Expert: Ivan Goldberg, M.D. - 2/8/2004

Question
My 18-year-old son was diagnosed with bipolar, hospitalized in 11/03 with attempted suicide and psychosis consisting of auditory and visual hallucinations, delusions.  He is now on Paxil, Depakote ER 1000 mg qd and Zyprexa 15 mg.  My question is-He has been on Zyprexa since 11/03.  Is it common practice to be on this for so long and to be on this along with Depakote?

Answer
Hi . . .

it is my practice to discontinue antipsychotic medication, such as Zyprexa, as soon as possible after the psychosis has resolved.  Please see the following abstract from a recent issue of the American Journal of Psychiatry:

Am J Psychiatry.  2004 Jan;161(1):169-71.  

Double-blind comparison of the continued use of antipsychotic treatment versus its discontinuation in remitted manic patients.

Zarate CA Jr, Tohen M.

Consolidated Department of Psychiatry, McLean Hospital, Harvard Medical School,Belmont, Mass, USA. zaratec@intra.nimh.nih.gov

OBJECTIVE: The goal of this study was to determine the benefits of the continued use of a typical antipsychotic agent following remission from an acute manic episode.

METHOD: Immediately following remission of a manic episode treated with the combination of a typical antipsychotic (perphenazine) and a mood stabilizer (lithium, carbamazepine, or valproate), 37 patients were randomly assigned to 6 months of double-blind treatment in which in addition to the mood stabilizer they received either continued perphenazine treatment or placebo.

RESULTS: Patients randomly assigned to continue perphenazine treatment, relative to those who discontinued it, were more likely to have a shorter time to depressive
relapse, discontinue the study, and have increased rates of dysphoria, depressive symptoms, and extrapyramidal symptoms.

CONCLUSIONS: There were no short-term benefits with the continued use of a typical antipsychotic after achieving remission from an episode of acute mania. In fact, its continued use was associated with detrimental effects.

PMID: 14702269 [PubMed - in process]


Best regards . . .

Ivan
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