Aripiprazole Adjunct Treatment in Bipolar I or II Disorder, Depressed State

Abstract

The symptomatic course of bipolar disorder (BPD) is chronic and dominated by depression. As recurrence rates are high, maintenance therapy is required. Although efficacious, mood stabilizers may be hampered by poor adherence, and second-generation antipsychotic medications may be associated with weight gain and metabolic abnormalities. There is evidence to suggest that aripiprazole is beneficial in major depressive disorder and BPD with depression. We therefore investigated 2-year clinical outcomes with aripiprazole adjunct therapy at 5 to 15 mg once daily alongside a mood stabilizer in 40 patients with BPD. All patients experienced marked improvements in Montgomery-Åsberg Depression Rating Scale scores by 6 weeks and substantial reductions in Clinical Global Impressions Scale scores by 6 months. All patients were able to return to optimal or premorbid functioning by 6 months to 1 year. By 1 year, all patients made a complete functional recovery on the Sheehan Disability Scale. Improvements were maintained on all measures up to 2 years. There were minimal adverse events, all of which decreased during therapy. Our findings indicate that aripiprazole adjunct treatment is safe and effective as an acute and maintenance therapy for BPD. However, the findings will need to be replicated by larger studies.

Functional outcome assessment in bipolar disorder: A systematic literature review

“…The second study used the Self‐reported Medical Outcomes Study SF‐36 Psychosocial Function and Health‐rating Questionnaire to assess improvements in physical, social, and major role activities due to poor health and the association with symptomatic remission and clinical recovery in acutely manic patients with BP‐I receiving daily olanzapine monotherapy in the 49‐week open‐label extension of a 3‐week randomized controlled trial. The third and most recent study used the Sheehan Disability Scale to assess functional recovery in family, social and work/school domains over 2 years in patients with BP‐I or BP‐II openly treated with aripiprazole and an adjunct mood stabilizer.…”

Pharmacological Treatment of Bipolar Depression: A Review of Observational Studies

“…Regarding appetite, McElroy et al showed increased and decreased appetite. A mild weight gain was reported by Malempati et al [ 40 ], while Dunn et al [ 37 ] demonstrated an increase in glucose levels, with concentrations in the normal range. All other trials did not find any weight change during aripiprazole treatment, but, of note, in most studies, the treatment duration was only of some weeks.…”

“…Of the remaining studies, 73 publications met the inclusion criteria and were further investigated in detail. The search found 16 publications on anticonvulsants [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], 20 on atypical antipsychotics [ 21 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ], 2 on lithium [ 49 , 50 ], 28 on antidepressants [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , …”

“…McElroy et al showed that response and remission rates were not affected by whether aripiprazole was received alone or as an add-on [ 43 ]. Finally, Malempati observed improvements in MADRS, CGI, and complete functional recovery on the Sheehan Disability Scale (SDS; [ 94 ]), when using aripiprazole as an adjunctive therapy [ 40 ]. Two studies on lurasidone were found.…”

“…Olanzapine treatment and quetiapine treatment were mainly associated with weight gain and somnolence, whereas Kishi et al found in their comparison that olanzapine was more associated with weight gain and decreased levels of high-density cholesterol, while quetiapine ER was associated with a greater risk of somnolence [ 33 ]. Of the seven studies on aripiprazole, six showed akathisia [ 37 , 38 , 40 , 41 , 42 , 43 ], four showed nausea [ 37 , 38 , 39 , 43 ], and two showed tremors [ 38 , 43 ]. Regarding appetite, McElroy et al showed increased and decreased appetite.…”