Atypical antipsychotics: efficacy across bipolar disorder subpopulations.

Atypical antipsychotic medications, used as monotherapy or as adjunctive therapy with mood stabilizers, have shown efficacy and tolerability for 4 subpopulations of patients with bipolar disorder: patients with mixed mania, patients with psychotic episodes, children and adolescents, and the elderly. Patients experiencing mixed mania generally respond poorly to lithium therapy and are more difficult to treat than patients with pure mania. Atypical antipsychotics are increasingly being considered for this bipolar subpopulation because of their efficacy as antimanic agents, and because they are less likely to cause as many or as severe adverse events as conventional antipsychotics. Atypical antipsychotics have also demonstrated beneficial effects as monotherapy and adjunctive therapy for bipolar I disorder patients experiencing psychotic states. In addition, they have shown effectiveness and tolerability in small-scale and open-label trials and case studies with pediatric and geriatric bipolar patients.