A prospective, open-label study of Aripiprazole mono- and adjunctive treatment in acute bipolar depression

Dunn, Robert T.; Stan, Vanessa A.; Chriki, Lyvia; Filkowski, Megan M.; Ghaemi, S. Nassir

doi:10.1016/j.jad.2008.01.004

Cited by 35 publications

(19 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14Y16 When used as an adjunctive therapy to standard treatments for bipolar mania and bipolar depression, aripiprazole also demonstrated a low potential for weight gain in short-term (6-week) studies. 17,18 Consistent with the weight gain reported with adjunctive aripiprazole, more patients treated with adjunctive aripiprazole than placebo experienced increases in their BMI category classification.…”

Section: Discussionmentioning

confidence: 78%

Metabolic Assessment of Aripiprazole as Adjunctive Therapy in Major Depressive Disorder

Fava¹,

Wisniewski²,

Thase³

et al. 2009

Journal of Clinical Psychopharmacology

View full text Add to dashboard Cite

In 2 identical multicenter, double-blind, placebo-controlled trials, an 8-week prospective treatment phase to ensure inadequate response to standard antidepressants was followed with 6 weeks of aripiprazole (2-20 mg/d) or placebo, plus a standard antidepressant. This pooled analysis involving 737 patients across the 2 studies evaluated the metabolic effects of adjunctive aripiprazole in patients with major depressive disorder. Outcomes included mean change from end of prospective treatment phase to endpoint in body weight, waist circumference, fasting levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides (TG), fasting plasma glucose, and glycosylated hemoglobin (hemoglobin A1C). Logistic regression determined whether baseline variables were associated with weight gain or whether weight change was associated with clinical outcome. Statistically significant increases occurred in mean body weight (adjunctive aripiprazole, +1.73 kg, vs adjunctive placebo, +0.38 kg; P < 0.001). Significantly more subjects receiving adjunctive aripiprazole had clinically relevant (> or = 7%) weight gain versus placebo (5.2% vs 0.6%; P < 0.001). More patients treated with adjunctive aripiprazole shifted body mass index category group from normal to overweight and from overweight to obese than those treated with adjunctive placebo. Body mass index, sex, age, Montgomery-Asberg Depression Rating Scale score, fasting TG, fasting glucose, and standard antidepressants were not clinically meaningful predictors of weight gain with adjunctive aripiprazole, and change in weight had no correlation with clinical outcome. Adjunctive aripiprazole produced no significant changes versus placebo in mean waist circumference, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, TG, fasting plasma glucose, or hemoglobin A1C. Also, there was no apparent change in the incidence of National Cholesterol Education Program-defined abnormal metabolic measures after treatment with aripiprazole.

show abstract

Section: Discussionmentioning

confidence: 78%

Metabolic Assessment of Aripiprazole as Adjunctive Therapy in Major Depressive Disorder

Fava¹,

Wisniewski²,

Thase³

et al. 2009

Journal of Clinical Psychopharmacology

View full text Add to dashboard Cite

show abstract

“…Moreover, the consensus in the present study was that the combination of an AAP (QTP, OZP, or ARI) with an MS was appropriate for the treatment of moderate to severe depression. Although a small randomized controlled trial did not find a significant effect of this type of treatment compared with placebo,37 some open-label trials have demonstrated the benefit of adjunctive ARI treatment for patients with bipolar depression 38,39. LTG was included in evidence category “B”, ie, limited positive evidence was available, in a previous controlled study5 and is a first-line treatment option according to CANMAT guidelines12 based on a meta-analysis of individual patient data that supported the efficacy of LTG treatment 40…”

Section: Discussionmentioning

confidence: 99%

Korean Medication Algorithm Project for Bipolar Disorder: third revision

Woo

Lee

Jeong

et al. 2015

NDT

View full text Add to dashboard Cite

ObjectiveTo constitute the third revision of the guidelines for the treatment of bipolar disorder issued by the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2014).MethodsA 56-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for the various phases of bipolar disorder and for special populations. The review committee included 110 Korean psychiatrists and 38 experts for child and adolescent psychiatry. Of the committee members, 64 general psychiatrists and 23 child and adolescent psychiatrists responded to the survey.ResultsThe treatment of choice (TOC) for euphoric, mixed, and psychotic mania was the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP); the TOC for acute mild depression was monotherapy with MS or AAP; and the TOC for moderate or severe depression was MS plus AAP/antidepressant. The first-line maintenance treatment following mania or depression was MS monotherapy or MS plus AAP; the first-line treatment after mania was AAP monotherapy; and the first-line treatment after depression was lamotrigine (LTG) monotherapy, LTG plus MS/AAP, or MS plus AAP plus LTG. The first-line treatment strategy for mania in children and adolescents was MS plus AAP or AAP monotherapy. For geriatric bipolar patients, the TOC for mania was AAP/MS monotherapy, and the TOC for depression was AAP plus MS or AAP monotherapy.ConclusionThe expert consensus in the KMAP-BP 2014 differed from that in previous publications; most notably, the preference for AAP was increased in the treatment of acute mania, depression, and maintenance treatment. There was increased expert preference for the use of AAP and LTG. The major limitation of the present study is that it was based on the consensus of Korean experts rather than on experimental evidence.

show abstract

“…Agents that may be applied adjunctively include aripiprazole (level 4),266, 267 armodafinil (level 4)268, 269 (Figure 3), asenapine (level 4),270 levothyroxine (level 3),271, 272 modafinil (level 2)268 (Figure 3), and pramipexole (level 3) 273, 274. rTMS targeted at the left or right dorsolateral prefrontal cortex (level 3)275 may also be used in addition to medication.…”

Section: Acute Management Of Bipolar Depressionmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

View full text Add to dashboard Cite

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

show abstract

A prospective, open-label study of Aripiprazole mono- and adjunctive treatment in acute bipolar depression

Cited by 35 publications

References 9 publications

Metabolic Assessment of Aripiprazole as Adjunctive Therapy in Major Depressive Disorder

Metabolic Assessment of Aripiprazole as Adjunctive Therapy in Major Depressive Disorder

Korean Medication Algorithm Project for Bipolar Disorder: third revision

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Contact Info

Product

Resources

About