Vraylar (cariprazine) for Bipolar Disorder
Dr. Danish frequently works with patients using various medications, including Vraylar (generic name cariprazine), to manage bipolar disorder. Vraylar is a medication specifically designed to help individuals with bipolar I disorder, particularly in treating depressive, manic, or mixed episodes. It is believed to function by balancing neurotransmitters such as dopamine and serotonin in the brain. By stabilizing these neurotransmitters, Vraylar helps manage the mood swings associated with bipolar disorder.
Vraylars effectiveness in bipolar disorder has been demonstrated in various studies. By targeting the neurochemical imbalances associated with bipolar I disorder, this medication provides a valuable tool in the comprehensive treatment plans that Dr. Danish and his team at Philadelphia Integrative Psychiatry develop for their patients. This holistic approach, which combines medication management with therapy, lifestyle adjustments, and other supportive measures, aims to address the multifaceted nature of bipolar disorder.
What is Vraylar?
Vraylar is an atypical antipsychotic approved for the treatment of bipolar I disorder in adults. It is used to manage both manic and depressive episodes, providing full-spectrum relief for the symptoms of bipolar I disorder. Vraylar works by modulating the activity of dopamine and serotonin, two key neurotransmitters involved in mood regulation. It is also used off-label to treat major depressive disorder (unipolar depression).
How Does Vraylar Work?
The exact mechanism of Vraylar is not fully understood, but it is believed to act on dopamine D3 and D2 receptors and serotonin 5-HT1A receptors. By adjusting the balance of these chemicals, Vraylar helps to stabilize mood and reduce the symptoms of both mania and depression associated with bipolar disorder. It theoretically reduces dopamine output when dopamine levels are high and increases dopamine output when levels are low, thus improving both positive and negative symptoms.
Evidence of Effectiveness
Clinical trials have shown that Vraylar is effective in reducing the symptoms of bipolar I disorder. In studies, patients treated with Vraylar experienced significant improvements in both manic and depressive symptoms compared to those who received a placebo. These findings support the use of Vraylar as a valuable component of a comprehensive treatment plan for bipolar disorder. Vraylar has been proven effective in treating bipolar I episodes across six studies, showing significant improvements at three weeks in manic/mixed episode studies and at six weeks in bipolar I depression studies.
Earl Response is a Positive Sign
Tohen’s research looking at patients who respond when treated for bipolar mania or depression, found that early symptomatic improvement with Vraylar is a strong predictor of later treatment response. For bipolar I depression, patients showing a 25% reduction in depressive symptoms by day 15 were 4 to 6 times more likely to achieve a 50% reduction by week 6. Similarly, early improvement in anxiety symptoms predicted a 3 to 4 times higher likelihood of significant anxiety reduction by week 6. For bipolar I mania, a 25% reduction in manic symptoms by day 7 predicted a 5 times higher likelihood of achieving a 50% reduction by week 3. These findings suggest that early improvement can guide therapeutic decisions, including dose adjustments, to optimize patient outcomes.
Highly Effective in Bipolar Depression
Martin-Correia’s research looking at bipolar depression found that Vraylar significantly reduced depression severity in BDI patients compared to placebo, with a mean difference of -2.53 points on the Montgomery-Åsberg Depression Rating Scale (MADRS). It also showed higher response rates (27% improvement) and remission rates (41% improvement) compared to placebo. Increasing doses of Vraylar (up to 4.5 mg) were associated with greater reductions in MADRS scores and higher response and remission rates in BDI patients.
Living with Bipolar I Disorder
Bipolar disorder is a condition that causes periods of severe changes in mood, energy levels, and the ability to carry out everyday tasks. It often starts in the late teen or early adult years and is frequently misdiagnosed. Living with bipolar I disorder can lead to relationship issues, substance abuse, and difficulty at work or school. Finding a treatment option that works for you, such as Vraylar, can be an essential first step in managing your mood swings. In addition to medication, lifestyle changes, including getting restful sleep and healthier eating, can help to reduce symptoms.
Common Symptoms Targeted by Vraylar
Depressive Symptoms (Lows)
Not enjoying things or having pleasure in activities
Feeling very down or sad
Sleeping too much or too little
Feeling tired or having low energy
Having trouble concentrating
Changes in appetite or weight
Feeling exhausted and overly anxious at the same time
Manic Symptoms (Highs)
Having too much energy while feeling very sad
Being talkative while pessimistic
Behaving impulsively while feeling exhausted
Increased spending
Feeling jumpy or wired
Feeling paranoid
Not feeling tired or needing little sleep
Becoming more active than usual
Talking really fast about a lot of different things
Feeling overconfident in your abilities
Possible Side Effects
Like all medications, Vraylar can cause side effects. It is important to discuss any side effects with your healthcare provider to ensure the best possible outcome.
Common side effects include restlessness, nausea, indigestion, and sedation.
More serious side effects may include tardive dyskinesia (uncontrolled body movements), metabolic changes, and an increased risk of death in elderly patients with dementia-related psychosis.
Getting in Touch with Dr. Danish and his Team
At Philadelphia Integrative Psychiatry, we take pride in our ability to practice the most subtle nuances of psychiatry, which is an inherently subjective field full of misdiagnoses and lazy and inaccurate assessment techniques. We want to provide the level of care we would want for our own family members. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for bipolar disorder or similar conditions, please text or call 610-999-6414 to learn how we can help.
For more on this topic and related subjects, check out these blogs:
Read Dr. Danish’s blog on the many subtypes of bipolar disorder.
Here is a blog that addresses some of the differences between true bipolar disorder and mood swings from other causes.
Please read this important blog on the risk for a movement disorder called tardive dyskinesia (TD), that can be caused by various medications, including antipsychotics.
Here is a breakdown of a commonly prescribed mood stabilizer and antipsychotic, Abilify (aripiprazole), which is used on- and off-label to treat a variety of disorders.
Disclaimer
Dr. Danish creates these handouts based on research, but they are not meant to be 100% comprehensive. Patients are invited to discuss the ideas brought up in the document with their provider. For full lists of side effects on medications and supplements, always refer to reputable sources like Drugs.com and WebMD, as new research is continually expanding our understanding.
