Clinical Medicine Insights: Therapeutics

Background: Bipolar disorder (manic depression) is a serious, long-term mental illness that affects about 1% of adults at some time during their life. It usually develops in late adolescence or early adulthood and affects men and women from all backgrounds. People with bipolar disorder experience wild mood swings that interfere with daily life and damage relationships. They can also have psychotic symptoms: they may see or hear things that are not there. During depressive episodes, affected individuals may feel helpless, worthless, and suicidal.

Treatments for bipolar disorder include drugs to stabilize mood swings (for example, lithium and anticonvulsant medications), antidepressants to treat depressive episodes and antipsychotic drugs to treat manic episodes. The development of second-generation atypical antipsychotics (SGAs) has increased the hopes of psychiatrists. SGAs, however, cannot be considered a unique pharmacological class since each SGA has many complex pharmacologic actions, only some of which are shared with other SGAs. Even though, many antipsychotics have similar efficacy on average, prescribers may be able to achieve better than average results by considering differences in selecting a specific drug for a specific patient. Clinicians know that each patient is unique and in order to achieve best outcomes for the individual patient, the better therapy is the therapy tailored for the single patient.

Objectives: With this article we provide information on a relatively new antipsychotic aripiprazole released in 2002 by Bristol-Myers Squibb for the treatment of schizophrenia; for acute manic and mixed episodes associated with bipolar disorder in 2004; as an adjunct for major depressive disorder on November 2007; and to treat irritability in children with autism on 2009. Compared with other first line atypical antipsychotics aripiprazole has a unique profile due to partial agonism at dopamine D2 and D3 and serotonin 5-HT1A receptors, and antagonism at 5-HT2A receptors. This paper describes the development of aripiprazole, its unique properties and its metabolically-friendly profile including its receptor binding affinities, pharmacokinetics, central nervous system activity results of clinical efficacy and relevant clinical trials, in particular safety, efficacy and patient acceptability are also examined. The available literature on aripiprazole of the last six years is reviewed.