Essentials of Psychiatry in Primary Care: Behavioral Health in the Medical Setting >Major Depression and

Related Disorders
Robert C. Smith, Gerald G. Osborn, Francesca C. Dwamena, Dale D'Mello, Laura Freilich, Heather S. Laird-Fick+
Table 4-15.Use of Atypical Antipsychotic Medications for Bipolar Disorders

Orthostatic
Indications Starting Dose (mg/d) Schedule of Uptitration Target Dose (mg/d) EPSb Metabolic Effect Sedation
Hypotension

Mania/hypomania 300-800
Quetiapine XR
Increase every 2-3
100 at bedtime +/− +++ ++ +++
Depression d as BP tolerates 300-600 (for
Seroquel XR

Maintenance depression)a

Risperidonec
Increase 1 mg/d as
Mania/hypomania 2 at bedtime 4-6 ++ ++ ++ ++
tolerated
Risperdal

Aripiprazole Increase by 5-10

Mania/hypomania 10 in AM every 2 d as 10-30 + + + +
Abilify tolerated

Ziprasidoned Increase by 20 mg
20 twice/day with
Mania/hypomania every 2 d as 160 + + + ++
food
Geodon tolerated

Olanzapine Mania/hypomania
Increase 5 mg/wk
5 at bedtime 10-20 + +/- +++ ++
as tolerated
Zyprexa Maintenance

BP = blood pressure; EPS = extrapyramidal syndrome.

Note: Elderly patients and those with comorbid renal or hepatic disease should be started at one-half the above dose recommendations.
aWhen quetiapine is used to augment unipolar depression, the target dose is 150-300 mg/d.
bSee Chapter 9 for details of the side effects.
cMay have marked prolactin increase; if clinical suspicion, obtain levels.
dMay prolong QTc (corrected QT interval on baseline ECG); if rises above >500 ms, discontinue medication.

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