What is the recommended dose of Abilify (aripiprazole) to augment Sertraline (sertraline)?

Aripiprazole Augmentation of Sertraline

For augmenting sertraline with aripiprazole in treatment-resistant depression or anxiety disorders, start with 10-15 mg daily of aripiprazole and titrate as needed, with most patients responding to doses between 10-30 mg daily. 1, 2

Dosing Strategy

Initial Dosing

• Start aripiprazole at 10-15 mg once daily when augmenting sertraline in patients with inadequate response 1
• This applies to patients who have failed to respond adequately to sertraline 100-200 mg/day for at least 12 weeks 1

Dose Range and Titration

• Effective dose range: 10-30 mg daily, with most patients responding within this range 2
• The 2025 INTEGRATE schizophrenia guidelines note aripiprazole starting doses of 5 mg daily for psychiatric conditions, though this is in a different context 3
• For borderline personality disorder with sertraline resistance, the specific range of 10-15 mg/day has demonstrated efficacy 1

Timeline for Response

• Early response can occur within 1-5 weeks of aripiprazole augmentation 2
• A 12-week trial is recommended to fully assess efficacy 1, 2
• Approximately 56-59% of treatment-resistant patients show significant improvement (CGI-I ratings of "much improved" or "very much improved") with this augmentation strategy 1, 2

Clinical Context

When to Consider Augmentation

Before adding aripiprazole, ensure adequate sertraline dosing:

• Sertraline should be at 100-200 mg/day for at least 6-12 weeks before considering augmentation 1, 4
• Note that increasing sertraline from 100 mg to 200 mg may actually result in lower response rates (56% vs 70%) compared to continuing 100 mg 4
• Continuing sertraline 100 mg/day for up to 8 weeks can yield additional responses (70% cumulative response) before changing strategy 4

Target Symptoms

Aripiprazole augmentation has demonstrated efficacy for:

• Treatment-resistant depression 2
• Anxiety disorders including panic disorder, generalized anxiety disorder, social anxiety, and PTSD 2
• Impulsive and psychotic-like symptoms in borderline personality disorder 1
• Specific improvement in BPRS scores, impulsivity measures (BIS-11), and dissociation/paranoid ideation 1

Safety and Tolerability

Common Adverse Effects

• Mild and generally well-tolerated: headache, insomnia, and anxiety are the most common side effects 1
• Dropout rates of approximately 24% due to anxiety/insomnia or non-compliance 1
• Aripiprazole has lower risk of extrapyramidal symptoms compared to other antipsychotics 3

Important Precautions

• Monitor for akathisia and restlessness, particularly in the first few weeks 3
• Consider potential drug-drug interactions via cytochrome P450 2D6 and 3A4 pathways 3
• Aripiprazole may cause headache, agitation, anxiety, insomnia, dizziness, or drowsiness 3
• Reduce dose in elderly patients and poor metabolizers of CYP2D6 3

Serotonin Syndrome Risk

When combining aripiprazole with sertraline, be aware of serotonin syndrome risk, though aripiprazole's partial D2 agonism provides some theoretical protection. Start with lower doses and monitor for symptoms including agitation, confusion, tremor, and autonomic instability, especially in the first 24-48 hours after dose changes. 3