Possible induction of mania and hypomania by olanzapine or risperidone: A critical review of reported cases

Article · Literature Review · October 2000with615 Reads
Source: PubMed
Abstract
Risperidone and olanzapine are atypical antipsychotics that are now widely used in clinical practice. A MEDLINE search (1966-1999) showed that, following the introduction of these agents in recent years, 26 cases of induced hypomanic and manic syndromes have been reported during standard olanzapine (N = 10) or risperidone (N = 16) treatment. A critical analysis of these case reports reveals that the effects on mood were sometimes insufficiently documented and that in about half of them (N = 16) evidence is highly suggestive of a causative role of risperidone or olanzapine in the induction of (hypo)manic symptomatology. Despite limitations, the available literature confirms intriguing effects of these 2 antipsychotics on mood. The risk factors as well as the mechanisms of action underlying these effects remain to be clarified.
    • Our two cases add to the existing literature in demonstrating the potential for aripiprazole, an agent with proven antimanic efficacy, to paradoxically precipitate a hypomanic or manic episode. Our cases meet several of the eight criteria proposed by Aubry and colleagues (Aubry et al. 2000) to evaluate a causal relationship between atypical antipsychotic use and initiation of hypomanic/manic symptoms, suggesting that aripiprazole was the proximate cause of hypomanic symptoms. In particular, in both cases prior to initiation of aripiprazole no active symptoms of hypomania or mania were evident (first criterion), classical DSM-IV symptoms of hypomania developed (second criterion) within few days from aripiprazole initiation (short interval from starting a medication and onset of hypomania – third criterion), dosages and titration of aripiprazole were standard (criterion four), none of the other medications either prior to (criterion five) or at the time (criterion six) of aripiprazole treatment contributed, in our view, to the induction of hypomania (less clear in case one), and finally a rapid remission of symptoms (in few days) after aripiprazole discontinuation was evident in both patients (criterion eight).
    Full-text · Article · Mar 2014
    • As with risperidone there are several case reports about mania and hypomania induced by olanzapine in patients with schizophrenia who had not previously experienced mania. Symptoms diminish after stopping Antipsychotic drugs in bipolar disorder 281 olanzapine and treatment with mood stabilizers or other antipsychotic drugs (Aubry et al., 2000).
    [Show abstract] [Hide abstract] ABSTRACT: Antipsychotic drugs are useful in the treatment of acute mania and as maintenance treatment. While both typical and atypical antipsychotic drugs are able to diminish manic symptoms, agitation and aggression in acute mania, the atypical antipsychotic drugs enjoy a number of advantages, including significantly less extrapyramidal symptoms, diminished risk of tardive dyskinesia, lack of increase in serum prolactin levels (with the exception of risperidone), improvement in cognition, and possible decrease in suicidality. Most of the atypical antipsychotic drugs have been found to be effective as an add-on treatment (with mood stabilizers and antidepressant drugs) and sometimes as monotherapy in treatment-resistant bipolar patients. Long-acting typical neuroleptic drugs may be useful in the treatment of non-compliant bipolar patients. A small number of patients with schizophrenia treated with risperidone, olanzapine, or quetiapine experience a first episode of hypomania or mania. It is not apparent if this is a true drug-induced event or coincidental. Side-effects of note with the atypical antipsychotic drugs are weight gain (most prominently with olanzapine and clozapine), sedation, and agranulocytosis (clozapine). Atypical antipsychotic drugs are recommended for use in bipolar disorder for acute treatment, maintenance treatment, and for treatment-resistant patients.
    Article · Oct 2003
    • Recently, induced hypomanic symptoms after 4 weeks of quetiapine treatment have been reported in a schizoaffective patient of the depressive type (Benazzi 2001). Mania induced by risperidone or olanzapine may be a consequence of their putative antidepressant effect in bipolar patients (Aubry et al. 2000). However, as several open and controlled studies in bipolar patients did not report induced or worsened mania under risperidone or olanzapine treatment (Jacobsen 1995; Schaffer and Schaffer 1996; Segal et al. 1998; Guille et al. 2000; Tohen et al. 2000), it is difficult to establish whether this is a real side effect or just an anecdotal exacerbation of manic symptoms or agitation not directly attributed to these drugs.
    [Show abstract] [Hide abstract] ABSTRACT: The available literature on the use of atypical antipsychotics for the treatment of bipolar disorder was reviewed. All uncontrolled and controlled reports were identified through a comprehensive Medline search. Based on the available evidence, olanzapine was found to be the most appropriate atypical antipsychotic agent utilized for the treatment of manic bipolar patients, although there is also preliminary data suggesting the efficacy of risperidone and clozapine. The preliminary data evaluating the efficacy of quetiapine and ziprasidone in bipolar disorder are still very limited. Double-blind controlled studies with atypical antipsychotics in the long-term treatment of bipolar disorder are still largely not available, but will be critical to determine the effectiveness of these agents in the maintenance treatment of bipolar disorder. There are recent uncontrolled suggestions that olanzapine may have beneficial effects in depressed bipolar patients, which deserve further investigation in controlled studies. In conclusion, atypical antipsychotics, due to lower potential for neurotoxicity and preliminary evidence suggesting better efficacy than typical antipsychotics, are increasingly having a more prominent role in the pharmacological management of bipolar patients. Nonetheless, until there is systematic data from long-term controlled follow-up studies on the comparative efficacy of these agents with mood stabilizers, atypical antipsychotics should be cautiously utilized, and preferably in combination with a mood stabilizer for the maintenance phase of treatment.
