Aripiprazole augmentation treatment in treatment resistant bipolar depression: two patient reports

It is known that in patients with bipolar disorder, depressive episodes last longer than mixed or manic/hypomanic episodes and there are reports detailing the difficulties confronted in its treatment. The concept of treatment resistant depression in bipolar disorder has not been as well described as that in treatment resistant unipolar depression. Here we present two patients with treatment resistant bipolar depression. The first patient in our study is a 51 year old woman whose diagnoses were bipolar disorder, depressive episode and multiple sclerosis (in remission with interferon treatment) at the time of augmentation with aripiprazole. The second patient is a 43 year old woman with bipolar disorder, depressive disorder without any comorbid illness at the time of augmentation with aripiprazole. Aripiprazole was administered variably between 20-30mg/daily based on tolerability and efficacy. In both cases, depression was assessed using the Hamilton Depression Rating scale (HDRS). Both patients responded to aripiprazole augmentation treatment. The effect of aripiprazole on bipolar depression needs to be further evaluated in double blind controlled studies. However, augmentation with aripiprazole in bipolar patients may be a future routine treatment for treatment resistant bipolar depression. In this report, treatment of refractory bipolar depression and the efficacy of aripiprazole augmentation treatment in bipolar depression are discussed through two patients in depressive episode who remitted with aripiprazole augmentation.