpride, studies determining the usefulness of this agent in the therapy of bipolar disorder are insufficient. Case reports indicating possible preventive effects of amisulpride in patients with significant metabolic disorders are very interesting.