Bipolar disorder 1 is considered a disability

Therapy protects against relapses

In the manic phase, doctors give mood stabilizers such as lithium and valproic acid or atypical neuroleptics as monotherapy or in combination. Several substances are approved for the acute treatment of mania: aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone. The youngest of the group is asenapine, which has been available as a sublingual tablet since May 2011. Clozapine is only used when other active ingredients do not help, added Volz. This is an off-label use.


The atypicals usually do not trigger a switch from mania to depression, reported Volz. In the past, this was very much feared when administering classic neuroleptics such as haloperidol.


The newcomer asenapine was less effective than olanzapine in two short-term studies over three weeks, but significantly better than placebo (read New on the market: asenapine, bazedoxifene, bilastine, conestat alfa and ..., PZ 01/2011). The patients had fewer extrapyramidal motor side effects than with olanzapine and practically no increase in prolactin, reported Volz. The weight gain was about half that. Most often, the patients complained of drowsiness and anxiety.


Asenapine only sublingually


As asenapine has a high first-pass effect, it is not given orally, but sublingually (10 mg twice a day). When placed under the tongue, the sublingual tablet dissolves within seconds. After that, the patient is not allowed to eat or drink for ten minutes.


Antimanic therapy usually works well, even over the long term. After three weeks of therapy, 80 percent of the patients respond, after 80 days it is 90 percent, reported the doctor. However, one in five falls ill again despite correct phase prophylaxis. However, the risk is much higher without treatment. "Anyone who has had two to three episodes and is bipolar has a 95 percent risk of a new episode if left untreated." /