Hypomania associated with adjunctive low-dose aripiprazole: two case reports and a brief review of the literature.

Aripiprazole is one of the newest atypical antipsychotic medications. It has proven to be effective in the treatment of schizophrenia (Hasan et al. 2012, 2013), bipolar manic and mixed states (Yatham et al. 2013, Grunze et al. 2013) and, recently, as an adjunctive agent in patients with treatment-resistant major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) (Wright et al. 2013, Pessina et al. 2009, Muscatello et al. 2011, Sayyah et al. 2012). Despite the proven efficacy in treating mania, several cases have been reported in which aripiprazole may have contributed to recurrence of manic symptoms or induction of the first ever mania (Barnas et al. 2009, Padala et al. 2007, Traber et al. 2007, Ducroix et al. 2008, Donohue 2009, Viikki et al. 2011, Lin et al. 2012). We report two patients that exhibited reversible hypomania after prescription of low-dose aripiprazole for treating bipolar depression (case one) and unipolar depression with comorbid OCD (case two). All psychiatric diagnoses are based on the Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition, Text Revised (DSM-IV-TR).