Over the past several years, the use of antipsychotics has expanded dramatically. Aside from the traditional indication, schizophrenia, various members of this class have received FDA approval for bipolar mania, bipolar depression, major depression, and autism, and increasingly they are used off-label for anxiety, insomnia, and agitation.

A recent NIMH-sponsored eight week trial compared two atypical antipsychotics, olanzapine (Zyprexa) and risperidone (Risperdal), to the first-generation antipsychotic, molindone (Moban) in the treatment of 116 youths with schizophrenia or schizoaffective disorder.

The FDA issued a Not Approvable letter regarding Vanda Pharmaceutical’s antipsychotic medication iloperidone (Fanapta). The agency based its decision on iloperidone’s question able efficacy results versus risperidone.

You’ve probably heard about Fanapta (iloperidone), a new antipsychotic marketed by Vanda Pharmaceuticals. No, it hasn’t been approved officially yet, but it is likely to win approval in July, and the company has already been taking out teaser ads in the journals and has even sponsored a touring promotional CME program run by Stephen Stahl.

Here is some selective coverage of interesting recent developments in antipsychotic medications.

Dr. Jibson, there have been several meta-analyses comparing atypical antipsychotics published over the last few years. They are all long, complicated papers, and the conclusions are often controversial. Can you help us understand this literature?

Tamoxifen, an estrogen blocker that is approved for the treatment of breast cancer, successfully treated patients with mania in a placebo-controlled trial.

Dr. Jeste, I know that you were responsible for some of the original research demonstrating that tardive dyskinesia is a possible side effect of antipsychotics. Why were you interested in the topic?

In a multi-center study conducted in Great Britain and Australia, 86 adults with mental retardation (IQ < 75) and aggressive behavior were randomized to double-blind treatment with Risperdal (mean dose, 1.8 mg/day), Haldol (mean dose, 2.9 mg/day), or placebo. The primary outcome was score on the modified overt aggression scale (MOAS) at 4 weeks.

Although we tend to feel comfortable counseling patients to continue antidepressants during pregnancy, because most of them do not appear to cause congenital abnormalities, mood stabilizers are trickier.