Olanzapine versus risperidone in bipolar disorder
Q: My Doctor wants me to take olanzapine instead of risperidone, i recently had a breakthrough episode of mania. At the end of the day is there anything to choose and if so what. Basically i need a medical opinion on the merits of olanzapine over risperidone. Can you help? many thanks in anticipation.
Dear Hugh --
So, it was with great surprise that I read a recent article by some serious mood experts basically concluding these two medications are both good, and both about the same as far as risk of inducing mania. In fact, I was shocked: who did they study to get this result? I've had about 3 patients in about 300-500 people get really agitated (actually a sort of increase in OCD-like thoughts and agitation/anxiety; not really very much like the rather more typical increase in hypomanic symptoms risperidone seems capable of kicking off). I think I've seen far more than that get hypomanic or worse on risperidone, especially at >2mg/day.
The article is A naturalistic comparison of clozapine, risperidone, and olanzapine in the treatment of bipolar disorder by Guille, Gary Sachs (head of the Harvard Bipolar Program), and Ghaemi. Here's the abstract. Note that this is folks with bipolar I. I'm not sure if that's the difference, i.e. they studied bipolar I and most of the trouble I've seen has been in bipolar II. Or maybe they used a different conception of hypomania, and that's why they didn't see people getting it. In my view, risperidone should be used with great caution. There's renewed enthusiasm for it these days for two reasons: 1) it doesn't cause the tremendous weight gain of olanzapine, and attendant risks; and 2) Janssen, the manufacturer, is spending a lot of money plugging this difference in risk (I can't remember; they may have paid to support the authors' research on which that article is based. This doesn't mean the authors are crooked or even just biased; it just means Janssen is paying for research that they know will make their product look good).
You touched a nerve there, didn't you? Good luck.
Bipolar World © 1998,
1999, 2000, 2001, 2002, 2003,
2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014
About Us Add a Link Advance Directives Alternative Treatments Ask the Doctor Ask Dr. Plyler about Bipolar Disorder Ask The Doctor/ Topic Archives Awards Benny the Bipolar Puppy Bipolar Chat Bipolar Children Bipolar Disorder News Bipolar Help Contract Bipolar World Forums Book Reviews Bookstore BP & Other mental Illness Clinical Research Trials & FDA Drug Approval Community Support Contact Us The Continuum of Mania and Depression Coping Criteria Criteria and Diagnosis Criteria-World Health Disabilities, DSMV-IV Dual Diagnosis eGroups Expressions (Poetry, Inspiration, Humor, Art Gallery, Memorials Family Members Getting Help for a Loved One who Refuses Treatment Greeting Cards History of Mental Illness Indigo Job and School Links Manage Your Medications Medications Medication and Weight Gain News of the Day Parent Chat Pay for Meds Personal Stories Self Help Self Injury Significant Others Stigma and Mental Health Law Storm's Column Suicide!!! The Suicide Wall Table of Contents Treatments Treatment Compliance US Disability Veteran's Chat What's New?