First-generation, or typical, antipsychotic medicine
Second-generation, or atypical, antipsychotic medicines
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These medicines are available in liquid, tablet, or injectable form.
These medicines balance certain chemicals in the brain (neurotransmitters). It is not clear exactly how these medicines work for the treatment of bipolar disorder. But they quickly improve manic episodes.
Each of these medicines has been approved by Health Canada's Therapeutic Products Directorate (TPD) to treat bipolar disorder. Some medicines work better for different people than others. Second-generation antipsychotic medicines may have fewer side effects than first-generation antipsychotic medicines. Be sure to talk with your doctor about how the medicine is working for you. Sometimes you might need to try more than one type of medicine before you find one that works best for you.
These medicines have all been found to be an effective treatment of manic episodes. Some antipsychotic medicines, such as olanzapine, are also being studied for the treatment of depression in bipolar disorder.
Drugs in this classification work quickly in the treatment of bipolar disorder, especially in older adults. These medicines have all been found to be an effective treatment of manic episodes. Some studies show the combination of an antipsychotic and a mood stabilizer may be more effective than a mood stabilizer alone.1
The use of antipsychotics has also been linked to the risk of movement disorders. The risk of developing a movement disorder is less for newer antipsychotics such as aripiprazole, olanzapine, risperidone, and quetiapine. But it is important to tell your doctor about any abnormal muscle movements.
Also, second-generation antipsychotics may raise the risk of diabetes and/or abnormalities in cholesterol levels.
The most common side effects of olanzapine include dry mouth, constipation, weight gain, drowsiness, and increased appetite.2 Other common side effects are shakiness or tremors, slurred speech, and low blood pressure that makes you feel dizzy when you stand up.
Risperidone may cause sleepiness, weight gain, abnormal cholesterol levels, and breast tenderness. Side effects include a rash, headaches, constipation, decreased sexual desire and function, or increased heart palpitations. Risperidone may be linked to an increased risk of stroke in older adults. It also may increase levels of the hormone prolactin. This can lead to larger breasts in both men and women.
Ziprasidone may make you sleepy or cause nausea, dizziness, restlessness, diarrhea, coughing, or a rash. Ziprasidone may also cause abnormal muscle movements such as tremors or shuffling. Ziprasidone can sometimes affect the heart rate. It should not be used by people who have a history of cardiac arrhythmia.
Quetiapine can cause side effects such as sleepiness, headaches, dizziness, rash, fever, weight gain, abnormal cholesterol levels, dry mouth, and other flu-like symptoms.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
Before taking olanzapine, risperidone, ziprasidone, or quetiapine, be sure to tell your doctor if you have:
You should not take ziprasidone if you have long QT syndrome (a specific heart-rhythm problem) or severe heart failure or you have had a recent heart attack. Ziprasidone should not be taken with certain medicines used to treat abnormal heartbeats.
Aripiprazole has been linked to a rare risk for neuroleptic syndrome. Neuroleptic syndrome is a life-threatening reaction that begins with a high fever along with changes in heart rate and breathing patterns.
These medicines should be started in low doses, especially in the elderly. Talk with your doctor about any other medicines you may be taking to make sure there are no negative drug interactions.
You may need regular blood tests and blood pressure monitoring while taking these medicines.
Avoid herbal stimulants (such as ma huang, ginseng, or kola), which may increase your chances of having serious side effects.
Talk to your doctor or pharmacist about drinking grapefruit juice while you are taking an antipsychotic medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases your chances of having serious side effects.
Taking medicines during pregnancy for bipolar disorder may increase the risk of birth defects. If you are pregnant, or thinking of becoming pregnant, talk to your doctor. Medicines may need to be continued if your bipolar disorder is severe. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.
- Scherk H, et al. (2007). Second-generation antipsychotic agents in the treatment of acute mania: A systematic review and meta-analysis of randomized controlled trials. Archives of General Psychiatry, 64(4): 442–455.
- Tohen M, et al. (2002). Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy. Archives of General Psychiatry, 59(1): 62–69.
Last Revised: May 3, 2012
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