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Asenapine in the treatment of older adults with bipolar disorder
Author(s) -
Sajatovic Martha,
Dines Philipp,
FuentesCasiano Edna,
Athey Melanie,
Cassidy Kristin A.,
Sams Johnny,
Clegg Kathleen,
Locala Joseph,
Stagno Susan,
Tatsuoka Curtis
Publication year - 2015
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.4213
Subject(s) - young mania rating scale , brief psychiatric rating scale , tolerability , clinical global impression , mania , bipolar disorder , psychiatry , discontinuation , psychology , asenapine , adverse effect , depression (economics) , major depressive episode , rating scale , mood , medicine , psychosis , developmental psychology , alternative medicine , pathology , economics , macroeconomics , placebo
Objective In spite of growing numbers of older people, 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 older adults (≥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, Montgomery Asberg Depression Rating Scale, and Young Mania Rating Scale. Other outcomes included the World Health Organization Disability Assessment Schedule II. Results Fifteen individuals were enrolled (mean age 68.6, SD 6.12; 53% female; 73% Caucasian, 13% African American, and 7% Asian). There were 4/15 (27%) individuals who prematurely terminated the study, whereas 11/15 (73%) completed the study. There were significant improvements from baseline on the BPRS ( p < 0.05), on CGI‐BP overall ( p < 0.01), and on CGI‐BP mania ( p < 0.05) and depression ( p < 0.01) subscales. The 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 Older people 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. Although risks versus benefits in older people must always be carefully considered, asenapine may be a treatment consideration for some non‐demented geriatric BD patients. Copyright © 2014 John Wiley & Sons, Ltd.