Asenapine for elderly bipolar manic patients

Baruch, Yehuda; Tadger, Shelly; Plopski, Igor; Barak, Yoram

doi:10.1016/j.jad.2012.05.027

Cited by 34 publications

(25 citation statements)

References 11 publications

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“…Quetiapine (level 2)655 can be considered as second‐line. Asenapine (level 4),656, 657 aripiprazole (level 4),658 risperidone (level 4),659 or carbamazepine (level 4)654 may be applied as third‐line treatments. For treatment‐resistant episodes, clozapine (level 4)660 and ECT (level 4)654 should also be considered.…”

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…In the study by Baruch et al . (), 11 highly symptomatic BD older adults (mean baseline YMRS = 33.5) had significant antimanic response and good tolerability. In this prospective, uncontrolled trial of 15 outpatient non‐demented older adults with BD, we observed global psychiatric symptom improvement on asenapine, although functional status did not improve.…”

Section: Discussionmentioning

confidence: 96%

“…To the best of our knowledge, there is only one previous report that has specifically investigated asenapine therapy in older adults with BD, a prospective analysis on inpatient BD older adults with acute mania (Baruch et al ., ). In the study by Baruch et al .…”

Section: Discussionmentioning

confidence: 97%

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Asenapine in the treatment of older adults with bipolar disorder

Sajatovic

Dines

Fuentes-Casiano

et al. 2014

Int J Geriat Psychiatry

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Objective In spite of growing numbers of elderly 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 elderly (≥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 (HAM-D), Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). Other outcomes included the WHO-Disability Assessment Schedule II (WHO-DAS II). Results Fifteen individuals were enrolled (mean age 68.6, SD 6.12), 53% female, 73% Caucasian, 13% African-American, 7% Asian). There were 4/15 (27%) individuals who prematurely terminated study while 11/15 (73%) completed study. There were significant improvements from baseline on BPRS (P<.05), on CGI overall (P<.01), and on CGI mania (P<.05) and depression (P<.01) sub-scales. 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 Elders 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. While risks vs. benefits in older people must always be carefully considered, asenapine may be a treatment consideration for some non-demented geriatric BD patients.

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“…A series of 11 consecutively admitted manic inpatients (mean age 68 years) were openly treated for 4 weeks with asenapine monotherapy (mean dose 20 mg/day) 63. There was a significant decrease in mean YMRS scores (−21.4) by the end of the trial.…”

Section: Efficacy Studiesmentioning

confidence: 99%

New approaches for the management of bipolar disorder: role of sublingual asenapine in the treatment of mania

Warren¹,

Dubovsky²

2013

NDT

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Bipolar disorder is a prevalent disorder that tends to become progressive without treatment and with inadequate treatment. Second generation (atypical) antipsychotic drugs have increasingly been used as adjunctive treatment or monotherapy for mania, but they have the potential for significant adverse effects and their role in maintenance treatment remains unclear. Asenapine is a new atypical antipsychotic medication formulated in a sublingual preparation that has been studied for mania but not maintenance therapy. Evidence indicating efficacy, adverse effects, and potential benefits and drawbacks of using asenapine in the treatment of bipolar disorder based on currently available published data are summarized.

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Asenapine for elderly bipolar manic patients

Cited by 34 publications

References 11 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Asenapine in the treatment of older adults with bipolar disorder

New approaches for the management of bipolar disorder: role of sublingual asenapine in the treatment of mania

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