Aripiprazole Augmentation to Mood Stabilizers for Obsessive-Compulsive Symptoms in Bipolar Disorder

Abstract

Background and Objectives: Aripiprazole is a first-line agent in the treatment of bipolar disorder (BD) and available data demonstrates its efficacy on clinical symptoms in serotonin reuptake inhibitors-resistant obsessive-compulsive disorder (OCD) patients. Therefore, aripiprazole augmentation to mood stabilizers could represent a promising treatment in BD patients with comorbid OCD. The study examined the efficacy and safety of aripiprazole added to lithium or valproate for the treatment of obsessive-compulsive (OC) symptoms in euthymic BD patients with comorbid OCD. Materials and Methods: This is a 12-week prospective observational study. The efficacy of aripiprazole on OC symptoms was assessed through the mean change of Yale–Brown Obsessive-Compulsive (YBOCS) total score. Tolerability was assessed with the Utvalg for Kliniske Undersogelser (UKU) side effect scale and by reporting adverse events. Results: A total of 70 patients were included in the analyses. The withdrawal rate was 21.4%, mainly due to adverse events. Mean ± SD final aripiprazole dose was 15.2 ± 5.3 in the completer sample (N = 55). The Y-BOCS mean score decreased from 24.0 ± 4.1 at baseline to 17.1 ± 4.3 at 12 weeks. Treatment response rate (Y-BOCS reduction ≥ 35%) was 41.8%, while partial response rate (Y-BOCS reduction greater than 25% but less than 35% from baseline) accounted for the other 18.2% of patients. Overall, 91.4% of completers had at least 1 adverse effect (tremor, tension/inner unrest, reduced duration of sleep, akathisia). No significant differences emerged comparing aripiprazole efficacy and tolerability between patients treated with lithium or valproate. Conclusion: Our findings show that aripiprazole addition to lithium or valproate can reduce OC symptoms in real-world BD euthymic patients.

Obsessive–Compulsive Disorder as an Epiphenomenon of Comorbid Bipolar Disorder? An Updated Systematic Review

“…In some cases, the use of SSRIs or clomipramine (first line compounds in OCD) is even associated with a “paradoxical” increase in the severity of OC symptoms in patients with “comorbid” OCD and BD [ 128 ], while the addition of other mood stabilizers to lithium or valproate is beneficial also on OC symptoms. [ 89 , 129 , 130 ]. These findings have significant implications for the clinical management of patients dealing with both BD and OCD, suggesting that physicians should exercise caution when considering antidepressant treatment for comorbid OC symptoms in BD.…”

Differentiating the third generation of antipsychotics: a focus on lumateperone’s similarities and differences

“…At 12 weeks, there was a YBOCS mean score reduction of 6.9. The treatment response rate, defined as YBOCS reduction ≥ 35%, was 41.8%, while the partial response rate, defined as YBOCS reduction greater than 25% but less than 35%, was seen in the other 18.2% of patients (Di Salvo et al , 2020).…”