Abstract
Mixed states in bipolar disorder are highly prevalent, with a global worse clinical outcome and present difficulties in their diagnosis and treatment. Mood stabilizers may be insufficient for the treatment of these episodes, and addition of an antipsychotic may be required; use of antidepressants is discouraged. Efficacy data of antipsychotics in mixed episodes have been traditionally reported in conjunction with pure manic episodes. In this article, specific data concerning the efficacy of atypical antipsychotics when reported exclusively in mixed states are reviewed. Although all the atypical antipsychotics show efficacy on symptoms of manic polarity within mixed states, asenapine, olanzapine and ziprasidone show data regarding a greater efficacy on depressive symptoms. Further studies are required regarding the efficacy of these agents on mixed symptoms according to DSM-5.
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