Asenapine for elderly bipolar manic patients

Background: Bipolar disorder (BPD) in the elderly is probably heterogeneous and its etiopathogenesis is complex. The data for the treatment of late-life BPD are limited. Asenapine is approved in the United States for acute treatment of manic or mixed episodes of bipolar I disorder with or without psychotic features. Aim: We report the results of acute treatment with asenapine in elderly patients with BPD. Method: Elderly patients (N=11), mean age: 67.7±6.1 years, consecutively admitted to the psychogeriatric ward due to acute bipolar mania were treated by asenapine 10 mg/BID monotherapy for 4 weeks. Safety and tolerability assessments included adverse events (AEs), laboratory values, and anthropometric measures. Response, a secondary assessment, was measured as change in Young Mania Rating Scale (YMRS) total score from baseline to week 4. Results: One patient developed a rash on day 6 of treatment and one patient developed peripheral edema on day 14 of treatment. Both AEs resolved rapidly following discontinuation of asenapine. Only mild sedation was reported by three patients. In all cases, mean (±SD) change (improvement) in YMRS total score at week 4 was -21.4±12.9 and 7/11 (63.6%) of patients remitted (YMRS≤12). Conclusion: In this small open-label study of elderly patients with bipolar mania, acute treatment with asenapine was well tolerated and effective.