title: Antipsychotic switching in bipolar disorders: a systematic review.
abstract: With the increasingly widespread use of antipsychotics in bipolar disorder (BD), switching among these agents and between antipsychotics and mood stabilizers has become more common, in particular, since the introduction of the novel atypical antipsychotics with mood stabilizer properties. This systematic review aims to provide a comprehensive update of the current literature in BD about the switching of antipsychotics, among them and between them and mood stabilizers, in acute and maintenance treatment. We conducted a comprehensive, computerized literature search using terms related to antipsychotic switching in BD in the PubMed/Medline, PsycINFO, CINAHL database; the Cochrane Library and; the Clinicaltrials.gov web up to January 9th, 2013 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search returned 4160 articles. After excluding duplications, reviews, case reports and studies that did not fulfil the selection criteria, 8 studies were included. Not only have few articles on antipsychotic switching been published but also recruitment in most studies included mixed samples of patients. In general, antipsychotic switching, regardless of the route of drug administration, was well tolerated and no interference was shown in antipsychotic effectiveness during the interchange of drugs. Metabolic improvement was perceived when the switch involved antipsychotics with a low metabolic risk profile. The evidence-base for antipsychotic switching in BD is scant, and little controlled data is available. Switch from quetiapine to lithium and from risperidone to olanzapine has proven successful. Switching to antipsychotics with low metabolic risk had some positive impact on several safety measures. In stabilized patients, the plateau cross-taper switch may be preferred.
authors.affiliation: Bipolar Disorders Unit, Clinical Institute of Neurosciences, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Iria
authors.initials: I
authors.lastname: Grande
authors.affiliation: Schizophrenia Unit, Clinical Institute of Neurosciences, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Bernardo
authors.affiliation: Área de Psiquiatría, Departamento de Medicina, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Asturias, España.
authors.forename: Julio
authors.initials: J
authors.lastname: Bobes
authors.affiliation: Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Saiz-Ruiz
authors.affiliation: Instituto de Neurociencias, Centro de Investigaciones Biomédicas (CIBM), Universidad de Granada, Granada, Spain.
authors.forename: Cecilio
authors.initials: C
authors.lastname: Álamo
authors.affiliation: Bipolar Disorders Unit, Clinical Institute of Neurosciences, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D000818:Animals; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D057915:Drug Substitution; D006801:Humans
chemical_list: D014150:Antipsychotic Agents