Is Abilify (aripiprazole) safe to take with a Selective Serotonin Reuptake Inhibitor (SSRI)?

From the Guidelines

Abilify (aripiprazole) can generally be safely taken with Selective Serotonin Reuptake Inhibitors (SSRIs) under proper medical supervision, with careful monitoring for potential side effects and serotonin syndrome, as noted in clinical practice guidelines 1. When combining these medications, it is crucial to be aware of the potential for increased side effects such as akathisia, weight gain, or sedation. The risk of serotonin syndrome, although relatively rare, necessitates careful consideration and monitoring, especially during the initial weeks of treatment or when adjusting doses. Key considerations include:

• Starting with a lower dose of Abilify (often 2-5mg daily) when added to an established SSRI regimen, with gradual increases as needed and tolerated.
• Monitoring for symptoms of serotonin syndrome, which can arise within 24 to 48 hours after combining medications, characterized by mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity 1.
• Being aware of the potential for drug-drug interactions, particularly with SSRIs that have a greater potential for such interactions, like fluvoxamine, which may interact with drugs metabolized by various CYP enzymes 1.
• Recognizing the importance of medical education, training, and experience in safely and effectively prescribing these medications, including the need for slow up-titration to avoid unintentionally exceeding the optimal medication dose 1. Any changes to medication should always be discussed with and monitored by a healthcare provider who can assess individual risk factors and adjust treatment accordingly, taking into consideration the unique risks and benefits associated with each SSRI, as well as the patient's specific condition and response to treatment 1.

From the Research

Safety of Abilify with SSRI

• The safety of taking Abilify (aripiprazole) with a Selective Serotonin Reuptake Inhibitor (SSRI) has been studied in several research papers 2, 3, 4, 5.
• According to a 2014 study, the combination of aripiprazole with an SSRI was generally well tolerated, with the most common adverse events being fatigue and akathisia 2.
• A 2005 study found that aripiprazole augmentation of SSRIs was effective in treating depression and anxiety disorders, with 59% of subjects showing significant improvement 3.
• A 2017 study compared the efficacy and safety of aripiprazole versus bupropion augmentation in patients with major depressive disorder unresponsive to SSRIs, and found that both treatments were effective and well tolerated, with no significant differences in adverse events 4.
• Another study in 2012 found that aripiprazole augmentation of paroxetine or sertraline was equally effective and tolerated in patients with refractory major depressive disorder 5.

Efficacy of Abilify with SSRI

• The efficacy of taking Abilify with an SSRI has been demonstrated in several studies 2, 3, 4, 5.
• A 2014 study found that the combination of aripiprazole with an SSRI resulted in significant symptom improvement, with a mean change in Clinical Global Impressions-Severity (CGI-S) score of -1.5 2.
• A 2005 study found that aripiprazole augmentation of SSRIs resulted in significant improvement in depression and anxiety symptoms, with 59% of subjects showing significant improvement 3.
• A 2017 study found that aripiprazole augmentation was at least comparable to bupropion augmentation in combination with an SSRI, with significant improvement in depressive symptoms and no significant differences in adverse events 4.
• A 2012 study found that aripiprazole augmentation of paroxetine or sertraline resulted in significant improvement in depressive symptoms, with no significant difference between the two combinations 5.

Adverse Events

• The most common adverse events associated with the combination of Abilify and an SSRI include fatigue, akathisia, and somnolence 2, 4.
• A 2014 study found that 93.8% of patients in the SSRI group and 97.8% of patients in the bupropion group experienced at least one adverse event 2.
• A 2017 study found that there were no significant differences in adverse events between the aripiprazole and bupropion groups, with the most common adverse events being fatigue, somnolence, and dry mouth 4.