Aripiprazole Augmentation Effective in Treatment of Comorbid Bipolar Disorder, OCD

Aripiprazole augmentation with mood stabilizers appears to be effective in the treatment of comorbid bipolar disorder and obsessive-compulsive disorder (BD-OCD), according to study data published in the Journal of Affective Disorders.

Investigators conducted a systematic review of the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library for literature on aripiprazole augmentation as treatment for BD-OCD. Studies published in English from database inception through August 31, 2018 were eligible for inclusion in the study. Studies were selected for review if diagnostic criteria for both bipolar disorder and obsessive-compulsive disorder were specified. As the primary outcome measure, researchers abstracted data on aripiprazole efficacy in BD-OCD symptom reduction. Data on aripiprazole dosing strategy and tolerability were extracted as secondary outcome measures.

Investigators identified 27 eligible studies in the literature search; 6 were selected for review. Of these studies, 5 were case studies and 1 was a randomized controlled trial. The majority of the studies were conducted in Europe and all study samples were hospital-based. In all cases, diagnoses were based on Diagnostic and Statistical Manual criteria and symptoms were assessed with validated scales.

Results from the placebo-controlled randomized controlled trial reported that more than 90% of patients treated with aripiprazole showed a >34% decrease in mean Yale-Brown Obsessive-Compulsive Scale score compared with 4% of patients with placebo. The case studies reported remission and stabilization of affective and obsessive-compulsive symptoms with aripiprazole augmentation with lithium and valproate for up to 24 months. Aripiprazole was typically added to patients’ current mood stabilizers at a starting dose of 5 mg/day, then titrated up weekly to 25 mg/day. The mean maintenance dose achieved across studies was 15.79 mg/day. No serious adverse events were reported with aripiprazole in combination with lithium or valproate. The most commonly reported adverse events were agitation, tremor, nausea, and headache, and were not severe enough to cause discontinuation in any study.

Further research with a larger patient cohort is necessary to confirm these findings.

Disclaimers: Dr. Amerio and Dr. Odone reported no conflicts of interest. Dr. Ghaemiis employed by Novartis Institutes for Biomedical Research, and holds equity in Novartis.

Reference

Amerio A, Odone A, Ghaemi SN. Aripiprazole augmentation in treating comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review. J Affect Disord. 2019;249:15-19.