Antipsychotic Medications for Bipolar Disorder

When you hear the term antipsychotics, you probably think of medications that are used to control psychosis—a condition in which a person has breaks with reality and hallucinations or delusions or disorganized thought processes. But just as aspirin can be a painkiller, a heart attack preventative, and a fever reducer, antipsychotic medications also serve a variety of functions in addition to treating psychoses. These include treatment of aggression, acute mania, tic disorder, and poor impulse control as well as maintenance treatment of Bipolar Disorder.

The first generation of antipsychotics, which began with Thorazine (chloropromazine) in the 1950s and then came to include Haldol (haloperidol), Mellaril (thioridazine), and Navane (thiothixene), provided an inroad into treating a variety of disorders but carried a risk of neurologic side effects, among them Parkinson-like symptoms (tremor, drooling, slow movement, expressionless face, and stiffness in arm movements), dystonia (painful muscle spasms most frequent in the face and neck), akathesia (a very uncomfortable sense of internal restlessness), and tardive dyskinesia (an abnormal movement disorder that has the potential to be irreversible).

The newest generation of antipsychotics and the ones most familiar to those reading this book are known as atypical antipsychotics—atypical because they are better tolerated and have fewer side effects than the previous antipsychotics and because similar side effects are less frequent. Unlike the typicals, the atypicals have somewhat different effects on neurotransmitters, making them safer than their predecessors. Any of the antipsychotics are serious medications that should be approached with appropriate caution. That being said, the atypicals can be significantly helpful in a variety of ways. They can help decrease a child's agitation, control aggression, decrease impulsivity, and treat psychosis. In adults, they are an FDA-approved treatment for Bipolar Disorder. As of this writing, the only atypical antipsychotic approved for use in children and adolescents is Risperdal. In late 2006, it received FDA approval for use in the treatment of irritability in autistic youngsters. However, the following atypicals are widely used off label in children.

• Zyprexa (olanzapine): Available as tablets or as Zyprexa Zydis(an orally disintegrating form) and Zyprexa IntraMuscular for injection.
• Risperdal (risperidone): This is one of the older atypicals and the one often used in children. Available as tablets or Risperdal M-Tabs (an orally disintegrating form) or as an oral solution.
• Seroquel (quetiapine): Available as tablets.
• Abilify (aripiprazole): Available as tablets and an oral solution.
• Geodon (ziprasidone): Available as capsules and an injectable form (ziprasidone mesylate), for intramuscular injection only.
• Clozaril (clozapine): A seldom-used medication, it carries a significant risk of serious side effects, including agranulocytosis (lack of a certain type of white blood cells), seizures, and serious heart problems. Available as tablets.