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Cariprazine-induced mania: A case series report
María T Pons-Cabrera1,2, Roberto Palacios-Garrán3, Laia Tardón-Senabre1,2
1Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
Bipolar Disorders
|November 19, 2021
Summary
Cariprazine, approved for bipolar depression, may trigger manic episodes (mood switches) in some patients. Clinicians and patients should monitor for these early warning signs during treatment.
Area of Science:
- Psychiatry and Neuropharmacology
- Bipolar Disorder Pathophysiology and Treatment
Background:
- Bipolar depression is the most common phase of bipolar disorder (BD).
- Antidepressants carry a risk of inducing treatment-emergent affective switches (TEAS) in BD patients, leading to contraindication for monotherapy.
- Cariprazine, a dopamine-serotonin partial agonist, is FDA-approved for BD type 1 (BD-I) depression monotherapy.
Purpose of the Study:
- To report on three cases of manic switch following cariprazine initiation in patients with bipolar disorder.
- To investigate the potential for cariprazine to induce treatment-emergent affective switches (TEAS) in bipolar depression.
Main Methods:
- Case series describing three patients admitted to an acute psychiatric ward.
- Patients diagnosed with BD type 1 (BD-I) or schizoaffective disorder, bipolar type, were treated with low-dose cariprazine (1.5 mg) during a depressive phase.
- Concurrent treatment with mood stabilizers was noted in all cases prior to manic switch.
Main Results:
- All three patients developed manic episodes after the introduction of low-dose cariprazine.
- The affective switches occurred despite concurrent treatment with mood stabilizers.
- Previous literature review indicated no significant evidence of cariprazine-induced TEAS in bipolar depression.
Conclusions:
- Cariprazine, even at low doses and in conjunction with mood stabilizers, may induce affective switches in BD-I patients.
- This case series suggests a potential risk of mood switching not previously highlighted in clinical trials.
- Increased awareness and monitoring for early warning symptoms of mood switching are crucial for patients and clinicians.
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