Bipolar disorder (BD) is a debilitating and difficult-to-treat
psychiatric disease that presents a serious burden to patients' lives as well as health care systems around the world. The essential diagnostic criterion for BD is episodes of
mania or
hypomania; however, the patients report that the majority of their time is spent in a depressive phase. Current treatment options for this component of BD have yet to achieve satisfactory remission rates.
Lurasidone is a
drug in the
benzisothiazole class approved by the US Food and Drug Administration in June 2013 for the acute treatment of
bipolar depression. Its pharmacological profile features high-affinity antagonism at D2, 5-HT2A, and 5-HT7 receptors; moderate-affinity antagonism at α2C-adrenergic receptors; low- to very low-affinity antagonism at α1A-adrenergic, α2A-adrenergic, H1, M1, and 5-HT2C receptors; and high-affinity partial agonism at 5-HT1A. Preliminary findings from two recent double-blinded clinical trials suggest that
lurasidone is efficacious in treating bipolar I depression, with clinical effects manifesting as early as the first 2-3 weeks of treatment (as measured by the Montgomery-Åsberg Depression Rating Scale and Clinical Global Impressions Scale for use in bipolar illness). Its therapeutic benefit appears to be comparable to the current US Food and Drug Administration-indicated treatments:
quetiapine and
olanzapine-
fluoxetine, according to a measure of effect size known as number needed to treat. These studies reported relatively limited extrapyramidal and metabolic side effects as a result of treatment with
lurasidone, with the most common side effect being
nausea. Safety data drawn from these studies, as well as a more extensive body of
schizophrenia research, indicate that in comparison with other atypical
antipsychotics, treatment with
lurasidone is less likely to result in metabolic side effects such as
weight gain or disturbances of serum
glucose or
lipid levels.
Lurasidone holds clinical potential as a novel, efficacious pharmacological treatment for
bipolar depression. However, current data on its use for the treatment of BD are limited, and more extensive research, both longer in duration as well as independently conducted, is needed.