A randomized, double-blind, controlled study examined the
utility of continued combination treatment with a mood stabilizer
(lithium, carbamazepine, or valproate) and a first-generation (typical)
antipsychotic (perphenazine) (46). Immediately following remission from
a manic episode, patients were randomly assigned to remain on the
combination therapy or to receive the mood stabilizer plus placebo.
Among those on continued combination therapy, there was shorter
time to depressive relapse, a higher rate of discontinuation, and higher
rates of dysphoria, depressive symptoms, and extrapyramidal symptoms.
The study concluded that there were no short-term benefits with
the continuation of the first-generation antipsychotic with a mood
stabilizer; in fact, its continued use was associated with the aforementioned