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:

• Hallucinations (audio and visual)
• Delusions
• Disorganized thinking
• Paranoia

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:

• Irritability
• Elevated mood
• Impulsivity
• Racing thoughts
• Inflated self esteem
• Decreased need for sleep

Typical Dose

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, I use Abilify primarily to treat acute mania or as an add-on for antidepressants that are not working well enough. I reserve it and all the other atypicals for the most serious situations or when other medications have not worked. While it has FDA approval for use in bipolar maintenance, the data supporting this use is not strong, and maintenance treatment means long-term exposure to the side effects of Abilify, which can be severe. I do what I can to use medicines other than atypicals for long-term use in bipolar disorder, but sometimes they are necessary.

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 – restlessness, an inability to sit still. Often this occurs in the first few weeks of treatment and resolves but can persist in some people.

Other Potential Side Effects

Being reported by five percent or more of those taking Abilify in the study and twice the rate as for those taking a placebo:

• Development of diabetes type II or pre-diabetes – problems with sugar and insulin metabolism. Regular lab tests are necessary to monitor this.
• Elevation of blood lipids, such as cholesterol and triglycerides. Regular lab work will be part of treatment to monitor this side effect.
• Constipation.
• Sleepiness.
• Tremor or rigid muscles (parkinsonian or extrapyramidal symptoms). These are dose related and reversible. These side effects are less likely in Abilify than in older antipsychotic medications.
• Tardive dyskinesia – involuntary, abnormal movements that can be irreversible. It is believed that Abilify presents a lower risk of tardive dyskinesia than older antipsychotics

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 website:
Atypical Antipsychotics for Bipolar Disorder - Psych Central (January 14, 2009)

Evidence for Abilify (Aripiprazole) in Maintenance of Bipolar Disorder Questioned | Bipolar Teen Blog (May 6, 2011)

    Last reviewed: 6 May 2011