Evidence from the meta-analysis shown on the slide of the efficacy of atypical antipsychotics versus control (variously placebo, lithium, valproate, or lamotrigine), in patients with bipolar disorder, showed that adjunctive therapy with quetiapine was the only treatment that reduced both manic and depressive episodes.2 Among patients that responded to antipsychotics during the acute phase, quetiapine was the only treatment found to be superior to lithium or valproate for both manic and depressive relapses, when administered as monotherapy.2 Olanzapine, quetiapine and risperidone monotherapy were shown to be superior to placebo in reducing the overall risk of relapse.2
References:
1. Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20 (2): 97–170.
2. Lindström L, Lindström E, Nilsson M, Höistad M. Maintenance therapy with second generation antipsychotics for bipolar disorder – a systematic review and meta-analysis. J Affect Disord 2017; 213: 138–150.