Adjunctive Aripiprazole in Treatment-Resistant Bipolar Depression
Terence A. Ketter MDPo W. Wang MD
Rebecca A. Chandler BS
Jenifer L. Culver PhD
Andrea M. Alarcon BA
pages: 169 - 172
- DOI: 10.1080/10401230600801176
- Version of record first published: 01Jun2006
Full Text
Abstract:
Background. There are limited management options for treatment-resistant depression in bipolar disorder (BD) patients.
Method. Open adjunctive aripiprazole was administered to outpatients with treatment-resistant depression assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation, and followed with the STEP-BD Clinical Monitoring Form.
Results. Thirty BD (11 type I, 15 type II, 4 NOS) patients (mean age 44.4 ± 17.0 years, 70% female) on a mean of 3.2 ± 1.6 other psychotropic and 2.3 ± 1.6 nonpsychotropic prescription medications received aripiprazole for a mean duration of 84 ± 69 days, with a mean final dose of 15.3 ± 11.2 (range 2.5–40) mg/day. Fourteen patients (47%) discontinued aripiprazole; due to inefficacy in 5/30 (17%), patient choice in 3/30 (10%), and adverse effects in 6/30 (20%). Aripiprazole yielded improvement in Clinical Global Impression–Severity (CGI–S, 4.4 ± 1.1 to 3.8 ± 1.2, p < 0.01), with 8/30 (27%) patients responding (CGI–S improvement > = 2), including 4/30 (13%) who remitted (final CGI–S < = 2). Global Assessment of Function, and depressed mood and suicidal ideation ratings also improved. Aripiprazole was generally well tolerated, with no significant change in mean adverse effect ratings or mean weight.
Conclusion. Aripiprazole appeared effective and generally well tolerated in treatment-resistant bipolar depression. Controlled trials are warranted to systematically explore these preliminary naturalistic observations.