Should I resume Abilify (aripiprazole) or start Seroquel (quetiapine)?

Cannot Make a Definitive Recommendation Without Critical Clinical Information

I cannot recommend resuming Abilify versus starting Seroquel without knowing your specific diagnosis, treatment history, current symptoms, and why you stopped Abilify. This decision fundamentally depends on context that is missing from your question.

Critical Information Needed to Guide This Decision

Your Diagnosis Matters Most

• For schizophrenia or psychosis: Abilify (aripiprazole) is generally preferred as initial monotherapy, with documented stability on medication for 6-12 months being crucial before any changes 1, 2
• For major depressive disorder: Aripiprazole as adjunctive therapy (added to an antidepressant) shows strong evidence with NNT of 7-14 for response 3, 4, 5
• For bipolar disorder: Both agents have roles, but specific phase (manic vs depressive) determines choice 6
• For Alzheimer's-related psychosis: Quetiapine may be preferred initially (12.5 mg twice daily, maximum 200 mg twice daily), though aripiprazole shows modest efficacy 1, 7

Why You Stopped Abilify Is Critical

• If you stopped due to side effects (especially akathisia, which occurs in ~17% with aripiprazole 5): Starting Seroquel may be more appropriate
• If you stopped due to non-adherence or ran out: Resuming Abilify is likely better, as medication discontinuation significantly increases relapse risk in schizophrenia (65-80% relapse within 1-5 years) 2
• If symptoms were inadequately controlled on Abilify: Consider whether you had an adequate trial at therapeutic doses before switching 1

General Principles When Choosing Between These Agents

Favor Resuming Abilify If:

• You previously achieved symptom stability on it without intolerable side effects 1
• You have schizophrenia and were stable on monotherapy 1
• Weight gain and metabolic effects are major concerns (aripiprazole has lower risk than quetiapine) 1
• You need a medication with lower sedation profile 1

Favor Starting Seroquel If:

• You experienced significant akathisia or restlessness on Abilify 5
• You need sedation for severe agitation or insomnia 1
• You have treatment-resistant depression and are already on an antidepressant (quetiapine extended-release shows efficacy with NNT 7-13) 4, 5
• You have Alzheimer's-related behavioral symptoms as first-line atypical antipsychotic 1

Critical Safety Considerations

Common Pitfalls to Avoid:

• Never abruptly discontinue antipsychotics in schizophrenia—this dramatically increases relapse risk 2
• Beware orthostatic hypotension with Seroquel, especially during initiation and dose increases 1
• Monitor for metabolic syndrome with both agents, but particularly with quetiapine (weight gain, diabetes, dyslipidemia) 1
• Akathisia is more common with aripiprazole (NNH of 6), though usually mild to moderate 3, 5

Specific Dosing Cautions:

• Quetiapine requires slow titration starting at 12.5 mg twice daily to minimize orthostasis 1
• Aripiprazole can be started at therapeutic doses but may cause initial anxiety/agitation 3

The Bottom Line

If you were previously stable on Abilify and stopped for reasons other than intolerable side effects, resume Abilify. Switching medications without clear justification increases risk of destabilization 1. If you had significant side effects on Abilify or never achieved adequate symptom control, starting Seroquel may be appropriate, but this requires proper medical evaluation to ensure correct diagnosis and dosing strategy 1, 4.

This decision requires immediate consultation with your prescribing physician who knows your complete history, as making the wrong choice could lead to symptom relapse, hospitalization, or serious adverse effects 2.