When to start aripiprazole therapy in patients with bipolar mania

Abstract

Aripiprazole is a third generation atypical antipsychotic with compelling evidence as a highly effective treatment option in the management of acute manic and mixed episodes of bipolar I disorders. It has a unique mode of action, acting as a partial agonist at dopamine D2 and D3, and serotonin 5-HT1A; and exhibiting antagonistic action at the 5-HT2A and H1 receptors. Overall, it has a favorable safety and tolerability profile, with low potential for clinically significant weight gain and metabolic effects, especially compared to other well-established treatments. It also has a superior tolerability profile when used as maintenance treatment. Side effects like headache, insomnia, and extrapyramidal side effects (EPSEs), such as tremor and akathisia may be treatment limiting in some cases. It is efficacious in both acute mania and mixed states, and in the long-term prevention of manic relapses. Aripiprazole therefore, is a significant player in the current portfolio of anti-manic pharmacological treatments. The data sources for this article are from EMBASE, MEDLINE, and the clinical trial database searches for all the literature published between January 2003 and September 2013. The key search terms were “aripiprazole” combined with “bipolar disorder”, “mania”, “antipsychotics”, “mood stabilizer”, “randomized controlled trial”, and “pharmacology”. Abstracts and proceedings from national and international psychiatric meetings were also reviewed, along with reviews of the reference lists of relevant articles.

Keywords:

• bipolar disorder
• mania
• maintenance
• aripiprazole

Disclosure

Dr Sayyaparaju received no support, grants, or sponsorships from any pharmaceutical companies or other organizations. Dr Grunze has received grants/research support, consulting fees, and honoraria within the last 3 years from AstraZeneca, BMS, Otsuka Pharmaceuticals, Desitin, Eli Lilly, Gedeon Richter, Hoffmann-La Roche, Lundbeck, Merck, Servier, and UBC. Dr Fountoulakis is/was a member of the International Consultation Board for various pharmaceutical companies and has received honoraria for lectures from AstraZeneca, Janssen-Cilag, and Eli-Lilly and research grants from AstraZeneca and Pfizer Foundation. He has received support for attending congresses by Janssen, BMS, Eli Lilly, Pfizer, AstraZeneca, and others. The authors report no other conflicts of interest in this work.