Clozapine for management of bipolar disorder: A case series

Abstract

Abstract Clozapine is considered to be the treatment of choice in patients with treatment-resistant schizophrenia. However, there is little information on the use of clozapine in patients with bipolar disorder (BD), especially in India. The aim of this paper is to present four cases of BD who were having frequent relapses while on a combination of two mood stabilizers and an antipsychotic medication, whose frequency of episodes reduced significantly after starting clozapine. Four patients with treatment-resistant BD (i.e., lack of response to a combination of two mood stabilizers) with a history of frequent suicidal behavior (in two patients) and marked aggression (in two patients) were managed with a combination of a mood stabilizer and clozapine (three patients) or combination of antidepressant and clozapine. The addition of clozapine led to the remission of hypomanic/manic episodes in all the patients. Three of the four patients who were followed for 3.5–8 years had a marked reduction in the number of episodes of either polarity, suicidality, aggression, and medication load. One patient who was followed up for 3 months also reported remission of manic symptoms and reduction in aggression. This report suggest that clozapine can be a helpful treatment option in patients with BD, especially those with treatment-resistant BD who usually do not respond adequately to other medications. Additionally, the use of clozapine in patients with BD is also associated with reduced self-harm behavior, aggression, and medication load.