Atypical Neuroleptics
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Q:  Atypical Neuroleptics

Dear Dr. Phelps: 
     At my local VA Hospital here in Shreveport, I 
have heard that "wonderful" results are being 
achieved with atypical neuroleptics in the treatment 
of bipolar disorder. 
     Can you bring us up to date on this new class of 

Dear Mr. C' -- 
In my view, "wonderful" is an overstatement.  Zyprexa definitely has mood stabilizing effects much like Depakote; but the weight gain is even worse, and the drug is known to cause diabetes in quite a few folks.  Risperidone quickly distinguished itself when introduced by causing mania in a few folks, leading to numerous case reports; I still use it only with caution about inducing the very symptoms I'm trying to treat (many other psychiatrists are not as leery of it as I; I still don't see why not.  A leading researcher last weekend said "that's the tyranny of the case report"; but I see it exacerbate things far more often than Zyprexa, which has a few case reports itself -- but it took much longer for those case reports to show up than it did for Risperidone, and I've only seen exacerbation of anxiety a few times with Zyprexa, compared to may with Risperidone. 

Then there's Seroquel, which has been useful for a few folks, mostly with severe PTSD.  It hasn't generated a lot of enthusiasm as a mood stabilizer, especially compared to Zyprexa, and even to Risperidone.  It's been dubbed "mellaril lite", and seems to work rather like mellaril indeed. 

Now there's Geodon, which is so new I don't understand why anybody would be using it unless they were absolutely driven into it.  Remember it takes about a year to see what really comes from using a new drug over time, in the way of side effects and risks.  However, some patients I've seen on it have done very well, and say it's better than Zyprexa -- and they were losing the weight they gained on Zyprexa too.  So, sounds good so far.  

And I skipped over Clozaril because it's so impractical with the blood tests and weight gain right up there with Zyprexa, maybe worse -- but a lifesaving medication with very strong mood stabilizing effects, to be tried for anyone with severe bipolar I not responding to conventional mood stabilizers.  

That's the run-down as of June 2001.  There are more coming (but not for a while now, to my knowledge).  

Dr. Phelps  

Published July, 2001


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