Starting Dose of Abilify for Depression
For adjunctive treatment of major depressive disorder, start aripiprazole at 5 mg once daily, with a dose range of 2-20 mg/day and a typical therapeutic dose of approximately 10-11 mg/day. 1
Dosing Algorithm
Initial Dosing
- Begin with 5 mg once daily when adding aripiprazole to ongoing antidepressant therapy 1
- No titration is required—the starting dose can be the therapeutic dose 2
- The drug demonstrates efficacy as early as the first or second week of treatment 2
Dose Adjustments
- Adjust within the range of 2-20 mg/day based on response and tolerability 1
- In clinical trials, the mean endpoint dose was approximately 11 mg/day for depression augmentation 1
- Lower doses (2.5-10 mg/day) have shown rapid antidepressant effects in treatment-resistant cases 3
Special Considerations for Lower Doses
- Consider starting at 2.5 mg/day in patients who may be particularly sensitive to side effects, especially akathisia 3
- If akathisia develops, reduce the dose rather than discontinue—symptoms typically respond to dose reduction 3
Efficacy Timeline
- Expect response within 1-2 weeks of initiating adjunctive therapy 2
- Full assessment of efficacy should occur by 6 weeks of treatment 1
- Remission rates of 25.4% and response rates of 32.4% were achieved with adjunctive aripiprazole versus 15.2% and 17.4% with placebo, respectively 1
Common Adverse Effects to Monitor
- Akathisia is the most common side effect, occurring in 25.9% of patients versus 4.2% with placebo 1
- Headache (9.0%) and fatigue (10.1%) are also reported 1
- The discontinuation rate due to adverse events is low at 3.7% 1
Drug Interactions Requiring Dose Adjustment
- Reduce aripiprazole dose by 50% when coadministered with strong CYP2D6 inhibitors 2
- Reduce aripiprazole dose by 50% when coadministered with strong CYP3A4 inhibitors 2
- Double the aripiprazole dose when coadministered with strong CYP3A4 inducers 2
Context of Use
This dosing applies specifically to adjunctive treatment in patients with major depressive disorder who have shown inadequate response to standard antidepressant therapy (SSRIs or SNRIs) 1. The evidence supports aripiprazole augmentation after failure of 1-3 antidepressant trials 1.