Abilify III: Bipolar Disorder (Depression)
Heading off label reveals some...less good uses
The Frontier Psychiatrists is a daily, health-themed newsletter. It's written by Owen Scott Muir, M.D., DFAACAP. Yes, those are more letters after my name. I became a distinguished fellow of the American Academy of Child and Adolescent Psychiatry recently! This article is part of a series on the histories and data behind medications commonly used to treat psychiatric conditions. The conceit is, that given the focus of my work has shifted, almost entirely, to brain stimulation instead of psychopharmacology, I would write a “farewell to meds” series. Abilify (aripiprazole) turned out to be WAY too big a topic for one article. Prior articles addressing Abilify include:
The Guide to the CATIE Trial, Part 1 and Part 2
Abilify in Bipolar Disorder, I
Thus far, we have reviewed the FDA on-label indications and the evidence supporting their use in bipolar disorder for acute mania. Today, we dive into bipolar depression and the abject failure of Abilify to treat this problem. Which, I will end up arguing, means it’s really hard to argue for Abilify as a first-line treatment for bipolar disorder, considering for most patients, depression is where they spend most of their time.1 In fact, there is three times as much time spent depressed vs manic( or hypomanic) in bipolar disorder.2 Thus, for most patients with this illness, having treatment for bipolar mania that doesn’t address the depressed phase of the illness is a partial treatment plan at best.3
Bipolar Depression4
After the success of aripiprazole in bipolar mania indication, it made sense to investigate the efficacy of aripiprazole in bipolar depression. The TL:DR? It did not work:
Although aripiprazole has proven efficacy for acute mania and the prevention of mania, the evidence available thus far does not support the efficacy of aripiprazole for the treatment of acute bipolar depression and prevention of depressive relapse. 5
Bipolar depression is not easy to treat, compared to mania. This is evidenced by the large array of treatments with Mania approval, but few with antidepressant indication in the disorder.6 Since most patients with the illness spend most of their time suffering from depression, not mania, it makes sense to focus on the treatment of that more serious problem for most. This is not what Abilify does, even when compared to other agents7: