What is the optimal dose of Abilify (Aripiprazole) for the treatment of treatment-resistant depression?

From the Guidelines

For treatment-resistant depression, the optimal dose of Aripiprazole (Abilify) is 5-15 mg daily, with 10 mg daily often being effective as an adjunctive treatment when added to an antidepressant. The dose should be started at 2-5 mg daily and gradually increased as needed, based on response and side effects 1. It is essential to start with a lower dose and increase gradually every 1-2 weeks to minimize side effects. Abilify should be taken once daily, with or without food, at the same time each day for consistent blood levels. Some key points to consider when using Abilify for treatment-resistant depression include:

• Allow 4-6 weeks at an adequate dose to evaluate effectiveness
• Common side effects include restlessness, weight gain, and metabolic changes
• Regular monitoring of weight, blood sugar, and lipids is important
• Abilify works as a partial dopamine agonist, helping to modulate dopamine and serotonin systems that may not be adequately addressed by traditional antidepressants alone According to the study published in the BMJ in 2020, Aripiprazole has a corresponding absolute probability of abstinence of 33% (12-63%) 1. Another study published in the Annals of Internal Medicine in 2008 recommends continuing treatment for 4 to 9 months after a satisfactory response in patients with a first episode of major depressive disorder, and an even longer duration of therapy may be beneficial for patients who have had 2 or more episodes of depression 1. However, the most recent and highest quality study, which is the 2020 BMJ study, does not provide specific guidance on the duration of therapy for treatment-resistant depression.

From the Research

Optimal Dose of Abilify (Aripiprazole) for Treatment-Resistant Depression

The optimal dose of Abilify (Aripiprazole) for the treatment of treatment-resistant depression is not explicitly stated in the provided studies. However, the following information can be gathered:

• A study published in 2015 2 found that standard-dose atypical antipsychotics, including aripiprazole, were significantly more efficacious than placebo in reducing depressive symptoms.
• A study published in 2006 3 used a mean final dose of 15.3 +/- 11.2 (range 2.5-40) mg/day of aripiprazole in patients with treatment-resistant bipolar depression, with 27% of patients responding to treatment.
• The same study 3 found that aripiprazole was generally well tolerated, with no significant change in mean adverse effect ratings or mean weight.

Key Findings

• Standard-dose atypical antipsychotics, including aripiprazole, are efficacious in reducing depressive symptoms 2.
• Aripiprazole may be effective in treatment-resistant bipolar depression, with 27% of patients responding to treatment 3.
• The optimal dose of aripiprazole for treatment-resistant depression is not explicitly stated, but a mean final dose of 15.3 +/- 11.2 (range 2.5-40) mg/day was used in one study 3.

Considerations

• Atypical antipsychotics, including aripiprazole, should be prescribed with caution due to abundant evidence of side effects 2.
• The benefits of using atypical antipsychotics for treatment-resistant depression must be weighed against their potential adverse events, such as weight gain, akathisia, and tardive dyskinesia 4.