Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.

I.INTRODUCTION

There is a substantial body of literature on the use of antipsychotic medications in the management of mood disorders. Most of the older literature addresses use of the conventional antipsychotic or typical compounds (1). Controlled studies have shown that typical antipsychotics are superior to placebo in the treatment of acute mania, and that typical antipsychotics may have a relatively rapid onset of action (2,3). However, while use of these older drugs was widespread in the past, particularly in situations where acute psychotic mania was the focus of treatment, typical antipsychotic treatment was also frequently associated with a number of problematic adverse effects. Adverse effects associated with typical antipsychotic drugs include neurological adverse effects such as acute dystonias, drug-induced parkinsonism, akathisia and tardive dyskinesia as well as non-neurological adverse effects such as sedation, othostatic hypotension, anticholinergic symptoms, and endocrine abnormalities (4). It has been suggested that individuals in treatment for mood disorders may be particularly vulnerable to medication associated dyskinesias (5). Moreover, it has been reported that the older, neuroleptic compounds may exacerbate post-manic major depressive episodes, and induce rapid cycling in some patients with bipolar illness (6). For the most part, the utilization of older antipsychotic medications in the treatment of mood disorders has been limited by the common occurrence of adverse effects, and concerns about negative effects on mood illness outcome.