More than half of people with bipolar disorder take second-generation/atypical antipsychotics on a regular basis to control mood. While effective, there is always a risk of adverse side effects. The list for antipsychotics is long, including dizziness, gastrointestinal distress, weight gain, sleepiness and seizures. The benefits generally outweigh the risks, but side effects are often listed as the main reason patients stop taking medication. However, one atypical antipsychotic seems to have advantages over others- aripiprazole (brand name- Abilify).
Atypical antipsychotics are effective at treating mania in bipolar disorder. They can also reduce anxiety. Most of the medications work by balancing dopamine. Too much dopamine can lead to manic symptoms and psychosis. Too little can lead to depression. Atypical antipsychotics also affect serotonin levels and act as an antihistamine. Blocking histamine increases the sedation effect of antipsychotics.
The problem with atypical antipsychotics is most of them come with side effects that prove intolerable for some patients, who may then discontinue medication without the guidance of a physician. Lack of efficacy is also cited as a reason patients quit taking medications. Some drugs, like olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) are infamous for causing these problems.
If so many bipolar disorder medications are causing problems, is there an alternative?
Researchers led by Dr. Young Sup Woo at the Catholic University of Korea studied 77 patients over a period of 24 weeks. The subjects were switched from their current atypical antipsychotic to aripiprazole (Abilify) to test whether the new drug would be more effective and/or have fewer side effects.
The researchers found that aripiprazole does have some benefits over other atypical antipsychotics.
An average of 20-60% of patients do not comply with their treatment plans. Reasons for this include believing they do not need medication, having too many side effects and the medication being ineffective. The researchers in this study found that only 11% of participants were treatment non-compliant when switched to aripiprazole (Abilify). Attitudes toward medication also improved.
-Higher remission rates
Remission is difficult to achieve in bipolar disorder. Medication only increases the chances for remission by 20-40%, so finding the most effective medication is imperative. When patients in Dr. Young Sup Woo’s study were switched to aripiprazole (Abilify), researchers noted a significant decrease in depressive symptoms. At the beginning of the study, only 7% of participants were considered in remission. At the end of the study, that number increased to 57%. Symptoms that improved most were problems concentrating, fatigue and depressive or suicidal thoughts.
-Lower rate of adverse metabolic effects
More than half of people gain weight or develop high cholesterol or metabolic syndrome when taking atypical antipsychotics. Patients average a weight gain of 20-35 pounds in the first year. Olanzapine (Zyprexa) causes the most weight gain, but quetiapine (Seroquel) and risperidone (Risperdal) also cause significant metabolic changes.
With aripiprazole (Abilify), Dr. Young Sup Woo found that cholesterol actually decreased when patients were switched from their previous atypical antipsychotic. The number of patients with high cholesterol went from 40% to 16% over the 24 week period. Abdominal obesity also decreased from a rate of 71% of patients to 52%.
There are limits to the benefits demonstrated in this study. First, the number of participants was relatively low for a study on bipolar disorder. Second, in regards to cholesterol and abdominal obesity, patients’ exercise and diet routines were not monitored.
Most importantly, not everyone responds to every drug the same way. That’s why there are so many available on the market. While aripiprazole (Abilify) may be a better choice for some, it can still produce adverse effects or prove ineffective for others. It’s important for patients to work closely with a psychiatrist to determine which medications and dosages are right for their situation.
Image credit: LaRae R. LaBouff