12. Aripiprazole in Bipolar Disorder

  1. Hagop S. Akiskal2 and
  2. Mauricio Tohen3
  1. Alessandra Nivoli and
  2. Eduard Vieta

Published Online: 13 APR 2011

DOI: 10.1002/9780470975114.ch12

Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition

Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition

How to Cite

Nivoli, A. and Vieta, E. (2011) Aripiprazole in Bipolar Disorder, in Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition (eds H. S. Akiskal and M. Tohen), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470975114.ch12

Editor Information

  1. 2

    International Mood Center, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0603, USA

  2. 3

    Department of Psychiatry, Division of Mood and Anxiety Disorders, University of Texas Health Science Centre at San Antonio, 7730 Floyd Curl Drive, San Antonio, TX 78229, USA

Author Information

  1. Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS-CIBERSAM, Villarroel 170, Barcelona 08036, Catalonia, Spain

Publication History

  1. Published Online: 13 APR 2011
  2. Published Print: 15 APR 2011

ISBN Information

Print ISBN: 9780470747216

Online ISBN: 9780470975114

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Keywords:

  • bipolar disorder;
  • aripiprazole;
  • treatment;
  • mania;
  • depression;
  • Treatment Guidelines;
  • maintenance treatment;
  • monotherapy;
  • adjunctive treatment;
  • efficacy

Summary

Aripiprazole is a partial agonist at dopamine D2 and 5HT1A receptors, approved for the treatment of acute manic/mixed episodes and maintenance of bipolar patients with recent manic/mixed episodes. The evidence-base for the acute and long-term treatment of mania is strong, while data on the treatment of acute bipolar depression are mostly negative: aripiprazole is efficacious in the treatment of acute manic/mixed episodes both as monotherapy or adjunctive therapy to either lithium or valproate, in the acute treatment of agitation associated with manic/mixed states, in the prevention of manic relapses and in rapid cycling bipolar disorder. Treatment guidelines recommend its use in acute mixed/dysphoric mania and rapid cycling, but not in acute bipolar depression as monotherapy. In long-term treatment, guidelines recommend aripiprazole in preventing manic/mixed episodes and, even with little evidence, depressive episodes too. In fact, there was a signal that aripiprazole might work as a “prompter” of response in bipolar depression, but effects faded away after six weeks, perhaps due to doses being too high in the trials. With regards to safety, aripiprazole is generally reported to be safe and well tolerated, with low metabolic risks, such as induction of type 2 diabetes, weight gain, hyperlipidemia, with little sedation, and generally mild extrapyramidal side effects, but in the short-term akathisia may be an issue and in the long-term there is still a subset of patients who may gain some weight.