Comparing Atypical Antipsychotics

Comparing Atypical Antipsychotics:

Schizophrenia, Bipolar Disorder, Depression, Dementia and Developmental Disorders


Banana5 (A) Schizophrenia

  • Clozapine is superior to Olanzapine in preventing suicide attempts and worsening suicidal behavior in patients at high risk.


  • Clozapine along with Olanzapine have lower rates of discontinuation of drug for any reason compared to other antipsychotics.


  • Asenapine has higher rates of extrapyramidal side effects and more severe symptoms than olanzapine.


  • Some studies also found risperidone and paliperidone had higher rates of extrapyramidal symptoms compared to olanzapine.


  • Risperidone was found to result in more frequent or more severe sexual dysfunction symptoms than quetiapine, but was similar to extended-release paliperidone or ziprasidone.


  • Among adolescents with schizophrenia, quetiapine was not superior to placebo based on response rate, but was superior based on improvements measured by the Positive and Negative Syndrome Scale.


  • Women had greater improvements than men with clozapine and with olanzapine.

Banana6 (B) Bipolar Disorder

  • In manic or mixed episode, no significant differences were found between risperidone and olanzapine or asenapine and olanzapine for quality of life, response, or remission outcomes.
  • Asenapine resulted in a higher risk of stopping the drug due to adverse events than olanzapine, but weight gain was greater with olanzapine.
  • Weight gain was also greater with olanzapine compared to risperidone, but there were no differences in extrapyramidal symptoms or rates of discontinuations due to adverse events.


  • In depressed episode, compared to placebo, only olanzapine and quetiapine (both immediate and extended-release) have evidence of significantly increasing the proportions of patients who achieve response and remission.


  • In children and adolescents, compared to placebo, the following drugs have all been shown to increase the proportions of children and adolescents who achieve treatment response and remission: aripiprazole, olanzapine, immediate-release quetiapine, and risperidone. Overall however, the evidence is limited.

Banana3 (C) Depression

  • The rate of treatment response was improved by the addition of aripiprazole, quetiapine (immediate and extended-release), and risperidone.


  • Observational evidence suggests that use of antidepressants (SSRIs) plus olanzapine is associated with significantly greater weight gain than SSRIs plus either quetiapine or risperidone.

Banana8 (D) Dementia

  • The best evidence found similar rates of response and withdrawal, and no differences in clinical outcome measures for olanzapine, risperidone, and quetiapine.

Banana4 (E) Developmental and Behavioral Disorders

  • Compared with placebo, risperidone, aripiprazole, and olanzapine improve behavioral symptoms in children with pervasive developmental disorders such as autism.


  • Risperidone and quetiapine showed efficacy in children and adolescents with disruptive behavior disorders such as conduct disorder.

SOURCE: PubMed Clinical Q&A [Internet].Laura Dean, MD. February 11, 2011.

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  1. I read recent guidelines where they mentioned that seroquel should be first choice in manic episode, and zyprexa comes as 3rd line. Risperdal is 1st line for manic episode. So, how zyprexa and risperdal have no difference in response/remission in manic episodes?

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