Abstract
Bipolar disorder (BP) is a chronic disorder with high rates of comorbidity and functional impairment. Aripiprazole, a partial dopamine and seronin agonist, is approved for treatment of acute manic episodes and in maintenance treatment for relapse prevention of manic episodes.
The paper is an updated expert consensus on the use of aripiprazole in therapy of BP, reviewing new data and clinical experience. Treatment guidelines rank aripiprazole montherapy among first-line drugs in the treatment of acute manic episodes.
Combination of aripiprazole with lithium or valproate is effective in only partial responders to monotherapy with mood stabilizers. Aripiprazole is also effective in acute psychotic and mixed episodes and rapid cyclers.
In prophylactic treatment, aripiprazole reduced number of manic epizodes, rehospitalizations and suicide rates. Aripiprazole is neither sufficiently effective nor tolerated in treatment and prevention of bipolar depression.
In addition to the rebound syndromes following previous antipsychotic withdrawal, switch to aripiprazole may be associted in some patients with transitory activation syndrome. Slow titration up, slow tapering off, or adjuvant administration of benzodiazepines and/or promethazine are recommended.
Aripiprazole in monotherapy or in combination with lithium/valproate does not induce metabolic side effects and does not increase prolactin levels. Aripiprazole treatment is associated with a relatively low risk of weight gain.
Extrapyramidal symptoms (including akathisia) can be observed mostly in the beginning of treatment and tend to decline in the long-term therapy.