Abstract
Bipolar disorder is characterized by exacerbations of opposite mood polarity, ranging from manic to major depressive episodes. In the current nosological system of the Diagnostic and Statistical Manual – 5th edition (DSM-5), it is conceptualized as a spectrum disorder consisting of bipolar disorder type I, bipolar disorder type II, cyclothymic disorder, and bipolar disorder not otherwise specified. Treatment of all phases of this disorder is primarily with mood stabilizers, but many patients either show resistance to the conventional mood stabilizing medications or are intolerant to their side-effects. In this setting, second-generation antipsychotics have gained prominence as many bipolar subjects who are otherwise treatment refractory show response to these agents. Aripiprazole is a novel antipsychotic initially approved for the treatment of schizophrenia but soon found to be effective in bipolar disorder. This drug is well studied, as randomized controlled trials have been conducted in various phases of bipolar disorders. Aripiprazole exhibits the pharmacodynamic properties of partial agonism, functional selectivity, and serotonin-dopamine activity modulation – the new exemplars in the treatment of major psychiatric disorders. It is the first among a new series of psychotropic medications, which now also include brexpiprazole and cariprazine. The current review summarizes the data from controlled trials regarding the efficacy and safety of aripiprazole in adult bipolar patients. On the basis of this evidence, aripiprazole is found to be efficacious in the treatment and prophylaxis of manic and mixed episodes but has no effectiveness in acute and recurrent bipolar depression.
Highlights
BackgroundBipolar disorder (BD) is a common neuropsychiatric condition with a prevalence rate of approximately 4% in the general population, considering the entire bipolar spectrum [1]
Bipolar disorder is a highly disabling condition with a large number of patients remaining symptomatic either because they are refractory to the traditional mood-stabilizing medications or cannot tolerate these due to adverse effects
Aripiprazole is the first among the unique group of novel antipsychotics that is well studied in all phases of BackgroundBipolar disorder (BD) and controlled trials have been very helpful in delineating its place in the treatment of this chronic, life-long disorder
Summary
Bipolar disorder (BD) is a common neuropsychiatric condition with a prevalence rate of approximately 4% in the general population, considering the entire bipolar spectrum [1] It is characterized by severe disturbances in the mood of opposite polarity, which range from mania to depression. It is a chronic condition with the usual onset in adolescence or early adulthood and affects males and females [2] It is highly comorbid with other diseases, such as anxiety spectrum disorders, substance abuse disorders, eating disorders, stressor-related disorders, and certain personality disorders, borderline personality disorder [3]. Even after adequate treatment with currently available agents, affective episodes often fail to remit completely with persistence of symptoms and accompanying myriad complications in the biopsychosocial domain
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