From the Guidelines
Sertraline and Abilify can be used together as a combination therapy for certain mental health conditions, but it is crucial to start with a low dose of the second medication and monitor for symptoms, especially in the first 24 to 48 hours after dosage changes, due to the risk of serotonin syndrome 1. When combining sertraline, an SSRI antidepressant, with Abilify, an atypical antipsychotic, it is essential to consider the potential interactions and side effects. Sertraline is typically prescribed at 50-200mg daily for depression, anxiety disorders, OCD, and PTSD, while Abilify is usually dosed at 2-30mg daily depending on the condition being treated. The key considerations for this combination therapy include:
- Starting with a low dose of the second medication and gradually increasing it to minimize the risk of adverse effects 1
- Monitoring for symptoms of serotonin syndrome, such as anxiety, agitation, and changes in mental status, especially in the first 24 to 48 hours after dosage changes 1
- Regularly assessing the patient's response to treatment and adjusting the dosages as needed to optimize the benefit-to-harm ratio 1
- Being aware of the potential for drug-drug interactions, particularly with other medications that affect the CYP2D6 enzyme, which can interact with sertraline 1
- Educating patients and their families about the importance of adherence to the medication regimen and the potential risks and benefits of the combination therapy 1
From the Research
Sertraline and Abilify Combination
- The combination of sertraline and aripiprazole (Abilify) has been studied in several clinical trials for the treatment of major depressive disorder (MDD) and bipolar depression 2, 3.
- A randomized, double-blind study found that the combination of aripiprazole and sertraline was effective in treating MDD patients who had an inadequate response to sertraline alone 3.
- Another study found that adjunctive low-dose aripiprazole could augment the efficacy of regular-dose sertraline in fresh major depressive disorder 2.
- The ASCEnD trial is currently investigating the clinical and cost-effectiveness of the aripiprazole/sertraline combination in comparison with quetiapine for the treatment of bipolar depression 4.
Efficacy and Safety
- The combination of aripiprazole and sertraline has been shown to be efficacious and well-tolerated in patients with MDD who have an inadequate response to sertraline alone 3.
- Treatment-emergent adverse events (TEAE) that occurred in ≥10% of patients with the aripiprazole/sertraline combination were nasopharyngitis and akathisia 3.
- The safety profile of the aripiprazole/sertraline combination was similar to that of the placebo/sertraline combination 3.
Clinical Implications
- The combination of aripiprazole and sertraline may be a useful treatment option for patients with MDD who have an inadequate response to sertraline alone 2, 3.
- Further studies are needed to confirm the efficacy and safety of the aripiprazole/sertraline combination in patients with bipolar depression 4.
- The use of aripiprazole and sertraline in combination should be carefully monitored due to the potential risk of adverse events, such as akathisia 3.