Olanzapine in the acute treatment of bipolar I disorder with a history of rapid cycling

Todd M. Sanger, Mauricio Tohen, Eduard Vieta, David L. Dunner, Charles L. Bowden, Joseph R. Calabrese, Peter D. Feldman, Thomas G. Jacobs, Alan Breier

Research output: Contribution to journalArticle

66 Scopus citations


Background: A substantial proportion of patients with bipolar disorder are characterized by a rapidly cycling course and are particularly resistant to conventional treatment. Methods: This secondary analysis, defined a priori, was conducted on a larger data set from patients with bipolar I disorder to determine the efficacy of a 3-week treatment with the atypical antipsychotic olanzapine (5-20 mg/day, n=19) versus placebo (n=26) in patients with ≥4 episodes in the preceding year. Results: Significantly fewer placebo patients completed treatment (34.6 vs. 73.7%, P=0.016), and more than half discontinued due to lack of efficacy (53.8 vs. 21.1%, P=0.035). Olanzapine reduced Young Mania Rating Scale (YMRS) total scores significantly more than placebo (-13.9 vs. -4.1, P=0.011). Clinical responses, defined as ≥50% improvement in YMRS, were achieved in 58% of olanzapine patients, compared with 28% of placebo patients (P=0.066). Extrapyramidal symptoms were not significantly changed in either group. Somnolence was the most common adverse event in both groups (olanzapine: 52.6%, placebo: 23.1%; P=0.060). No event occurred significantly more frequently with olanzapine than with placebo. No patients discontinued due to an adverse event. Limitations: The duration of this study was limited to 3 weeks, precluding conclusions about long-term efficacy of olanzapine. Moreover, a sizeable placebo effect was obtained, possibly masking optimal therapeutic effect. Despite these limitations, treatment differences in efficacy were highly significant. Conclusions: These results indicate that olanzapine was effective in reducing symptoms of mania and well tolerated in patients with bipolar I disorder with a rapid-cycling course.

Original languageEnglish (US)
Pages (from-to)155-161
Number of pages7
JournalJournal of Affective Disorders
Issue number1-2
StatePublished - Jan 1 2003


  • Bipolar disorder
  • Mania
  • Olanzapine
  • Rapid cycling

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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    Sanger, T. M., Tohen, M., Vieta, E., Dunner, D. L., Bowden, C. L., Calabrese, J. R., Feldman, P. D., Jacobs, T. G., & Breier, A. (2003). Olanzapine in the acute treatment of bipolar I disorder with a history of rapid cycling. Journal of Affective Disorders, 73(1-2), 155-161. https://doi.org/10.1016/S0165-0327(02)00334-8