Aripiprazole Augmentation May Be Effective in Comorbid OCD, Bipolar Disorder

Aripiprazole augmentation to mood stabilizers such as lithium carbonate was effective in the clinical management of comorbid bipolar disorder (BD) and obsessive-compulsive disorder (OCD), according to literature meta-analysis results published in the Journal of Affective Disorders.

Investigators conducted a systematic search of MEDLINE, Embase, PsychINFO, and the Cochrane Library for research on the treatment of comorbid BD and OCD (BD-OCD) published between July 2013 and September 2018. Eligible studies specified diagnostic criteria for both BD — types I, II, and not otherwise specified — and OCD. Both population-based and hospital-based studies were eligible for inclusion in the study. Studies of patients younger than age 6 were excluded. Two researchers independently assessed studies for eligibility and quality; disputes were resolved by consensus.

Of 282 articles retrieved during the search, 15 hospital-based studies were included in subsequent analyses. The studies included seven case reports, four prospective non-randomized cohort studies, three randomized controlled trials, and one cross-sectional study. In all studies, patients received treatment with mood stabilizers, either alone or in tandem with second-generation antipsychotics. Higher rates of non-response to pharmacologic treatments were reported in patients with comorbid BD-OCD compared with patients with one disorder alone.

The efficacy of aripiprazole augmentation in treating patients with BD-OCD was examined in six studies (40% of sample). Based on review, five indicated that aripiprazole augmentation to lithium carbonate or valproate was an effective maintenance therapy for BD-OCD, even at low doses. In addition, one of these six studies indicated that aripiprazole was also effective in treating OCD symptoms during manic episodes.

In all selected studies, patients with BD-OCD required mood stabilizers, confirming mood stabilization as an appropriate therapy target. Due to the risk of manic/hypomanic switches, the addition of serotonin reuptake inhibitors agents may be contraindicated in patients with BD-OCD. Instead, antipsychotic augmentation to mood stabilizers may be the most effective strategy for BD-OCD management. Even so, one study conducted in Italy reported that patients with BD-OCD were more likely to receive serotonin reuptake inhibitors than patients with BD or OCD alone.

The main limitation of the review was the sample size.

Further research into augmentation with aripiprazole is necessary to expand on these findings and develop clinical recommendations for BD-OCD treatment.  

Reference

Amerio A, Maina G, Ghaemi SN. Updates in treating comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review [published online June 6, 2019]. J Affect Disord. doi:10.1016/j.jad.2019.06.015