What are disadvantages of antipsychotics for bipolar disorder?

Antipsychotic mood stabilizers for bipolar disorder have some disadvantages. With the exception of Abilify and Saphris, the members of this class have a strong tendency to promote weight gain, and sometimes even Abilify or Saphris do so. At times this weight gain is marked and can lead to obesity and even Type II diabetes.

Many of the medications in this class are highly sedating. This is an advantage in that we can put the acutely manic patient to sleep and break the mania with them. This is a disadvantage in that daytime sedation can occur and this is not desirable. Another disadvantage is that, in contrast to the more traditional mood stabilizers, there is no evidence that the antipsychotic mood stabilizers lengthen the time between cycles, and therefore likely do not improve the long-term course of the illness. This is a point that is still debated, but in my years of experience of treating thousands of bipolar patients, I have developed the belief that the antipsychotic mood stabilizers lack this important characteristic.

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