Tratamiento a largo plazo del trastorno bipolar: papel de los antipsicóticos

Therapy of the patient suffering bipolar disorder requires continuation beyond the acute phases to prevent new episodes. The objective of this non-systematic review is to analyze the role of antipsychotic drugs in long-term therapy of bipolar disorder. Clinical practice guidelines (CPG) published between 2009 and 2014 have been reviewed. Several atypical antipsychotic drugs (aripiprazole, olanzapine, quetiapine, long-acting risperidone, and ziprasidone) are recommended, as monotherapy or combined with a mood-stabilizing drug, as first line long-term treatment in several CPG. Most drugs have an indication for prevention of manic episodes, and only quetiapine is recommended to prevent depressive episodes as well. Considering long-term treatment of bipolar disorder with antipsychotic drugs is adequate, but risk/benefit ratio of these drugs has to be kept in mind, given the limitations of available studies and the possible side effects of prolonged treatment.