Cariprazine Shows Efficacy for Bipolar Mania With Mixed Features

A multi exposure concept image of a woman appearing displaying emotions from happy to sad.
Cariprazine significantly reduced mixed features in patients with bipolar I disorder.

The use of cariprazine significantly improved manic and depressive symptoms in patients with bipolar mania with mixed features, according to results from a study published in the Journal of Affective Disorders.

Researchers conducted a post hoc analysis, using pooled data from three double-blind, placebo-controlled, randomized studies of 1037 patients with bipolar I disorder and current mixed or manic episode. The efficacy of cariprazine (3-12 mg/d) for the improvement of manic and depressive symptoms was compared with placebo and evaluated after a 3-week treatment and 2-week follow-up period. Changes in symptoms were measured using the Young Mania Rating Scale.

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After analysis, the researchers found that cariprazine significantly improved mean Young Mania Rating Scale scores vs placebo using the following criteria: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (≥3 depressive symptoms); ≥2 depressive symptoms; and a Montgomery-Åsberg Depression Rating Scale total score ≥10.

The least-squares mean differences were −3.79 (P =.0248), −2.91 (P =.0207), and −5.49 (P <.0001) for ≥3 depressive symptoms, ≥2 depressive symptoms, and ≥10 Montgomery-Åsberg Depression Rating Scale, respectively.

One key limitation of the study was the post hoc nature of the analysis.

“More cariprazine- than placebo-treated patients met [Young Mania Rating Scale] response and remission criteria,” the researchers wrote.

“Cariprazine may represent a novel treatment option for treating mixed features associated with bipolar I disorder,” they concluded. Future studies might evaluate the efficacy of cariprazine in patients with bipolar II depression and treatment-resistant bipolar disorder.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


McIntyre RS, Masand PS, Earley W, Patel M. Cariprazine for the treatment of bipolar mania with mixed features: A post hoc pooled analysis of 3 trials. J Affect Disord. 2019;257:600-606.