Long-Term Olanzapine Therapy in the Treatment of Bipolar I Disorder

Sanger, T.M.; Grundy, Starr; Gibson, P. Joseph; Namjoshi, M.; Greaney, M. G.; Tohen, Mauricio

doi:10.4088/jcp.v62n0410

Cited by 87 publications

(53 citation statements)

References 17 publications

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“…Olanzapine recently received Federal Drug Administration approval for the treatment of acute manic episodes associated with bipolar disorder based on data from two placebo-controlled clinical trials (Tohen et al, 1999;McElroy et al, 1998), and may be effective in long-term treatment (Sanger et al, 2001). Clozapine also appears to have independent mood-stabilizing properties (Green et al, 2000;Suppes et al, 1999;Zarate et al, 1995).…”

Section: Potential Clinical Ramifications Of Olanzapine-and Clozapinementioning

confidence: 99%

Olanzapine and Clozapine Increase the GABAergic Neuroactive Steroid Allopregnanolone in Rodents

Marx

VanDoren

Duncan

et al. 2003

Neuropsychopharmacol

131

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The neuroactive steroid allopregnanolone is a potent g-aminobutyric acid type A (GABA A ) receptor modulator with anxiolytic and anticonvulsant effects. Olanzapine and clozapine also have anxiolytic-like effects in behavioral models. We therefore postulated that olanzapine and clozapine would elevate allopregnanolone levels, but risperidone and haloperidol would have minimal effects. Male rats received intraperitoneal olanzapine (2.5-10.0 mg/kg), clozapine (5.0-20.0 mg/kg), risperidone (0.1-1.0 mg/kg), haloperidol (0.1-1.0 mg/ kg), or vehicle. Cerebral cortical allopregnanolone and peripheral progesterone and corticosterone levels were determined. Adrenalectomized animals were also examined. Both olanzapine and clozapine increased cerebral cortical allopregnanolone levels, but neither risperidone nor haloperidol had significant effects. Olanzapine and clozapine also increased serum progesterone and corticosterone levels. Adrenalectomy prevented olanzapine-and clozapine-induced elevations in allopregnanolone. Allopregnanolone induction may contribute to olanzapine and clozapine anxiolytic, antidepressant, and mood-stabilizing actions. Alterations in this neuroactive steroid may result in the modulation of GABAergic and dopaminergic neurotransmission, potentially contributing to antipsychotic efficacy.

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Section: Potential Clinical Ramifications Of Olanzapine-and Clozapinementioning

confidence: 99%

Olanzapine and Clozapine Increase the GABAergic Neuroactive Steroid Allopregnanolone in Rodents

Marx

VanDoren

Duncan

et al. 2003

Neuropsychopharmacol

131

View full text Add to dashboard Cite

show abstract

“…However, only 2 of 23 severely ill bipolar patients in the study by Vieta et al (2001b) were actually in remission at the endpoint with olanzapine adjunctive therapy. Most of the patients (59%) in the study by Sanger et al (2001), a 6-month open continuation of a placebo-controlled, double-blind study (Tohen et al 1999) needed the addition of lithium and/or fluoxetine, due to the recurrence of manic or depressive symptoms, and 68 of 113 patients (60%) discontinued…”

Section: Olanzapinementioning

confidence: 99%

Atypical antipsychotics and mood stabilization in bipolar disorder

2003

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The available literature on the use of atypical antipsychotics for the treatment of bipolar disorder was reviewed. All uncontrolled and controlled reports were identified through a comprehensive Medline search. Based on the available evidence, olanzapine was found to be the most appropriate atypical antipsychotic agent utilized for the treatment of manic bipolar patients, although there is also preliminary data suggesting the efficacy of risperidone and clozapine. The preliminary data evaluating the efficacy of quetiapine and ziprasidone in bipolar disorder are still very limited. Double-blind controlled studies with atypical antipsychotics in the long-term treatment of bipolar disorder are still largely not available, but will be critical to determine the effectiveness of these agents in the maintenance treatment of bipolar disorder. There are recent uncontrolled suggestions that olanzapine may have beneficial effects in depressed bipolar patients, which deserve further investigation in controlled studies. In conclusion, atypical antipsychotics, due to lower potential for neurotoxicity and preliminary evidence suggesting better efficacy than typical antipsychotics, are increasingly having a more prominent role in the pharmacological management of bipolar patients. Nonetheless, until there is systematic data from long-term controlled follow-up studies on the comparative efficacy of these agents with mood stabilizers, atypical antipsychotics should be cautiously utilized, and preferably in combination with a mood stabilizer for the maintenance phase of treatment.

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“…In fact, the useful properties of the atypicals may depend on simultaneous effects caused by interactions with multiple G protein-coupled receptors (GPCRs) (Roth, 1994(Roth, , 2000. From this perspective, it is not surprising that atypical antipsychotic drugs are effective in bipolar and schizoaffective disorders and depression (Ghaemi et al, 2000;Narendran et al, 2001;Sanger et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Aripiprazole, A Novel Atypical Antipsychotic Drug with a Unique and Robust Pharmacology

Shapiro

Renock

Arrington

et al. 2003

Neuropsychopharmacol

845

701

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Atypical antipsychotic drugs have revolutionized the treatment of schizophrenia and related disorders. The current clinically approved atypical antipsychotic drugs are characterized by having relatively low affinities for D 2 -dopamine receptors and relatively high affinities for 5-HT 2A serotonin receptors (5-HT, 5-hydroxytryptamine (serotonin)). Aripiprazole (OPC-14597) is a novel atypical antipsychotic drug that is reported to be a high-affinity D 2 -dopamine receptor partial agonist. We now provide a comprehensive pharmacological profile of aripiprazole at a large number of cloned G protein-coupled receptors, transporters, and ion channels. These data reveal a number of interesting and potentially important molecular targets for which aripiprazole has affinity. Aripiprazole has highest affinity for h5-HT 2B -, hD 2L -, and hD 3 -dopamine receptors, but also has significant affinity

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Long-Term Olanzapine Therapy in the Treatment of Bipolar I Disorder

Cited by 87 publications

References 17 publications

Olanzapine and Clozapine Increase the GABAergic Neuroactive Steroid Allopregnanolone in Rodents

Olanzapine and Clozapine Increase the GABAergic Neuroactive Steroid Allopregnanolone in Rodents

Atypical antipsychotics and mood stabilization in bipolar disorder

Aripiprazole, A Novel Atypical Antipsychotic Drug with a Unique and Robust Pharmacology

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