Can Abilify (aripiprazole) be prescribed for bipolar disorder?

Aripiprazole for Bipolar Disorder

Yes, aripiprazole (Abilify) is FDA-approved and clinically effective for bipolar disorder, specifically for acute manic and mixed episodes and for maintenance treatment to prevent manic relapses, but it is not effective for bipolar depression or prevention of depressive episodes. 1, 2

Indications and Efficacy

Acute Mania

• Aripiprazole is effective as both monotherapy and adjunctive therapy (with lithium or valproate) for treating manic and mixed episodes in bipolar I disorder 1, 3
• The FDA has approved aripiprazole for:
  • Treatment of acute manic and mixed episodes
  • Maintenance treatment of bipolar I disorder 1

Maintenance Treatment

• Aripiprazole is superior to placebo in:
  • Delaying time to relapse for manic episodes
  • Preventing recurrence of manic episodes 1, 2
• Important limitation: Aripiprazole does not significantly prevent depressive episodes or reduce time to depressive relapse 2

Bipolar Depression

• Not recommended as first-line therapy for bipolar depression 4
• Clinical trials showed aripiprazole was not significantly different from placebo at the primary endpoint for bipolar depression 2
• First-line options for bipolar depression include lamotrigine, lithium, and olanzapine-fluoxetine combination (OFC) 4

Dosing and Administration

• For acute manic episodes: Start with 10-15 mg/day with option to increase to 30 mg/day if needed 1
• For maintenance therapy: 15-30 mg/day 1
• Lower doses (10 mg/day) may be better tolerated, especially in adolescents 5

Advantages of Aripiprazole

• Unique mechanism as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors 3
• Lower risk of metabolic side effects compared to other atypical antipsychotics 3, 6
• Low risk of prolactin elevation and QT interval prolongation 3
• Favorable option for long-term maintenance due to tolerability profile 6

Side Effects and Monitoring

• Extrapyramidal symptoms (EPS) occur in up to 28% of patients, higher than placebo but lower than with haloperidol 3
• Weight gain is generally not clinically significant in short-term use, but may become significant with long-term treatment 3
• Regular monitoring recommended:
  • Weight, BMI, waist circumference
  • Blood pressure, fasting glucose, and lipid panel
  • EPS symptoms 4

Combination Therapy

• Aripiprazole combined with mood stabilizers (lithium or valproate) is effective for:
  • Acute mania treatment
  • Maintenance treatment to prevent manic relapses 7
• The aripiprazole-valproate combination may be particularly beneficial for patients with comorbidities such as anxiety, drug abuse, or obsessive-compulsive disorder 7

Clinical Considerations and Caveats

• Aripiprazole lacks sedative properties, which may be advantageous for some patients but could be a limitation when immediate sedation is needed 6
• Not effective for bipolar depression or prevention of depressive episodes, so additional treatment strategies may be needed to address the depressive phase of bipolar disorder 2
• Antidepressants should only be considered as adjunctive therapy after establishing adequate mood stabilization, with careful monitoring for treatment-emergent mania 4

Aripiprazole represents a valuable treatment option for bipolar disorder, particularly for acute manic episodes and maintenance treatment to prevent manic relapses, with a favorable metabolic profile compared to other atypical antipsychotics.