Molecular psychiatry

Best length of risperidone or olanzapine added to mood stabilizers after recovery from a manic episode: A controlled clinical trial

Updated

Abstract

A 52-week trial with 159 patients found that discontinuing atypical antipsychotic treatment after 24 weeks significantly prolonged the time to mood episode relapse compared to stopping at the beginning.

  • Continuing risperidone or olanzapine treatment for 52 weeks resulted in an average weight gain of 3.2 kg.
  • Patients who stopped antipsychotic treatment at 24 weeks experienced a similar relapse rate to those who continued for 52 weeks.
  • There was a significant difference in relapse risk based on the type of antipsychotic: olanzapine showed a potential benefit, while risperidone did not.
  • The relapse risk was lower for the 24-weeks group compared to the 0-weeks group, with a hazard ratio of 0.53.
  • The potential benefits of continuing olanzapine beyond 24 weeks are uncertain and should be balanced against the risk of weight gain.

Simplified

Key numbers

0.53
Increase in Time to Mood Episode
Hazard ratio comparing 24-weeks vs. 0-weeks group
3.2 kg
Average Weight Gain
Weight change in the 52-weeks group

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Funding

Competing interests

Dr Lakshmi N Yatham reports grants from Lilly, Janssen and from the Canadian Institutes of Health Research during the conduct of the study. He also received grants and personal fees from AstraZeneca, Bristol Myers Squibb and Dianippon Sumitomo. He received personal fees from Forrest, Glaxo Smithkline, Lundbeck, Sunovion and Lilly outside the submitted work. Dr Serge Beaulieu reports grants and personal fees from Astra Zeneca, BMS, Lundbeck, Otsuka and Sunovion. He received grants from Novartis, Canadian Institutes of Health Research, Fonds de recherche du Québec, Réseau Santé Mentale au Québec, Brain and Behavior Research Foundation, Stanley Foundation and Pfizer Reseach Award. He reports receiving personal fees from Forest Laboratories, Lilly, Merck and Pfizer from outside the submitted work. Dr Ayal Schaffer reports grants from Canadian Institute of Health Research during the conduct of the study. He received grants from Pfizer Canada and personal fees from AstraZeneca, Eli Lilly, Sunovion, Lundbeck and Bristol-Myers Squibb outside the submitted work. Dr Marcia Kauer-Sant'Anna reports grants from Stanley Medical Research Institute, grants and personal fees from Eli-Lilly, and grants from CNPq-INCT-TM, CNPq-Universal, FIPE-HCPA and NARSAD outside the submitted work. Dr Flavio Kapzinski reports receiving support for research from AstraZeneca, Eli Lilly, Janssen-Cilag and Servier outside the submitted work. Dr Verinder Sharma reports grant support from Bristol-Myers Squibb, Cephalon, Elan Pharmaceuticals and Shire; personal fees from AstraZeneca, Eli Lilly, Janssen, Servier, Sunovion, Lundbeck and Bristol-Myers Squibb outside the submitted work. Dr Sagar V Parikh reports personal fees from Sunovion, Pfizer, BMS, Otsuka, Astra-Zeneca, Lundbeck and Lilly, and grant funding from Lundbeck outside the submitted work. Dr Andree Daigneault reports grants and personal fees from Astra Zeneca, BMS and personal fees from Lundbeck, Sunovion and Valeant, outside the submitted work. Dr David J Bond reports grants from Pfizer and personal fees from Sunovion, Pfizer, BMS, Otsuka, Astra-Zeneca and Janssen, outside the submitted work. Dr Roumen Milev reports grants and personal fees from Astra Zeneca, BMS, Pfizer and Eli Lilly. He also reports personal fees from Merck, Otsuka, Sunovion, Valeant, as well as personal fees and non-financial support from Lundbeck outside the submitted work. Dr Philippe Baruch reports personal fees from BMS and Sunovion, outside the submitted work. Dr Raymond W. Lam reports grants from Canadian Institutes of Health Research, other from Janssen and Eli Lilly, during the conduct of the study. He also received grants from Bristol Myers Squibb, Coast Capital Savings, Pfizer and St. Jude Medical; grants and personal fees from Lundbeck; and personal fees from AstraZeneca, Canadian Psychiatric Association, Lundbeck Institute, Otsuka, Servier, Canadian Network for Mood and Anxiety Treatments, outside the submitted work. In addition, Dr Lam has a patent Lam Employment Absence and Productivity Scale (LEAPS) issued, a patent Cambridge University Press with royalties paid, a patent Informa Press with royalties paid, and a patent Oxford University Press with royalties paid. Dr Beny Lafer, Dr Hong Qian, Dr Peter H Silverstone, Ms. Nazlin Walji, Dr Angelo da Cunha, Dr Joao Quevedo, Dr Rodrigo Dias, Dr Mauricio Kunz, Dr L Trevor Young and Dr Hubert Wong declare no conflict of interest.
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