Potential use of lurasidone for the treatment of bipolar psychosis

Abstract

Introduction: Second-generation antipsychotics (SGA) are new treatment options for bipolar disorders (BDs). Lurasidone is one such SGA, which is currently approved as a monotherapy for bipolar I depression (BPID) and as an add-on therapy for acute schizophrenia.

Areas covered: In this drug evaluation, the authors illustrate the pharmacological profile of lurasidone and review its development history. The aim of this review is to evaluate whether this compound could be used in psychotic BDs.

Expert opinion: The pharmacological profile of lurasidone, its action on receptors, its role in neurogenesis and its cognitive performance suggests a potential use in psychotic episodes of BDs and mania. This hypothesis is also supported by the clinical observations from case reports concerning resolutions of BPID with psychotic features, where psychotic episodes were diagnosed as schizophrenia and reclassified as BDs after the patient was able to reconstruct his/her clinical history. The use of lurasidone may have the advantage of a low side-effect profile and a possible efficacy in preventing the impairment of cognitive performance. However, randomized clinical trials assessing the efficacy of lurasidone in the treatment of manic episodes as well as manic episodes with psychotic components are still needed.

Keywords:

• bipolar disorders
• lurasidone
• psychotic simptoms
• second generation antipsychotics
• stabilizers

Declaration of interest

MG Carta has received grants from the European Commission, through the European Social Fund, AIFA (Agenzia Italiana del Farmaco), Fondazione Banco di Sardegna and the Sardinia Region. MG Carta is advisor for the Economic and Social Committee of the European Union. MF Moro received grants from Fondazione Banco di Sardegna. AE Nardi has received research grants from: FAPERJ, CAPES, CNPq FINEP, INCT-TM. AE Nardi is also an advisory board member of: Aché, CNPq, GlaxoSmithKline, Grupo A, Lundbeck A/S and is on the speaker bureau for: Solvay, Cristália, GlaxoSmithKline, Roche and Aché. JR Calabrese is the recipient of the Bipolar Disorders Research Chair, the director the Bipolar Disorders Research Centre, and the director of the Mood Disorders Program at Case Western Reserve University. He has directed or co-directed three separate research centres that were dedicated to improving clinical outcomes in under-served populations of bipolar disorder, including those with bipolar depression, rapid cycling, children and adolescents, adults with substance use disorders as well as members of the Reserve Component of the US Department of Defence. JR Calabrese has received five lifetime achievement awards, including the ‘The Nola Maddox Falcone Prize for Affective Disorders’ in 2005 (NARSAD), the Gerald L. Klerman Lifetime Achievement Award in 2008, and the 2013 Lifetime Achievement Award from the European Bipolar Forum. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.