Advances in Psychiatric Treatment (2008) 14: 330-338. doi: 10.1192/apt.bp.107.004150
© 2008 The Royal College of Psychiatrists
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Atypical antipsychotics in bipolar disorder: the treatment of mania

John Cookson

John Cookson is a consultant psychiatrist at the East London Foundation Trust (Mile End Hospital, London E1 4DG, UK. Email: john. cookson{at}eastlondon.nhs.uk). He has had a career-long interest in psychopharmacology and in bipolar disorder, and has authored two editions of Use of Drugs in Psychiatry published by Gaskell.

The development of atypical antipsychotics has stimulated research on the treatment of mania. Several well-established options now exist for monotherapy of mania. None of the atypicals has shown greater efficacy than haloperidol in improving manic symptoms, but they all produce fewer extrapyramidal side-effects and they may differ in their effects on depressive symptoms. Combinations of an antipsychotic with lithium or valproate offer further options, with somewhat greater efficacy in treating mania but also with more side-effects.