Bipolar disorder often exists on a continuum of mood disturbance. In some types of bipolar disorder, psychotic features are prominent during a mood episode. One form of psychosis is paranoia, in which people think they are being watched, targeted or persecuted by another person or an organization. Certain approved atypical antipsychotic medications used in the treatment of bipolar mania may be helpful in treating the psychotic features, including paranoid thinking.
Aripiprazole
Aripiprazole works by affecting the levels of dopamine and serotonin in the brain. It may be more effective when used in combination with mood stabilizers like lithium or valproic acid than when used alone in the treatment of bipolar disorder, according to an article in the journal Bipolar Disorders. Agitation is one commonly reported side effect of this medication.
Olanzapine
Olanzapine, like other atypical antipsychotics, also works by affecting levels of dopamine and serotonin in the brain. It tends to be slightly more sedating than some other atypical antipsychotics because of its chemical similarity to benzodiazepines. Also, because this medication is metabolized by an important biochemical system within the liver, it is essential that the professional prescribing it know the patient's complete medication list.
Quetiapine
This medication works by affecting the levels of serotonin, dopamine, histamine and norepinephrine in the brain. Because of its antihistamine properties, it has a sedative effect, which patients often desire. Quetiapine also bears a black box warning from the Food and Drug Administration regarding a potential increase in suicidality in people taking it, which should be discussed at the time of prescription.
Risperidone
Another atypical antipsychotic that affects serotonin and dopamine within the brain, risperidone has been available longer than other atypical antipsychotics. Risperidone has received additional FDA-approved indications over the years as a result of extensive research. One common side effect is weight gain, which is not as significant an issue with some other atypical antipsychotics.
Ziprasidone
Ziprasidone affects serotonin and dopamine pathways within the brain. It also has some effect on histamine, potentially explaining its sedative effects. Ziprasidone should be used with caution in patients who are elderly and have psychoses related to brain disorders such as dementia. There are also some cardiovascular side effects. A complete medication history is helpful in preventing complications related to these side effects, according to an article in Expert Opinion on Pharmacotherapy.
References
- "Bipolar Disorders;" Antipsychotic Agents in the Treatment of Bipolar Mania; M. Tohen and E. Vieta; June 2009
- "Expert Opinion on Pharmacotherapy;" Treatment-Refractory Bipolar Disorder; P. Gajwani; August 2009
