Psychotropic Drugs and Adverse Events in the Treatment of Bipolar Disorders Revisited

Psychopharmacology research aims to expand the therapeutic ratio between efficacy, on the onehand, and adverse events and safety, on the other. The novel antipsychotics are now the antipsychoticsof choice in the treatment of bipolar disorders. They have the advantages of potential antidepressantproperties and low risks of extrapyramidal side effects and, especially, of tardive dyskinesia. However,novel antipsychotics may also have varying propensities to cause side effects, such as somnolence,hyperprolactinemia, weight gain (sometimes significant), and possibly diabetes mellitus. Theincreasing use of these novel agents requires careful assessment and monitoring of emergent side effectsand diligent consideration of associated medical complications. Two new anticonvulsants, lamotrigineand topiramate, have recently shown promise in the treatment of bipolar disorders. Most oftheir adverse effects can be avoided by slow titration toward the recommended doses. In contrast tocarbamazepine and valproic acid, topiramate may be associated with weight loss.