Aripiprazole for the maintenance treatment of bipolar disorder: a review of available evidence

Abstract

Roger S McIntyre1,2,3,4, Jinju Yoon3, Jeanette M Jerrell5, Samantha S Liauw31Department of Psychiatry, University of Toronto, Toronto, ON, Canada; 2Department of Pharmacology, University of Toronto, Toronto, ON, Canada; 3Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; 4Institute of Medical Science, University of Toronto, Toronto, ON, Canada; 5Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USAAbstract: We aimed to review and synthesize results reporting on the maintenance efficacy of Aripiprazole in adults with bipolar I disorder. Aripiprazole is FDA approved for the acute and maintenance treatment of bipolar I disorder. Aripiprazole's efficacy during the long-term treatment of bipolar disorder is supported by extension of acute phase studies and long-term (ie, 100-week) double-blind placebo controlled recurrence prevention registration trials. Aripiprazole is not established as efficacious in the acute or maintenance treatment of bipolar depression. Moreover, aripiprazole's efficacy during the acute or maintenance phase of bipolar II disorder has not been sufficiently studied. Aripiprazole has a relatively lower hazard for metabolic disruption and change in body composition when compared to other atypical agents (eg, olanzapine, quetiapine). Moreover, aripiprazole has minimal propensity for sedation, somnolence and prolactin elevation. Aripiprazole is associated with extrapyramidal side effects, notably akathisia, which in most cases is not severe or treatment limiting. Future research vistas are to explore aripiprazole's efficacy in bipolar subgroups; recurrence prevention of bipolar depression; and in combination with other mood stabilizing agents.Keywords: aripiprazole, bipolar disorder, maintenance, pharmacology