Bipolar disorder in childhood or adolescence presents a unique clinical challenge. The antipsychotic medications used for adult bipolar patients often are associated with unwanted side effects, including weight gain and other metabolic imbalances. The first generation of antipsychotic drugs may also induce what are called “movement disorders,” involuntary twitches and ticks that make life unpleasant. Until recently, psychiatrists were forced to weigh negative side effects from medication against the potential positive outcomes of pharmaceutical treatment. In the last several years, the development of “atypical antipsychotics” has balanced the scales somewhat. The newest of these drugs, Abilify (aripiprazole), shows relatively few side effects compared with the older line of antipsychotic medications. Even more encouraging, Abilify is at least as effective in treating schizophrenia and mood disorders as the earlier drugs. An observational study in Taiwan demonstrated the Abilify may even be useful in the long-term maintenance of bipolar disorder in children and adolescents.
The study in Taiwan consisted of a 24-week trial with 28 willing subjects. The average age of subjects was 18.5 years. At the beginning of the study, participants were scored on three standard tests of psychological wellbeing. Follow-up tests were taken at regular intervals throughout the 6-month program. While participants may have been taking other medications, Abilify was the only antipsychotic medication. Numerous research studies have demonstrated that pharmaceutical intervention is very important in treating bipolar disorder in childhood and young adulthood. Little evidence exists on the long-term effectiveness of Abilify when compared with older medications for treating bipolar disorder. Taiwanese researchers hoped to shed light on this question.
Of the 28 subjects who began the trial, 18 ended their participation early. For the most part, these early dropouts were experiencing depressive or mixed episodes. The adherence of those experiencing mania was much higher. Those who continued the trial for a full 24 weeks showed significant improvement on nearly every aspect of psychological health. The greatest improvements were among those with a tendency toward manic states. Those with mixed episodes—part mania, part depression—showed the least amount of improvement.
The results indicate that for bipolar adolescents with a tendency toward mania, Abilify is well tolerated and effective. None of the trial participants experienced weight gain. The most common side effect was rigidity, which affected about 10% of the participants. Other less frequent side effects included sedation, restlessness, and increased appetite. Compared with the first-generation antipsychotic medications, Abilify could present an equally effective method of treatment with fewer adverse effects. This is especially true when mania is the dominant expression of the disease. For patients who cycle through regular bouts of depression, sticking with a treatment plan is sometimes difficult. Bipolar patients are notoriously unfaithful to their doctors’ prescriptions. The largely positive results of this study argue for more intensive talk therapy and interventions to ensure medication adherence.
Tang, C., Yeh, C., Huang, Y., Wang, L., Chou, W., Chou, M., et al. (2010). Long-term effectiveness of aripiprazole in adolescents and young adults with bipolar disorder: A naturalistic study. International Journal of Psychiatry in Clinical Practice, 14, 252-256.
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