Use of Atypical Antipsychotics as Mono/Polytherapy with Mood Stabilizers for the Treatment of Bipolar Disorder. An Update

Over the last decade, the class of the atypical antipsychotics has become the gold standard for the treatment of bipolar disorder (BD), at least for its manic/mixed phases. This phenomenon has different explanations: first, the number of compounds with formal approvals for BD is higher in comparison with other mood-stabilizers including lithium and anticonvulsants. Second, the sample size of randomized controlled trials assessing the efficacy and safety of different pharmacological treatments is usually larger for most recently approved compounds (i.e., atypical agents for the treatment of BD). If the role of atypical antipsychotics is well-established in the treatment of BD, doubts still persist about their optimal efficacy as monotherapy vs combination treatment with other mood-stabilizers, in particular. In addition, a possible superiority in terms of efficacy for polytherapy needs to be balanced in relation to tolerability issues. The present article was aimed to review the state of the art in the field reviewing the latest evidence arising from international guidelines recommendations and meta-analyses.