Does Abilify Cause Fatigue?
Yes, Abilify (aripiprazole) can cause fatigue, though it occurs at relatively modest rates—approximately 6% in adults and 10% in pediatric patients compared to 4% and 2% with placebo, respectively. 1
Evidence from FDA Drug Labeling
The official FDA prescribing information clearly lists fatigue as an adverse reaction in clinical trials:
- In adults with schizophrenia: Fatigue occurred in 6% of aripiprazole-treated patients versus 4% receiving placebo across pooled trials 1
- In pediatric patients (ages 6-18): Fatigue was more common at 10% versus 2% with placebo, making it one of the more frequent adverse effects in younger patients 1
These data come from multiple placebo-controlled trials involving over 3,000 adult patients and 1,686 pediatric patients, providing robust safety information 1
Clinical Context and Mechanism
The fatigue associated with aripiprazole appears related to its unique pharmacological profile as a partial dopamine D2 agonist-antagonist, though the exact mechanism remains unclear 2, 3. Unlike sedation or somnolence (which also occur with aripiprazole at rates of 5-16%), fatigue represents a distinct symptom of reduced energy rather than drowsiness 1
Comparative Perspective
Important caveat: When evaluating fatigue with aripiprazole, consider that:
- The incidence is only modestly higher than placebo (2-8 percentage point difference) 1
- Aripiprazole has a generally favorable tolerability profile compared to other antipsychotics, with lower rates of weight gain, metabolic effects, and extrapyramidal symptoms 2, 4, 5
- In long-term studies extending to 52 weeks, aripiprazole demonstrated continued efficacy and good compliance, suggesting tolerability issues like fatigue do not typically lead to discontinuation 3, 6
Clinical Management Considerations
If fatigue develops on aripiprazole:
- Assess for other contributing factors: The underlying psychiatric condition itself (depression, schizophrenia) commonly causes fatigue 6
- Review concomitant medications: Drug interactions affecting CYP3A4 or CYP2D6 metabolism can alter aripiprazole levels 1, 4
- Consider dose adjustment: In long-term treatment of depression, lower maintenance doses (2-5 mg) may be effective with fewer side effects compared to higher doses (>5-10 mg) 6
- Monitor timing: Fatigue typically emerges early in treatment; if it persists beyond initial weeks, reassessment is warranted 1
The relatively low discontinuation rates due to adverse effects (5% in pediatric trials, similar in adults) suggest that when fatigue occurs, it is usually manageable and does not necessitate stopping the medication 1