Journal of Affective Disorders 49 (1998) 119–122 Research report Olanzapine in treatment-resistant bipolar disorder a, b b c d * Susan L. McElroy , Mark Frye , Kirk Denicoff , Lori Altshuler , Willem Nolen , d e a b a Ralph Kupka , Trisha Suppes , Paul E. Keck, Jr. , Gabrielle S. Leverich , Geri F. Kmetz , b Robert M. Post a Stanley Foundation Bipolar Treatment Outcome Network, including the Biological Psychiatry Program, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Bethesda Avenue, Cincinnati, OH 45267, USA b Biological Psychiatry Branch, NIMH, Bldg. 10, RM 3N212, 9000 Rockville Pike, Bethesda, MA 20892, USA c VA Medical Center, West 11301 Sawtelle Blvd, Los Angeles, CA 90073, USA d HC Rumke Group, Willem Arntz Huis, P .O. Box 61 3500AB, Utrecht, Netherlands e SW Medical Center at Dallas, St. Paul Prof . Bldg. [1, 5959 Harry Hines Blvd, Suite 600, Dallas, TX, USA Received 4 November 1997; accepted 9 December 1997 Abstract Background: We evaluated the response to olanzapine in 14 consecutive patients with bipolar I disorder who were inadequately responsive to standard psychotropic agents. Methods: Fourteen patients with bipolar I disorder by DSM-IV criteria experiencing persistent affective symptoms inadequately responsive to at least one standard mood stabilizer were treated with open-label olanzapine by one of the authors. Response was assessed with the Clinical Global Impression Scale modified for use in bipolar disorder (CGI-BP). Results: The 14 patients received olanzapine at a mean (SD dosage of 14.167.2 (range 5–30) mg/day for a mean6SD of 101.4 1 56.3 (range 30–217) days of treatment. Of the 14 patients, 8 (57%) displayed much or very much overall improvement in their illness. In general, olanzapine was well tolerated. The most common side effects were sedation, tremor, dry mouth, and appetite stimulation with weight gain. Limitations: Data were obtained nonblindly and without a randomized control group, and olanzapine was added to ongoing psychotropic regimens. Conclusion: Olanzapine may have antimanic and mood-stabilizing effects in some patients with bipolar disorder, and is generally well tolerated. Controlled studies of olanzapine in bipolar disorder appear warranted.  1998 Elsevier Science B.V. Keywords: Olanzapine; Bipolar disorder 1. Introduction Substantial clinical data suggest that the atypical antipsychotic clozapine may be effective in the acute * and prophylactic treatment of some patients with Corresponding author. Tel.: 1 1 513 5581132; fax: 1 1 513 5582882. bipolar disorder, including some patients inade- 0165-0327 / 98 / $19.00  1998 Elsevier Science B.V. All rights reserved. PII S0165-0327(98)00002-0