With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Over the past several weeks, we covered four commonly used atypical antipsychotics, including Zyprexa (olanzapine) and Seroquel (quetiapine). Because the Zyprexa post contains a great deal of information that applies to the atypical antipsychotics as a group, we encourage you to read it first.
Like Zyprexa and the other atypical antipsychotics, Abilify (aripiprazole) was developed primarily to treat schizophrenia and psychosis but has been approved to treat acute bipolar mania.
Abilify has FDA approval for maintenance treatment of bipolar – reducing or eliminating recurrence of mood episodes. It does not have an indication for treating bipolar depressive episodes but it is approved for treating mixed episodes. It now also has an FDA indication as an add-on medication for unipolar depression that is not responding to antidepressants alone. It is the only atypical to have approval to treat acute manic or mixed episodes in children as young as 10 years old.
Elderly patients, diagnosed with psychosis as a result of dementia should not take Abilify or most other medications in its class, due to an increased risk of death.
You should not take Abilify if you are allergic to aripiprazole or any other ingredients in Abilify. Allergic reactions range from rash, hives and itching to anaphylaxis, which may include difficulty breathing; tightness in the chest; or swelling of the mouth, face, lips, or tongue.
Abilify can improve symptoms of schizophrenia and psychotic symptoms that may occur in bipolar, including the following:
It may also improve conditions such as social isolation, limited motivation, and reduced speech activity for some people.
Abilify can also improve symptoms related specifically to mania, including the following:
For bipolar disorder, your prescriber is likely to start you on a low dose, such as 5 mg once a day, and then increase your dose slowly. (If you have low blood pressure, poor liver function, or are elderly or in a weakened condition, your prescriber may ramp up the dose even more slowly.) Most patients take 30 mg or less per day.
In my practice, Abilify is often a first or second choice medication in bipolar and related conditions. It is an effective agent in reducing mood symptoms and explosive and irritable reactions. When it was first released, I was hopeful that it would have less weight gain than other medications, but this has not been the case. Abilify often causes weight gain, and this needs to be monitored and discussed in treatment. Abilify is particularly noted for a side effect referred to as akathisia. This means restlessness – an inability to sit still. Often this occurs in the first few weeks of treatment and resolves but can persist in some people.
Being reported by five percent or more of those taking Abilify in the study and twice the rate as for those taking a placebo:
Other common side effects include headache, anxiety, insomnia, nausea, vomiting, dizziness, and upset stomach.
Unlike most other atypical antipsychotics, Abilify does not increase levels of the reproductive hormone prolactin. Many other atypical agents do increase this hormone, which can affect menstrual cycles.
For more about Abilify, visit Bristol-Myers Squibbs’ Abilify page.
If you’ve taken any form of Abilify for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.
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From Psych Central's :
Atypical Antipsychotics for Bipolar Disorder - Psych Central (January 14, 2009)
I USED TO BE a size 6. That was this summer. Within 2 months I was a size 12. I eat normally and work out. WTF? I went off Abilify and my body has NOT recovered from this POISON.
just recieved lab results indicating elevated cholesterol and triglycerides–my MD wants to start lofibra for high cholesterol–what is known about the interactions of Abilify and anti-cholesterol meds? Is there a better way to deal with this–weight gain has occurred too–what is the cause of this–how does Abilify cause weight gain? metabolic disturbences? I plan to go on a long hike soon–should I be concerned about danger from overheating etc?
After taking abilify I develope movement disorder chorea…please tel me if this is reversible..
I am28 years old and I am scared.
I took Abilify 2.5, then 5, then 19 mg for a little over a year. I developed a Parkinson like tremor and went to see a movement neurologist. He had me stop Abilify. The tremor went away. Dyskinesia started and will probably be irreversible, according to the movement neurologist. Now what do I do? Should I sue them? This is forever.
Correction: not 19 mg but 10 mg.
Sometimes you can take an anti-parkinson med like amantadine with atypical antipsychotics which usually makes shakes and tremors go away. Stimulants too can keep Akathisia at bay. For example, despite the controversy, phentermine, the pseudo-amphetamine diet med has been very effective for me in keeping away shakes, tremors, tics. It also improves my Lexapro. I know there is a lot of bs about phentermine causing “serotonin syndrome” but other tests show that not to be true. For me, after 60 some meds–phentermine made those horrible shakes disappear, controlled the weight gain associated with atypicals, and has a very good antidepressant value as well. There’s just no “money” in testing or using this med, but many psychiatrists have experience with it. Hope this helps. As for TD, it is often reversible or decreases over time. Depends on how much A-pscyh you took and for how long. Overall, I try to live without antipsychotics now. The risks from side effects are too frightening.
I’ve tried a few atypical antipsychotic medications, most of which hit me so hard that I felt like a zombie (Rispedal, Geodon). Abilify has been the least zombifying med of the bunch for me. The most irritating side effect is the heat intolerance: I take it at night and wake up stuffy with heat, and this not pleasant for an obese person in a Phoenix summer. On high doses, Abilify makes me lactate (not cool), and when that happens it makes me think I have a brain tumor causing that, which makes me wonder if the pill is actually working if I still have that sort of delusion. Then there is the actual physical illness (not side effect imho) it brings which is high blood pressure and riskier numbers on liver tests. Overall I hate taking anything that gives me a physical illness, but Abilify wipes up the mess in my mind on the worst days.
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