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By J. Walden, H. Grunze

Complement factor: Neuropsychobiology 2002, Vol. forty five, Suppl. 1

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3 Brown ES, Dilsaver SC, Shoaib AM, Swann AC: Depressive mania: Response of residual depression to bupropion. Biol Psychiatry 1994; 35:493–494. 4 Wright G, Galloway L, Kim J, Dalton M, Miller L, Stern W: Bupropion in the long-term treatment of cyclic mood disorders: Mood stabilizing effects. J Clin Psychiatry 1985;46:22– 25. 5 Shopsin B: Bupropion’s prophylactic efficacy in bipolar affective illness. J Clin Psychiatry 1983;44:163–169. 36 6 Sachs GS, Lafer B, Stoll AL, Banov M, Thibault AB, Tohen M, Rosenbaum JF: A doubleblind trial of bupropion versus desipramine for bipolar depression.

Especially in his depressed phases, he had strong suicidal ideations. We decided to taper lithium, lamotrigine and paroxetine gradually and to start treatment with clozapine. After the titration phase, the daily dose of clozapine was 250 mg. In the following 6 months, his manias subsided completely, and the depressive episodes became fewer and milder. With the later addition of ˆ-3 fatty acids it was possible to manage also his depressive episodes. The combination treatment of valproate, clozapine and ˆ-3 fatty acids was shown to be safe and effective.

Br J Psychiatry 1979;134:382–389. 16 Goren JL, Levin GM: Mania with bupropion: A dose-related phenomenon? Ann Pharmacother 2000;34:619–621. Erfurth/Michael/Stadtland/Arolt Neuropsychobiology 2002;45(suppl 1):37–42 Clozapine as Add-On Medication in the Maintenance Treatment of Bipolar and Schizoaffective Disorders A Case Series B. Hummel S. Dittmann A. Forsthoff N. Matzner B. Amann H. Grunze Department of Psychiatry, LMU University Hospital, Munich, Germany Key Words Bipolar disorder W Schizoaffective disorder W Clozapine Abstract Atypical neuroleptics are increasingly used in the treatment of bipolar and schizoaffective disorders.

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