Hypomania induced by aripiprazole in a patient with treatment-resistant depression
DOI:
https://doi.org/10.25118/2763-9037.2024.v14.1340Keywords:
aripiprazole, drug-related side effects and adverse reactions, depressive disorder treatment-resistant, maniaAbstract
Introduction: Aripiprazole is classified as a third-generation atypical antipsychotic, widely used in psychotic disorders, manic/hypomanic episodes, and treatment-resistant major depressive disorder. Its action is exerted through partial agonism at dopaminergic D2 and serotonergic 5-HT1A receptors, as well as antagonism at 5-HT2A receptors, with mania/hypomania induction being a rare event. Case Presentation: This report describes the case of a 63-year-old woman with persistent depressive disorder, who developed a hypomanic episode shortly after starting low-dose aripiprazole (5 mg on alternate days) for antidepressant augmentation. Method: Case report. CAAE: 82055624.7.0000.5192 Parecer N. 7.062.61 Discussion: The prescription of aripiprazole in reduced doses has a predominantly "stimulating" effect, potentially triggering hypomanic/manic symptoms. It is observed that symptoms can begin early, with no evidence of a relationship between the prescribed medication amount and the onset, intensity, or duration of mood changes. The actual prevalence of these events may be underestimated, often confused with akathisia, complicating diagnosis. Conclusions: The need for caution and vigilance regarding potential mood changes is highlighted when prescribing low doses of aripiprazole to patients with treatment-resistant depressive disorder.
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DeLeon A, Patel NC, Crismon ML. Aripiprazole: a comprehensive review of its pharmacology, clinical efficacy, and tolerability. Clin Ther. 2004;26(5):649-66. https://doi.org/10.1016/s0149-2918(04)90066-5 PMID:15220010 DOI: https://doi.org/10.1016/S0149-2918(04)90066-5
Sarin LM, Del Porto JA. Antipsicóticos atípicos na depressão refratária. J Bras Psiquiatr. 2009;58(2):73-8. https://doi.org/10.1590/S0047-20852009000200001 DOI: https://doi.org/10.1590/S0047-20852009000200001
Furukawa Y, Hamza T, Cipriani A, Furukawa TA, Salanti G, Ostinelli EG. Optimal dose of aripiprazole for augmentation therapy of antidepressant-refractory depression: preliminary findings based on a systematic review and dose-effect meta-analysis. Br J Psychiatry. 2022;221(2):440-7. https://doi.org/10.1192/bjp.2021.165 PMID:35049482 DOI: https://doi.org/10.1192/bjp.2021.165
Benyamina A, Samalin L. Atypical antipsychotic-induced mania/hypomania: a review of recent case reports and clinical studies. Int J Psychiatry Clin Pract. 2012;16(1):2-7. https://doi.org/10.3109/13651501.2011.605957 PMID:22122647 DOI: https://doi.org/10.3109/13651501.2011.605957
Barnas ME, Hussain N, Petrides G. Treatment-emergent psychosis with aripiprazole. J Clin Psychiatry. 2005;66(10):1339. https://doi.org/10.4088/jcp.v66n1019h PMID:16259556 DOI: https://doi.org/10.4088/JCP.v66n1019h
Traber R, Schneiter R, Modestin J. A case of aripiprazole-induced mania. Pharmacopsychiatry. 2007;40(1):37-8. https://doi.org/10.1055/s-2006-951609 PMID:17327959 DOI: https://doi.org/10.1055/s-2006-951609
Padala PR, Wengel SP, Petty F. Manic episode during treatment with aripiprazole. Am J Psychiatry. 2007;164(1):172-3. https://doi.org/10.1176/ajp.2007.164.1.172a PMID:17202565 DOI: https://doi.org/10.1176/ajp.2007.164.1.172a
Ducroix C, Beghelli F, Rousset I, Vacheron MN. Induction d'un état maniaque par antipsychotique: revue de la littérature à propos d'un cas. Therapie. 2008;63(2):153-4. https://doi.org/10.2515/therapie:2008019 PMID:18677815 DOI: https://doi.org/10.2515/therapie:2008019
Donohue A. First manic episode in a 55-year-old man after initiation of aripiprazole. Psychiatry (Edgmont). 2010;7(4):37-9. PMID:20508807 - PMCID:PMC2877620
Souza MGS, Santos CHR, Moreno RA. Mania/hipomania induzida por aripiprazol. Arch Clin Psychiatry (São Paulo). 2010;37(4):175-7. https://doi.org/10.1590/S0101-60832010000400006 DOI: https://doi.org/10.1590/S0101-60832010000400006
Viikki M, Valtonen HM, Leinonen E. Three cases of hypomania and one case of mania during aripiprazole treatment. Pharmacopsychiatry. 2011;44(2):78-81. https://doi.org/10.1055/s-0030-1268428 PMID:21157696 DOI: https://doi.org/10.1055/s-0030-1268428
Lenze EJ, Mulsant BH, Blumberger DM, Karp JF, Newcomer JW, Anderson SJ, Dew MA, Butters MA, Stack JA, Begley AE, Reynolds CF 3rd. Efficacy, safety, and tolerability of augmentation pharmacotherapy with aripiprazole for treatment-resistant depression in late life: a randomised, double-blind, placebo-controlled trial. Lancet. 2015;386(10011):2404-12. https://doi.org/10.1016/s0140-6736(15)00308-6 PMID:26423182 PMCID:PMC4690746 DOI: https://doi.org/10.1016/S0140-6736(15)00308-6
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Copyright (c) 2024 Dennison Carreiro Monteiro, João Cortez de Oliveira, Thamires da Silva Sampaio Medrado, Víctor Câmara Gusmão Cardoso, Vitor Gama Vieira de Araújo Régis
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