A 12-month placebo-controlled olanzapine monotherapy trial demonstrated that olanzapine was significantly superior to placebo in preventing any mood episode, including manic, depressive,
and mixed recurrences.68 In a 47-week see more double-blind trial, 251 bipolar patients, through a manic or mixed episode, were randomized to olanzapine (n=125) or divalproex (n=126) Efficacy was rated with the YMRS (at least 20 for inclusion, lower than 12 for remission, and higher Inhibitors,research,lifescience,medical than 15 for relapse) At end point the olanzapine group achieved significantly greater mean improvement in YMRS. Nevertheless, no difference was noted in rates of bipolar relapse between both treatments. Some olanzapine-treated patients presented Inhibitors,research,lifescience,medical somnolence, dry mouth, increased appetite, weight gain,
akathisia, and high alanine aminotransferase levels, while nausea, and nervousness were reported by the divalproex-treated patients.96 Olanzapine was compared with lithium in a double-blind trial comprising 431 patients. After 52 weeks, olanzapine was similar to lithium in preventing depressive episodes, but superior in preventing manic or mixed relapses.114 This study Inhibitors,research,lifescience,medical suggested olanzapine’s efficacy in relapse prevention, which was tested in a double-blind placebo-controlled 12-month clinical trial. Patients with an Inhibitors,research,lifescience,medical acute manic or mixed episode received olanzapine for 6-12 weeks. Those who remitted were randomized to olanzapine (n=225) or placebo (n=136) and joined a double -blind 52-week trial. Olanzapine was superior to placebo in preventing any kind of bipolar relapse (46.7% vs 80.1%;P<0.001) and relapse into a manic episode (16.4% vs 41 .2%;P<0.001) or a depressive episode (34.7% vs 47.8%,P=0.015). Side effects were more prominent in the olanzapine-trcatcd group (weight gain, fatigue, and
akathisia) Inhibitors,research,lifescience,medical than in the placebo group. More patients finished the study in the olanzapine group.114 Efficacy of olanzapine ADAMTS5 combined with a mood stabilizer in prevention of bipolar relapses was studied in an 18month double-blind study. At the starting point, patients scored at least 16 on the YMRS. Fifty-one were randomized to olanzapine and 48 to placebo. Both groups received lithium or valproate semisodium. Median time to bipolar symptomatic relapse was significantly higher in the olanzapine-mood stabilizer group (163 vs 42 days;P=0.023),but there were no differences in time to bipolar syndromic relapse (94 vs 40.5 days;P=0.742).115 Olanzapine is one of the best-studied second-generation antipsychotics in bipolar disorder. The main downside for its use in maintenance is its propensity to induce weight gain and the risk of metabolic syndrome.