Aripiprazole Therapy in 20 Older Adults With Bipolar Disorder

Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 01/2008; 69(1):41-6. DOI: 10.4088/JCP.v69n0106
Source: PubMed


Bipolar disorder in older adult populations has gained increasing attention due to the growing proportion of elderly in the United States and worldwide. A continuing unmet need is the identification of agents that are generally well-tolerated and effective in later life bipolar disorder. Aripiprazole is an atypical antipsychotic compound that is approved by the U.S. Food and Drug Administration for the treatment of bipolar mania and for the long-term treatment of bipolar disorder. This study is an open-label, prospective trial of aripiprazole therapy in 20 older adult patients with bipolar disorder.
Older adults with bipolar I disorder (confirmed by the Mini-International Neuropsychiatric Interview) who were currently suboptimally responsive to their prescribed medication treatments received 12 weeks of open-label aripiprazole added on to existing mood stabilizer medication treatment. Aripiprazole was initiated at 5 mg daily and increased as tolerated. Efficacy outcomes included psychopathology measures (the Young Mania Rating Scale [YMRS] and the Hamilton Rating Scale for Depression [HAM-D]), extrapyramidal symptoms, and a level of functioning measure (the Global Assessment Scale [GAS]). The study was conducted from April 2004 to June 2005.
Twenty older adults (mean age = 59.6 years, range 50-83 years) received aripiprazole therapy. Compared to baseline, individuals had significant reductions in mean depression scores (HAM-D baseline = 13.8, HAM-D end point = 6.1, p < .001), as well as mania scores (YMRS baseline = 8.6, YMRS end point = 3.9, p < .03). There were also significant improvements in functional status as measured by the GAS (p < .001). The mean +/- SD daily dose of aripiprazole was 10.26 +/- 4.9 mg/day. Overall, aripiprazole was adequately tolerated in this older adult population.
Aripiprazole therapy may reduce symptoms in bipolar older adults, and it appears to be reasonably tolerated. However, larger, controlled trials are needed to confirm these preliminary findings.

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    • "In both of these trials, however, there was an increased rate of cerebrovascular events including fatalities in the aripiprazole-treated patients. Twenty older adults with bipolar disorder received open-label aripiprazole for 12 weeks.41 While no patients discontinued due to adverse effects, the most common events were restlessness (n = 3, 15.8%); weight gain over 7% of baseline level (n = 3, 15.8%); and sedation (n = 2, 10.5%). "
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    ABSTRACT: Antipsychotics are frequently used in elderly patients to treat a variety of conditions, including schizophrenia. While extensively studied for their impact in younger populations, there is comparatively limited evidence about the effectiveness of these agents in older patients. Further complicating this situation are the high co-morbidity rates (both psychiatric and medical) in the elderly; age-related changes in pharmacokinetics leading to a heightened proclivity for adverse effects; and the potential for multiple, clinically relevant drug interactions. With this background in mind, we review diagnostic and treatment-related issues specific to elderly patients suffering from schizophrenia and other psychotic conditions, focusing on the potential role of aripiprazole.
    Clinical Interventions in Aging 09/2010; 5:253-8. · 2.08 Impact Factor
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    • "The results suggest aripiprazole has no meaningful effect on lamotrigine steady-state pharmacokinetics in patients with bipolar I disorder [84]. An open-label 12-week trial of adjunctive aripiprazole (initiated at 5 mg daily and increased as tolerated) to existing mood stabiliser medication treatment in 20 older adults (aged 50 to 83 years) reported significant improvement in both manic and depressive symptoms with good tolerability [85]. "
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    ABSTRACT: The current article is a systematic review concerning the efficacy and safety of aripiprazole in the treatment of bipolar disorder. A systematic Medline and repositories search concerning the usefulness of aripiprazole in bipolar disorder was performed, with the combination of the words 'aripiprazole' and 'bipolar'. The search returned 184 articles and was last updated on 15 April 2009. An additional search included repositories of clinical trials and previous systematic reviews specifically in order to trace unpublished trials. There were seven placebo-controlled randomised controlled trials (RCTs), six with comparator studies and one with add-on studies. They assessed the usefulness of aripiprazole in acute mania, acute bipolar depression and during the maintenance phase in comparison to placebo, lithium or haloperidol. Aripiprazole appears effective for the treatment and prophylaxis against mania. The data on bipolar depression are so far negative, however there is a need for further study at lower dosages. The most frequent adverse effects are extrapyramidal signs and symptoms, especially akathisia, without any significant weight gain, hyperprolactinaemia or laboratory test changes.
    Annals of General Psychiatry 08/2009; 8(1):16. DOI:10.1186/1744-859X-8-16 · 1.40 Impact Factor
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    • "Aripiprazole is a novel atypical antipsychotic that has shown rapid and sustained efficacy and tolerability in short-term and long-term controlled clinical trials and retrospective studies in patients with schizophrenia, schizoaffective disorder and bipolar disorder (Liebermann 2004; Madhusoodanan et al 2004; Sajatovic et al 2008). Recently FDA approved the use of aripiprazole as an adjunctive to antidepressants for the treatment of major depressive disorder in adults (Prescribing information 2007). "
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    ABSTRACT: Psychosis of Alzheimer's disease (AD) is characterized by delusions or hallucinations and may be associated with agitation, negative symptoms or depression. There are no psychotropic medications that are approved by the US FDA for the treatment of psychosis of AD. However, atypical antipsychotics have been widely used and recommended by geriatric experts in the management of psychosis of AD in view of the modest efficacy and relative safety until FDA warnings were issued in 2005 and meta-analytic studies showed no significant difference to placebo. The FDA warnings on the cardiac, metabolic, cerebrovascular, and mortality risks have caused serious concerns for the use of atypical antipsychotic agents in elderly patients with dementia. Only a few studies have evaluated prospectively the effects of aripiprazole in psychosis associated with AD. These studies show improvement in the symptoms of psychosis associated with AD with aripiprazole. The safety and tolerability profile of aripiprazole suggests a low potential for negative impact on dementia and overall patient health. Further studies comparing the efficacy and tolerability of aripiprazole vs other atypical antipsychotics in dementia are needed.
    Clinical Interventions in Aging 02/2008; 3(3):491-501. · 2.08 Impact Factor
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