Current and Emerging Therapies for the Management of Bipolar Disorders

Abstract

Bipolar disorder is a complex condition to treat because agents that may be effective for a specific phase may not be effective for other phases, or may even worsen the overall course of the illness. Over the last decade there has been an increase in research activity in the treatment of bipolar illness. There are now several agents that are well established for the treatment of acute mania (lithium, divalproex, carbamazepine, nearly all antipsychotics), acute bipolar depression (lamotrigine, quetiapine, olanzapine/fluoxetine combination), and relapse prevention (lithium, lamotrigine, divalproex, most second generation antipsychotics). There are also novel treatments that are being studied for all three phases. These include eslicarbazepine, cariprazine, MEM-1003, memantine, tamoxifen and pentazocine for acute mania; pramipexole, modafinil, armodafinil, divalproex, lurasidone, agomelatine, cariprazine, lisedexamfetamine, riluzole, RG-2417, bifeprunox, ropinirole, GSK1014802, and magnetic stimulation for bipolar depression; and asenapine, lurasidone, and cariprazine for relapse prevention. Additionally, there are accumulating data that antidepressants, particularly serotoninergic ones, are not particularly effective in acute bipolar depression and may worsen the course of the illness.

Management of obsessive-compulsive disorder comorbid with bipolar disorder

“…[115117] In an open-label study, riluzole (100–200 mg/day) was effective in bipolar depression when added to lithium. [52118119] However, no report of use of riluzole in mania has been published so far. [52118] Further studies are needed to confirm its use in BD-OCD.…”

“…[52118119] However, no report of use of riluzole in mania has been published so far. [52118] Further studies are needed to confirm its use in BD-OCD.…”

Cariprazine for the Treatment of Bipolar Disorder

“…In a systematic review of the literature, a total of 12 articles were found that described the safety and tolerability of cariprazine in humans: seven were review articles (Caccia, Invernizzi, Nobili, & Pasina, ; Citrome, a, b, ; El‐Mallakh, Elmaadawi, Gao, Lohano, & Roberts, ; George, Amrutheshwar, Rajkumar, Kattimani, & Dkhar, ; Javitt, ), four were short‐term (6‐week), double‐blind, randomized controlled trials of fixed‐dose cariprazine used in the acute treatment of schizophrenia with results reported in poster sessions or industry press releases, and one was a 3‐week double‐blind, randomized control trial of cariprazine in mania (Durgam, Nasrallah, et al., ; Durgam et al., ; Forest Laboratories, Inc., b; Lieberman et al., ; Zukin et al., ). Cariprazine was found to significantly reduce symptoms of schizophrenia in lower oral dose ranges (1.5 mg once daily) and treatment effects were greater in doses of 3.0–4.5 mg once daily, but tolerability was not dose related (Durgam, Starace, et al., 2014).…”

Ropinirole in Bipolar Disorder: Rate of Manic Switching and Change in Disease Severity

“…Ropinirole is a non-ergoline D 2 /D 3 dopamine receptor agonist used primarily for treating restless legs syndrome (RLS) and Parkinson's disease (PD) either through monotherapy or combination methods (Mavirikaki, Schintu, Nomikos, Panagis, & Svenningsson, 2015;Product Information, 2009;Tundo, de Filippis, & Proietti, 2015;Wijemanne & Jankovic, 2015). Similar to pramipexole, ropinirole has also been found to be a novel treatment for treatment-resistant bipolar depression (El-Mallakh, Elmaadawi, Gao, Lohano, & Roberts, 2011;Tundo et al, 2015). Ropinirole has been shown to positively affect emotionality in rats through increasing activity and motion in various tests, supporting the idea that it could be used for similar emotional deficiencies in human PD and RLS patients (Mavirikaki et al, 2015).…”