Inflammation in the Affective Disorders
Bipolar children exhibit more inflammation than healthy children, according to a paper presented by Pandey, Dwivedi, and Pavuluri from the University of Illinois at the American College of Neuropsychopharmacology in December 2009.
In “Pro-inflammatory cytokines in plasma of patients with pediatric bipolar disorder,” the researchers described their study in which 21 normal controls were compared with 22 children with pediatric bipolar disorder who were unmedicated for a period of at least two weeks. The level of the inflammatory cytokine interleukin-1b (IL-1b) was significantly higher in the pediatric bipolar patients compared with controls, and levels of TNF alpha, another inflammatory marker, were significantly higher as well. Not only is this evidence of increased inflammatory processes in pediatric bipolar disorder, but TNF alpha is associated with activation of transcription factors and the initiation of preprogrammed cell death, or apoptosis.
Aripiprazole (Abilify), the Atypical Atypical Antipsychotic
This is an overview of the drug aripiprazole.
Spectrum of Efficacy
Aripiprazole has now been approved for acute and maintenance treatment of pediatric patients with bipolar disorder from ages 10 to 17. It had already been approved for adult bipolar disorder, schizophrenia, and as an adjunctive treatment for acute unipolar depression inadequately responsive to antidepressants of the serotonin-selective class or the serotonin-norepinephrine reuptake inhibitor venlafaxine. Aripiprazole, along with risperidone, is one of only two drugs FDA-approved for the treatment of irritability in autism.
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Reconsidering Ziprasidone (Geodon) for Kids with Bipolar Disorder
Ziprasidone has shown efficacy in pediatric BP I disorder (ages 10 to 17). Its metabolic profile is the most benign of the atypical antipsychotics, including being the only one that does not produce weight gain in children. None of the other metabolic indices increased either.
This drug is currently rarely used in children because of concerns about its effects on electrocardiogram (EKG), which have rarely been seen in clinical practice. Perhaps the overall assessment of its risk/benefit ratio should be re-evaluated.
We’ve posted before about ziprasidone’s benign side effects profile.
Aripiprazole (Abilify) Now FDA-Approved to Decrease Irritability in Children with Autism
In a recent study, children 6-12 years old with autism were treated with aripiprazole and showed improvement in irritability. The study lasted 52 weeks and had an open-label flexible-dose design (ranging from 2-15 mg/day) with an average dose of 9.6 mg/day. Few discontinuations occurred due to adverse effects, suggesting that aripiprazole is generally safe for use in this patient cohort. Increase in weight gain was the reason seven subjects (2%) discontinued the drug, although weight gain appeared to plateau with continued treatment.
Aripiprazole is already FDA-approved for the treatment and prevention of mania in adults and children (10-17 years). It is also approved as an adjunct (add-on) to poorly effective antidepressants in adults with unipolar (non-psychotic) major depression.
EDITOR’S NOTE: The general safety and tolerability of aripiprazole for the treatment of irritability in children with autistic disorder in this study means the drug can be added to the list of potential treatments for patients with autism. Previously, only risperidone had shown strong placebo-controlled data for efficacy in autism. A study by Hollander published in Neuropsychopharmacology this year indicated that valproate was also significantly better than placebo in treating irritability in children with autism spectrum disorders.
