Q:  Can Atypical Antipsychotics Induce Mania

Is there any evidence that atypical antipsychotics like Risperdal can actually activate mania in some people, and if a person is activated by one of the newer antipsychotics, will he/she have the same problem with all of this group of meds?

Dear Mr. or Ms. M' -- 
There is clear evidence that Risperidone can do this; we noticed that capacity pretty quickly when we first started using it.  I've not been anywhere near as worried about something like zyprexa doing that, but here's an article that puts them in nearly the same ballpark in that respect.  I have not found them at all similar in this way (i.e. in my experience, Risperidone is much more worrisome for acting like an antidepressant, and it's a pretty good one in that way sometimes!)  

Note that the article is a review of case reports, not a research study; most psychiatrists have given both risperidone and olanzapine hundreds of times, so asking a doc' for his/her opinion is actually more representative in this case than an article in the literature, especially if you ask a bunch of doc's, as I've done -- that's the basis for my stance on the relative risk of mania with these two agents. 

By comparison, Seroquel seems not to do this mania-induction at all in my very limited experience with it (I'm just starting to use it).  I've heard more about Geodon acting like risperidone (I'm not using it much yet, still waiting to see what it really does and who needs what warnings with it).  

Good question. 

Dr. Phelps