Can low-dose Abilify (Aripiprazole) cause hypomania?

From the Guidelines

Low-dose Abilify (aripiprazole) can potentially cause hypomania in some individuals, particularly those with bipolar disorder or an underlying predisposition to mood disorders. The mechanism of action of Abilify as a partial dopamine agonist contributes to its activating properties, which can trigger hypomanic symptoms even at low doses (2-5 mg) 1. Key points to consider include:

• Abilify's unique mechanism of action, which can both block and stimulate dopamine receptors depending on the existing dopamine levels in the brain
• The potential for hypomanic symptoms, including increased energy, reduced need for sleep, racing thoughts, increased talkativeness, and elevated mood
• The importance of monitoring for these symptoms, especially in patients with a history of mood disorders
• The need for healthcare providers to adjust the dose, add a mood stabilizer, or switch to a different medication if hypomanic symptoms emerge 1. It is essential to weigh the benefits of Abilify against the potential risks, particularly in populations vulnerable to mood disorders, and to closely monitor patients for signs of hypomania or other adverse effects.

From the FDA Drug Label

Advise the patient to read the FDA-approved patient labeling (Medication Guide) Discuss the following issues with patients prescribed aripiprazole tablets: Clinical Worsening of Depression and Suicide Risk Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down.

Hypomania is listed as a potential symptom that may emerge during treatment with aripiprazole, especially when the dose is adjusted up or down.

• The FDA label does not specify that this is exclusive to high doses, and low-dose aripiprazole may also carry this risk.
• Patients should be monitored for the emergence of hypomania and other unusual changes in behavior, especially early during treatment and when the dose is adjusted. 2

From the Research

Low-Dose Abilify (Aripiprazole) and Hypomania

• The provided studies do not directly address the question of whether low-dose Abilify (Aripiprazole) can cause hypomania 3, 4, 5, 6, 7.
• However, some studies suggest that aripiprazole can be effective in treating mania and preventing the recurrence of mood episodes in patients with bipolar disorder 3, 5, 6.
• One study found that aripiprazole augmentation to mood stabilizers, even at low doses (10-15 mg/day), helped to achieve significant remission in affective and obsessive-compulsive symptoms in patients with comorbid bipolar disorder and obsessive-compulsive disorder 4.
• Another study found that standard doses of aripiprazole were associated with a decreased risk of relapse in patients with bipolar disorder, but did not specifically address the risk of hypomania 7.
• It is worth noting that aripiprazole is a partial agonist of dopamine D(2) and D(3), and serotonin 5-HT(1A) receptors, and a modest antagonist of 5-HT(2A) receptors, which may contribute to its therapeutic effects and potential side effects 3.

Key Findings

• Aripiprazole is effective in treating mania and preventing the recurrence of mood episodes in patients with bipolar disorder 3, 5, 6.
• Low-dose aripiprazole (10-15 mg/day) can be effective in achieving significant remission in affective and obsessive-compulsive symptoms in patients with comorbid bipolar disorder and obsessive-compulsive disorder 4.
• Standard doses of aripiprazole are associated with a decreased risk of relapse in patients with bipolar disorder 7.

Limitations

• The provided studies do not directly address the question of whether low-dose Abilify (Aripiprazole) can cause hypomania.
• More research is needed to fully understand the potential risks and benefits of low-dose aripiprazole in patients with bipolar disorder.