Treating bipolar disorder in the primary care setting: the role of aripiprazole

Abstract

Objective: The objective of this article is to present practical strategies for detecting and diagnosing bipolar disorder in the primary care setting and to review the evidence for the efficacy and safety of aripiprazole treatment for bipolar disorder.

Data sources: A review of the literature from 1980 to 2007 was conducted from November 2006 through February 2007 using a MEDLINE search and the key words bipolar disorder, primary care, detection, diagnosis, and aripiprazole.

Study selection: A total of 100 articles that focused on the accurate detection and diagnosis of bipolar disorder and the evidence of the efficacy and safety of aripiprazole in the treatment of bipolar disorder were selected.

Data synthesis: Patients with bipolar disorder often present to primary care physicians with depressive or mixed symptoms as opposed to purely hypomanic or manic symptoms. Accurate diagnosis of bipolar disorder is essential in order to provide timely and appropriate treatment. One treatment option available is aripiprazole, a partial agonist of dopamine (D)₂ and D₃ and serotonin (5-HT)(₁A) receptors and an antagonist of the 5-HT(₂A) receptor. Clinical trial data have shown aripiprazole to be effective in treating manic and mixed episodes associated with bipolar I disorder, both in the acute phase and over an extended period of treatment lasting from 6 months to 2 years.

Conclusions: Accurate diagnosis and treatment of bipolar disorder are challenges increasingly faced by primary care physicians. Strategies geared toward detection, diagnosis, and management of bipolar I disorder and other bipolar spectrum disorders may improve the treatment outcome for patients. Aripiprazole may be considered as another first-line choice for the treatment of bipolar I disorder; however, its utility in patients with bipolar spectrum disorders is yet to be determined.

Figure 1

Mean Change From Baseline in Young Mania Rating Scale (YMRS) Total Score (last-observation-carried-forward analysis) During a 3-Week Randomized, Double-Blind, Placebo-Controlled Study^{a,b a}Reprinted with permission from Sachs et al. ^bMean baseline values: aripiprazole: 28.8 and placebo: 28.5. *P ≤ .01 vs placebo. †P ≤ .001 vs placebo.

Figure 2

Mean Change From Baseline in Young Mania Rating Scale (YMRS) Total Score (last-observation-carried-forward analysis) During a 12-Week Randomized, Double-Blind, Placebo- and Lithium-Controlled Study^{a,b,c a}Reprinted with permission from Keck et al. ^bBaseline mean (SE) YMRS scores: placebo: 28.9 (0.4), lithium: 39.2 (0.4), and aripiprazole: 28.5 (0.4). ^cAfter the initial 3-week period, patients in the placebo group were switched in a blind manner to double-blind aripiprazole for the remaining 9 weeks of the study (data not shown). *P < .05 vs placebo. **P < .01 vs placebo. ***P < .001 vs placebo.

Figure 3

Aripiprazole vs Placebo: Kaplan-Meier Survival Curves Demonstrating Time From Randomization to Relapse for Any Reason^{a,b a}Reprinted with permission from Keck et al. ^bLog rank P = .011; hazard ratio = 0.53 (95% CI, 0.32–0.87).