Aripiprazole (Abilify) Should NOT Be Used to Treat Impulsivity
Aripiprazole is contraindicated for treating impulsivity and may paradoxically worsen impulsive behaviors, including pathological gambling, hypersexuality, compulsive shopping, and substance use. The FDA issued a warning in 2016 specifically about aripiprazole causing new impulse control problems 1.
Evidence Against Use for Impulsivity
Paradoxical Worsening of Impulsive Behaviors
The most concerning finding is that aripiprazole can induce or exacerbate impulsive-compulsive behaviors rather than treat them:
- A systematic review of 59 cases found that gambling was the most common impulsivity adverse effect, followed by hypersexuality, obsessive-compulsive symptoms, problem eating, and compulsive shopping 2
- These symptoms typically appeared within 30 days of starting aripiprazole and resolved within 30 days of discontinuation 2
- The average dose associated with these effects was only 11.63 mg daily 2
Lack of Efficacy for Substance Use Disorders
For conditions where impulsivity is a core feature, aripiprazole has failed to demonstrate benefit:
- Strong recommendation against use for alcohol use disorder - aripiprazole showed no superiority over placebo for abstinence or decreased use 3
- Strong recommendation against use for stimulant use disorder - not only ineffective, but two studies reported significant increases in stimulant consumption in the aripiprazole group 3
- Case reports document aripiprazole increasing urges and compulsive substance use in patients with substance use disorder history 4
FDA-Approved Indications (What Abilify IS For)
Aripiprazole is FDA-approved only for 1:
- Schizophrenia (adults: 10-15 mg/day; adolescents: 10 mg/day target)
- Bipolar I disorder manic/mixed episodes (15 mg/day)
- Adjunctive treatment of major depressive disorder (2-15 mg/day)
- Irritability associated with autistic disorder (5-15 mg/day)
- Tourette's disorder
Critical Clinical Pitfall
Before prescribing aripiprazole for ANY indication, screen for:
- History of gambling problems
- Compulsive sexual behaviors
- Shopping addiction
- Binge eating
- Substance use disorders
- Any impulse control difficulties
If any of these are present, choose an alternative medication as aripiprazole may trigger or worsen these behaviors 2, 5.
Monitoring Requirements
If aripiprazole must be used in a patient (for an approved indication), monitor closely for:
- New or worsening gambling urges
- Hypersexuality
- Compulsive shopping or eating
- Increased substance cravings
- Other impulsive behaviors
Educate patients and families that these symptoms can emerge rapidly and require immediate dose reduction or discontinuation 2.
Alternative Approaches for Impulsivity
While the provided evidence doesn't directly address impulsivity treatment, the guidelines suggest that for agitation and behavioral dyscontrol in specific contexts:
- Mood stabilizers like divalproex sodium (better tolerated than other mood stabilizers) may be considered for severe agitated, repetitive, and combative behaviors 6
- SSRIs for anxiety-related impulsivity in appropriate contexts 7
The key message: Aripiprazole is not a treatment for impulsivity and may make it significantly worse.