Meds for Bipolar with Mixed Episodes

Bipolar with variable symptoms may benefit from long term use of antipsychotics

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Some people with bipolar disorder have mixed episodes – they have symptoms of both mania and depression at the same time. Are anti-psychotics safe and effective for mixed symptoms?

A recent study looked at how well Seroquel (quetiapine), an anti-psychotic, worked for people with mixed episodes over two years. These researchers found that Seroquel helped to give some people more time between mood change episodes.

The researchers said side effects from the medication with longer use were similar to those experienced with short-term use.

"Ask your psychiatrist about which Rx is best."

Researchers, led by Eduard Vieta, MD, PhD, Clinical Institute of Neuroscience at the University of Barcelona in Spain, were interested in how people with mixed episodes fared on Seroquel over a longer time period.

They combined information from two studies using Seroquel for bipolar disorder. The researchers looked at patients with mixed episodes, meaning they had symptoms of both mania and depression happening at the same time.

All the patients were taking either lithium or Depakote (divalproex) as a mood stabilizer. Doctors determined which was best for each patient.

In addition, they were given Seroquel, an atypical antipsychotic, for 12 weeks.  Only patients whose symptoms remained stable while taking Seroquel were included in the second part of the study.

During this first phase of taking Seroquel, 227 people with mixed episodes dropped out of the study because of unwanted side effects. They reported sedation and drowsiness as their reason for not continuing.

A total of 445 patients went on to get either Seroquel or placebo, a sugar pill, for an additional two years. They all continued to take their mood stabilizer.

The researchers tracked the patients to see when patients had another bout of mania, depression or mixed mood. The people that continued to take Seroquel spent more time without mood symptoms than those taking placebo.

The researchers reported that no new safety issues or side effects popped up while people were taking Seroquel for longer periods of time.

However, 5.5 percent of the people who continued taking Seroquel dropped out of the study because of unwanted side effects. Common side effects of Seroquel that were seen in both short- and long-term use were: headache, sedation, weight gain and back pain.

During the long-term use of Seroquel, 10 percent the patients that completed the study had a 7 percent or greater increase in their body weight. Weight gain is a common and troublesome side effect of most antipsychotics. The US Food and Drug Administration (FDA) safety information also warns that high blood sugar or diabetes can develop while taking Seroquel.

The authors concluded that people with bipolar and mixed symptoms may benefit from long-term use of the antipsychotic, Seroquel, in addition to their mood stabilizer.

The authors noted that this study is limited in that it selected only people who responded to Seroquel. People who did not respond to the drug or who had major side effects did not continue in the study.

So it is likely that some people with bipolar mixed episodes would not benefit from taking Seroquel for long periods of time.

The study was published in the December issue of the Journal of Affective Disorders. The study was funded by AstraZeneca, the maker of Seroquel.  Authors on the study report financial affiliations with multiple pharmaceutical companies.

Reviewed by: 
Review Date: 
October 30, 2012
Last Updated:
November 19, 2012