Adjunctive aripiprazole in bipolar I depression.

BACKGROUND

Aripiprazole has demonstrated efficacy in treatment of bipolar mania, as well as in the maintenance treatment of bipolar disorder. There has been only one report supporting a role for this agent in the depressed phase of the illness.

OBJECTIVE

To evaluate the effectiveness of adjunctive aripiprazole in bipolar I depressed patients who are nonresponders to standard therapy.

METHODS

Chart records were reviewed for all patients with bipolar I depression, diagnosed by Diagnostic and Statistical Manual of Mental Disorders, 4th revision, criteria between June 2004 and January 2006 from the Long Beach Veterans Affairs Mood Disorders Clinic. Included subjects had experienced moderate to marked depressive symptoms (Clinical Global Impression-Bipolar Depression > or =4) despite at least 2 months of treatment with adequate doses of at least one mood stabilizer. In addition, all subjects had been treated subsequently with aripiprazole 15-30 mg/day added to the existing regimen. Detailed chart notes were used to retrospectively rate symptoms. The presence or absence of each symptom was recorded before and after aripiprazole augmentation. Based on these data, Clinical Global Impression bipolar severity (CGI-BP-S) ratings and CGI-BP improvement scores for bipolar I depression were assigned.

RESULTS

Ten subjects met study criteria. Adjunctive aripiprazole given for 21-110 days resulted in significant improvements in CGI-BP-S depression ratings. Seven of 10 patients were assigned CGI-BP improvement ratings of much or very much improved. Adverse events were mild and included akathisia, nausea, and insomnia. Dose adjustments of aripiprazole or the addition of drugs to treat adverse effects excluded subjects from further data collection. No patient stopped aripiprazole due to adverse effects.

CONCLUSIONS

This study adds to a previous report indicating beneficial effects of adjunctive aripiprazole in treatment of bipolar I depression. Double-blind, placebo-controlled investigations are needed to confirm these findings.