From the Guidelines
Vraylar (cariprazine) may be effective for treating an acute hypomanic episode induced by Lexapro (escitalopram), as it is FDA-approved for bipolar I disorder, which includes treatment of manic and mixed episodes. For acute hypomania, a typical starting dose is 1.5 mg once daily, potentially increasing to 3-6 mg daily based on response and tolerability 1. However, this medication choice should be made by a healthcare provider who can properly evaluate your specific situation. Antidepressant-induced hypomania typically requires immediate discontinuation or dose reduction of the triggering medication (Lexapro) under medical supervision. Vraylar works as an atypical antipsychotic with partial agonist activity at dopamine D2/D3 and serotonin 5-HT1A receptors, which helps regulate the neurotransmitter systems involved in mood regulation. The medication may take 1-2 weeks to reach full effectiveness, and common side effects include restlessness, movement disorders, and weight gain. Regular monitoring by your healthcare provider is essential during treatment. Some key points to consider when treating acute hypomanic episodes include:
- The importance of discontinuing or reducing the dose of the triggering medication (Lexapro) under medical supervision 1
- The potential benefits and risks of using atypical antipsychotics like Vraylar for treating acute hypomania 1
- The need for regular monitoring and follow-up with a healthcare provider to adjust treatment as needed 1
- The potential for Vraylar to take 1-2 weeks to reach full effectiveness, and the importance of patience and close monitoring during this time 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment of Acute Hypomanic Episode Induced by Lexapro
- Vraylar (cariprazine) is an atypical antipsychotic that has been approved for the treatment of schizophrenia and acute manic or mixed episodes associated with bipolar I disorder 2.
- It has also been shown to be effective in reducing manic and depressive symptoms in patients with bipolar I disorder mood episodes 3.
- However, there is no direct evidence to suggest that Vraylar is specifically effective in treating acute hypomanic episodes induced by Lexapro (escitalopram).
- Lexapro is an antidepressant that can sometimes induce hypomanic episodes in patients with bipolar disorder 4.
- Cariprazine has been shown to have a low risk of treatment-emergent affective switch (TEAS) in patients with bipolar I disorder, which suggests that it may be a suitable treatment option for patients who are at risk of switching to a hypomanic episode 3.
Mechanism of Action
- Cariprazine is a dopamine D3 and D2 receptor partial agonist, which preferentially binds to the D3 receptor 2.
- It also has partial agonist activity at serotonin 5-HT1A receptors, which may contribute to its therapeutic effects in bipolar disorder 2.
- The exact mechanism of action of cariprazine in treating acute hypomanic episodes is not fully understood, but it is thought to involve its ability to modulate dopamine and serotonin signaling in the brain 5.
Clinical Evidence
- There is limited clinical evidence to support the use of Vraylar in treating acute hypomanic episodes induced by Lexapro.
- However, cariprazine has been shown to be effective in reducing manic and depressive symptoms in patients with bipolar I disorder, and it may be a suitable treatment option for patients who are at risk of switching to a hypomanic episode 4, 3.