Aripiprazole - from research results to clinical practice

This theoretical and practical article discusses the results of studies on aripiprazole in terms of its anti-maniac, antipsychotic effectiveness, its efficacy in relapse and re-hospitalisation prevention, and its effects on cognition. Study results indicate that aripiprazole may not only be a valuable component of combination therapy, but also, and perhaps above all, is an effective drug when used in monotherapy. The use of aripiprazole in too low doses does not allow for its full clinical effect. The use of high doses of the drug, exceeding 20 mg/day, translates into a high degree of dopaminergic receptor involvement. When excess dopamine is present, aripiprazole competes with dopamine for receptor binding, thereby acting as a D-2 receptor antagonist. Therefore, the use of too low doses of the drug often has the opposite effect to the intended one, with aripiprazole acting as a dopaminergic receptor agonist, which results in additional activation instead of anti-manic and antipsychotic effects. Understanding the mechanism of action of this drug is therefore the key to successful treatment with aripiprazole. Data from scientific studies are presented and discussed below, explaining why and in which situations the 30 mg/day dose has an advantage over the 15 mg/day dose. The article answers the most common questions and explains doubts expressed by doctors, along with scientific background and a reference to the literature. Presenting data from the literature, the author also presents their clinical implications and refers to practical experience with the use of aripiprazole both in the hospital and in outpatient practice.