Bipolar Chic

Updated 5/10/09

Mental health professionals have found antipsychotics to be helpful not only in treating schizophrenia, but for the manic phase of bipolar disorder as well. These medications aid in controlling mania and the delusions and/or hallucinations that may accompany it. There are, however, some potentially serious side effects, so the patient should be watched and blood tests should be routinely administered.
There are two types of antipsychotics, typical and atypical.

Typical (or conventional) antipsychotics were first developed in the 1950s to treat psychosis associated with schizophrenia. They can also be used to treat acute mania. Some types of typical antipsychotics are fluphenazine (Proxilin), haloperidol (Haldol), and chlorpromazine (Thorazine). Side effects include dry mouth, muscle cramps and stiffness, weight gain, and tremors associated with extra pyramidal symptoms (EPS). EPS includes a variety of symptoms occurring from the use of these types of medications, which include involuntary muscle movement, restlessness, rigidity, changes in heart rate and breathing, and muscle contractions. The involuntary muscle movements are called tardive dyskinesia and most often manifest as facial tics and tongue movements. Muscle tremors and rigidity are referred to as Parkinsonism because the symptoms resemble Parkinson’s disease. Body restlessness is called akathisia and is generally shown by pacing and being unable to sit still. The muscle contractions associated with EPS are called acute dystonia. These are muscle spasms usually in the eyes, neck, and trunk, and are often painful to the person. The changes in heart rate and breathing are part of neuroleptic malignant syndrome, which can be fatal if left untreated. Symptoms of this syndrome include labile blood pressure, high fever, tremors, muscle rigidity, autonomic disturbances and cognitive dysfunction. It usually occurs within the first week of treatment. Developing this condition is rare.

Atypical, or second-generation antipsychotics were also discovered in the 1950s, but physicians didn’t start to use them until the 1970s. The FDA has approved all of these antipsychotics for treating schizophrenia. Some of them have been approved for treating bipolar disorder as well. Clozapine (Clozaril) was the first atypical antipsychotic created. Risperidone (Risperdal), Olanzapine (Zyprexa), and quetiapine (Seroquel) came out in the 1990s, and in the early 2000s, ziprasidone (Geodon) and aripiprazole (Abilify) were introduced.

I used to take Risperdal and while it was effective in controlling my symptoms, I experienced a strange side effect which was lactation. I wouldn’t have worried about it so much, except that it was causing me pain. Now I take Invega, which my therapist calls “a new improved version of Risperdal”. It works the same way Risperdal does, but I don’t have the lactation side effect.

In the past, I tried Seroquel and Abilify. Seroquel made me so drowsy, I couldn’t even take the full-prescribed amount of 200 mg. The most I could take in a day was 150 mg, which didn’t do anything but make me sleep. Abilify made my throat swell and it was hard to swallow. I only took that for a few days.

I know a few people who have taken Zyprexa and seemed to do well with it.

Nowadays, doctors are gradually replacing the typical antipsychotics with atypical ones. Experts claim that with the use of atypical antipsychotics, there is a lower risk of EPS and tardive dyskinesia.

Side effects of atypicals vary from drug to drug. Zyprexa and Risperdal can cause strokes in elderly patients with dementia. The FDA claims that all atypicals can cause hyperglycemia and diabetes, and requires manufacturers to include a warning on the labels. However, not all of these medications cause the same degree of weight gain and insulin sensitivity. Researchers found that Clozaril and Zyprexa have the greatest effect on weight and insulin, followed by Risperdal and Seroquel.

All medications have potential side effects. Not all patients develop side effects. If they do, it’s up to the doctor and the patient to determine whether the benefits of taking the medication outweigh the risks. Medications can be changed and dosages adjusted to decrease the amount of side effects. If you experience serious side effects of any medication, call your physician immediately.