Augmentation of Clozapine Treatment With Aripiprazole

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Sir: Ischemia from cerebrovascular disease may be etiologically important in a subtype of geriatric depression called vascular depression.¹ It is less clear if a similar subtype of vascular mania exists. However, patients with late-onset mania have more vascular risk factors than those with early-onset, supporting the idea of a secondary mania related to cerebrovascular disease.²