title: Combination of aripiprazole with mood stabilizers for the treatment of bipolar disorder: from acute mania to long-term maintenance.
abstract: BACKGROUND
  Bipolar disorder is characterized by a complex set of symptoms, including recurrent manic, depressive or mixed episodes. Acute and long-term treatment of patients with bipolar disorder is mandatory to prevent symptom relapse and episode recurrences. Outcomes with monotherapy are often unsatisfactory in clinical practice, hence combinations of mood stabilizers and antipsychotics are widely utilized in patients showing no or partial response to, as well as intolerance to, monotherapies. This may offer a therapeutic advantage, however, the possibility of an increased incidence of side effects should be considered.
  
  
  METHODS
  This paper reviews the current treatment guidelines for the treatment of bipolar disorder and examines the rationale behind the use of aripiprazole in combination with mood stabilizers for acute and long-term treatment of bipolar disorder.
  
  
  CONCLUSIONS
  The combination of aripiprazole and mood stabilizers seems to offer an effective and relatively well-tolerated option for the treatment of acute mania and for the maintenance treatment of patients with bipolar I disorder. The combination presents a lower risk of metabolic side effects compared with other combination therapies, but increases the risk of extrapyramidal side effects with long-term treatment. The aripiprazole-valproate combination seems to be particularly promising in the treatment of patients with comorbidities such as anxiety and drug abuse, obsessive-compulsive disorder and bipolar disorder, as well as in mixed depressive disorder. Controlled trials are necessary in order to confirm these observations and to provide a useful insight for improving the use of drug combinations in bipolar patients.
authors.affiliation: University of Napoli Federico II, Laboratory of Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Napoli, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: de Bartolomeis
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
mesh_terms: D000339:Affect / Q000187:drug effects; D018692:Antimanic Agents / Q000008:administration & dosage*; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D000068180:Aripiprazole; D001714:Bipolar Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D018020:Lithium Compounds / Q000008:administration & dosage; D010879:Piperazines / Q000008:administration & dosage*; D015363:Quinolones / Q000008:administration & dosage*; D014635:Valproic Acid / Q000008:administration & dosage
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds; D010879:Piperazines; D015363:Quinolones; D014635:Valproic Acid; D000068180:Aripiprazole