The evidence base for the prescribing of aripiprazole in maintenance treatment of bipolar Air Jordan 6s disorder is limited to a single trial, sponsored by the manufacturer of aripiprazole, according to a rigorous appraisal of the evidence for its use led jointly by of Harvard University, Boston USA, and Nicholas Rosenlicht of the University of California San Francisco, USA.

Bipolar disorder (also known as manic depression) is a common and serious psychiatric illness. Individuals with bipolar disorder experience mood swings with manic episodes (where they may feel euphoric, restless, and behave impulsively), along with depressive episodes where they may feel low, worthless, and suicidal. Aripiprazole is a second generation antipsychotic medication and the newest of such drugs to have received approval by the US Food and Drug Administration (FDA) for use both in treatment of acute episodes and, more recently, for maintenance therapy.

Drs. Tsai and Rosenlicht and their colleagues conducted a systematic search to find all published and unpublished studies relating to use of aripiprazole for maintenance therapy of bipolar disorder, including a request to the FDA under Freedom of Information Act legislation. They critically appraised this evidence and then used citation searches to examine how the primary evidence Air Jordan 2010 was subsequently referenced in the medical literature. Further, they found significant limitations of this trial that constrain its interpretation as supporting the use of aripiprazole for this indication. First, the trial duration was too short to show that the drug was truly helpful in maintaining initial benefit or preventing mood swings over the long term. Second, very few participants in the trial completed the entire study. Third, the trial was based on a select minority of subjects who had shown an initial response to the drug, making it difficult to extrapolate these findings to patients with bipolar disorder more widely. Fourth, the trial had a design whereby patients assigned to placebo were abruptly taken off aripiprazole treatment given to them during a previous “run in” phase and reassigned to placebo; differences in risk of relapse seen between trial arms may thus also reflect the potentially harmful effects of rapid drug withdrawal in patients given placebo. Specifically, the findings do not mean patients should cease their medication; despite the limitations of the evidence described here, this drug may be helpful to them. ACT received salary support as a Robert Wood Johnson Health and Society Scholar at Harvard University. No funding bodies had any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: ACT receives salary support through the Robert Wood Johnson Foundation Health and Society Scholars Program. The Robert Wood Johnson Foundation’s stated mission is to improve the health and health care of all Americans. NZR is a member of the National Physicians Alliance, a not for profit organisation whose stated primary goal is to restore physicians’ primary emphasis on the core values of service, integrity, and advocacy. The National Physicians Alliance rejects funding from commercial health care interests and encourages its members to do the same. NZR, JNJ, and PIP are members Air Jordan 7s of Healthy Skepticism, an international not for profit organisation whose stated aim is to improve health by reducing Air Jordan 11s harm from misleading drug promotion; GIS joined Healthy Skepticism after this article was accepted for Air Jordan 6 Rings publication. GIS is a current shareholder (