title: Asenapine in the treatment of older adults with bipolar disorder.
abstract: OBJECTIVE
  In spite of growing numbers of older people, there are few treatment studies on late-life bipolar disorder (BD). This was a 12-week prospective, open-label trial to assess efficacy and tolerability of adjunct asenapine in non-demented older adults (≥ 60 years) with sub-optimal previous response to BD treatments.
  
  
  METHODS
  Asenapine was initiated at 5 mg/day and titrated as tolerated. Effects on global psychopathology were measured with Clinical Global Impression, bipolar version (CGI-BP), and the Brief Psychiatric Rating Scale (BPRS). Mood polarity severity was measured with the Hamilton Depression Rating Scale, Montgomery Asberg Depression Rating Scale, and Young Mania Rating Scale. Other outcomes included the World Health Organization Disability Assessment Schedule II.
  
  
  RESULTS
  Fifteen individuals were enrolled (mean age 68.6, SD 6.12; 53% female; 73% Caucasian, 13% African American, and 7% Asian). There were 4/15 (27%) individuals who prematurely terminated the study, whereas 11/15 (73%) completed the study. There were significant improvements from baseline on the BPRS (p < 0.05), on CGI-BP overall (p < 0.01), and on CGI-BP mania (p < 0.05) and depression (p < 0.01) subscales. The mean dose of asenapine was 11.2 (SD 6.2) mg/day. The most common reported side effects were gastrointestinal discomfort (n = 5, 33%), restlessness (n = 2, 13%), tremors (n = 2, 13%), cognitive difficulties (n = 2, 13%), and sluggishness (n = 2, 13%).
  
  
  CONCLUSIONS
  Older people with BD had global improvements on asenapine. Most reported adverse effects were mild and transient, but adverse effects prompted drug discontinuation in just over one quarter of patients. Although risks versus benefits in older people must always be carefully considered, asenapine may be a treatment consideration for some non-demented geriatric BD patients.
authors.affiliation: Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.|Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.|Department of Neurology, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dines
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Edna
authors.initials: E
authors.lastname: Fuentes-Casiano
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Athey
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Cassidy
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Johnny
authors.initials: J
authors.lastname: Sams
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Clegg
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Locala
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Stagno
authors.affiliation: Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.|Department of Neurology, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy*; D003986:Dibenzocycloheptenes; D005260:Female; D006576:Heterocyclic Compounds, 4 or More Rings / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales
chemical_list: D014150:Antipsychotic Agents; D003986:Dibenzocycloheptenes; D006576:Heterocyclic Compounds, 4 or More Rings; C522667:asenapine
keywords: antipsychotic medications; bipolar disorder; geriatric; manic depressive disorder; mood stabilizers; older adults