    Full-text · Article · May 2003
    • Podobnû jsou popisovány antidepresivní úãinky pfii podávání mal˘ch dávek fluphenazinu , ale i jin˘ch klasick˘ch antipsychotik [52]. Nûkteré kazuistiky popisují u depresivních pacientÛ léãen˘ch risperidonem a olanzapinem pfiesmyk do mánie [53].
    [Show abstract] [Hide abstract] ABSTRACT: Antipsychotic drugs were introduced to clinical use 50 years ago. These drugs are primarily used for the treatment of schizophrenia and other mental disorders, their action potential is, however, much broader. Therapeutical strategies as well as the terminology of antipsychotic drugs have changed with the developing knowledge and may be confusing for physicians who are not specialised in psychiatry, and therefore the introduction to this paper is focused on this issue. Thanks to the development of functional image methods we are able to see how antipsychotic drugs act in the brain; several new findings are discussed in this paper. In addition, the paper reviews the most frequent adverse effects of neuroleptics which are also described in relation to therapeutical opportunities of antipsychotics utilization from the clinical point of view which is focused on the individual groups of symptoms and/or on specific patient populations.
    Full-text · Article · Nov 2002 · The Primary Care Companion to The Journal of Clinical Psychiatry
    • [40,145,146] Clozapine is reserved for use in patients with treatment-resistant bipolar mania , as its use is associated with potentially fatal agranulocytosis necessitating mandatory regular haematological monitoring. [135] Results of limited studies with risperidone and quetiapine have shown some efficacy in the treatment of patients with bipolar I disorder, although, unlike olanza- pine, [121] risperidone has been associated with induction of hypomania and hyperprolactinaemia in this population. [146] Treatment guidelines, including the surveybased Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder 2000, [147] recommend a mood stabiliser as a first-line option in all phases of bipolar disorder.
    [Show abstract] [Hide abstract] ABSTRACT: Unlabelled: Olanzapine, a thienobenzodiazepine derivative, is a psychotropic agent that has shown efficacy in the treatment of patients with bipolar I disorder. Olanzapine has a multireceptorial binding profile including a greater affinity for serotonin 5-HT(2A) than for dopamine D(2) receptors. Olanzapine 5 to 20 mg/day demonstrated significantly greater antimanic efficacy than placebo in two double-blind, randomised 3- or 4-week trials of patients with bipolar I disorder of either manic or mixed episodes, with or without psychotic features. Additionally, in one of these trials, improvements in cognitive function and hostility were superior with olanzapine. In cohorts of severely depressed and rapid cycling patients, improvements in manic and depressive symptoms and in manic symptoms only, were superior with olanzapine compared with placebo. Significant improvements from baseline in symptoms of mania, depression, cognitive functioning and hostility were seen with olanzapine in a 49-week extension phase study. In double-blind trials, olanzapine 10 mg/day appeared to have similar antimanic efficacy to oral lithium 400mg twice daily in the treatment of patients with pure mania (4-week small study). In patients with acute manic or mixed episodes olanzapine 5 to 20 mg/day appeared to be more effective than oral valproate semisodium (divalproex sodium) 500 to 2500 mg/day (3-week study) and at least as effective as oral haloperidol 3 to 15 mg/day (12-week study). Preliminary results from a large 6-week placebo-controlled study suggest that olanzapine 5 to 20 mg/day in combination with mood stabilisers (lithium or valproate semisodium) provides effective augmentation of antimanic treatment of patients with bipolar I disorder, with benefits seen in the first week. Adverse events reported significantly more often with olanzapine than with placebo were somnolence, dry mouth, dizziness and bodyweight gain, and in comparison with valproate semisodium were somnolence, dry mouth, increased appetite and bodyweight gain. Olanzapine was generally well tolerated with no clinically relevant abnormalities in laboratory tests, vital signs or electrocardiogram results. Conclusion: Olanzapine demonstrated superior efficacy compared with placebo in the short-term treatment of patients with bipolar I disorder with manic or mixed episodes, with or without psychotic features, and was generally well tolerated. According to preliminary data the antimanic efficacy of olanzapine appears similar to that of haloperidol and better than that of valproate semisodium in patients with bipolar I disorder experiencing a manic or mixed episode; among nonpsychotic patients with manic or mixed episodes olanzapine appears to be superior to haloperidol. Available data support the choice of olanzapine as an option in the short-term management of mania in patients with bipolar I disorder with manic or mixed episodes, with or without psychotic features.
    Article · Feb 2001
  • [Show abstract] [Hide abstract] ABSTRACT: Atypical antipsychotics are a class of novel agents increasingly employed for the treatment of psychotic disorders. The pharmacodynamic properties of the atypicals appear to impact a broader spectrum of psychotic symptoms than had been appreciated with older generation antipsychotics. In addition, the atypical agents appear to have a reduced risk of neurologic side effects compared with conventional antipsychotic use. Both of these features enhance the appeal of the atypical antipsychotics and may be associated with enhanced patient compliance. The atypical antipsychotics appear to be effective for schizophrenia as well as other psychotic disorders, including schizoaffective disorder and mood disorders with psychotic features. Consequently, atypical antipsychotics are now considered to be the first-line treatment for schizophrenia, with the exception of clozapine, which is considered a second-line agent because of risks associated with its use. This review will discuss the literature on atypical antipsychotic efficacy in psychotic disorders. Issues related to antipsychotic use, dosing, adverse effects, and drug interactions are also discussed.
    Article · Jan 2001
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