What is the recommended dose of Abilify (aripiprazole) for treating depression?

Aripiprazole (Abilify) Dosing for Depression

For major depressive disorder, aripiprazole is used as adjunctive therapy to antidepressants at doses of 2-15 mg daily, starting at 2.5-5 mg daily and titrating based on response and tolerability.

FDA-Approved Indication

Aripiprazole is FDA-approved as adjunctive therapy to antidepressants for treatment-resistant major depressive disorder, not as monotherapy 1. This means it must be combined with an ongoing antidepressant (SSRI, SNRI, or bupropion) that has shown incomplete response after adequate trial 2.

Dosing Strategy

Starting Dose

• Begin with 2.5 mg daily 2
• The lower starting dose significantly reduces akathisia risk compared to starting at 10 mg daily (discontinuation rates: 1/8 patients vs 3/7 patients at 4 weeks) 2

Titration and Target Dose

• Effective dose range: 2.5-15 mg daily 3, 2
• Most patients respond to 5-15 mg daily 4
• Some studies used 15-30 mg daily for persistent symptoms 3
• Titrate gradually based on response and side effects 2

Timing of Response

• Rapid onset possible: 40% of responders (6/15 patients) achieved remission within 1 week of starting aripiprazole 2
• By week 2,60% (9/15 patients) had achieved remission 2
• Full assessment should occur by 6 weeks 1

Clinical Considerations

When to Initiate

Start aripiprazole augmentation after ≥8 weeks of adequate antidepressant monotherapy that has resulted in partial or no response 2. The mean duration of failed antidepressant therapy in successful augmentation studies was 43 weeks 2.

Duration of Treatment

• Acute phase: 6-12 weeks to establish response 1
• Maintenance: Benefits sustained up to 2 years in bipolar depression studies 4
• For unipolar depression, continue as long as augmentation benefit persists 1

Combination with Antidepressants

Aripiprazole has been successfully combined with:

• SSRIs (most common) 3, 2
• Venlafaxine 2
• Bupropion 2

Response does not appear related to which specific antidepressant is used 2.

Safety and Tolerability

Common Side Effects

• Akathisia is the most significant concern, occurring more frequently than in schizophrenia treatment 1
• Most akathisia cases are mild-to-moderate 1
• Starting at 2.5 mg daily reduces akathisia-related discontinuation by 50% 2
• Weight gain is minimal over 6 weeks 1

Critical Warning

Screen for history of impulse control disorders before prescribing, as aripiprazole can provoke compulsive behaviors including pathological gambling 5. The FDA issued warnings about this risk in 2016 5.

Monitoring

• Assess for akathisia at each visit, especially in first 2-4 weeks 2
• Monitor for emergence of compulsive behaviors 5
• Evaluate response by week 2-6 1, 2

Practical Algorithm

1. Confirm adequate antidepressant trial (≥8 weeks at therapeutic dose) with persistent symptoms 2
2. Screen for impulse control history and counsel about compulsive behavior risk 5
3. Start aripiprazole 2.5 mg daily 2
4. Assess at week 1-2 for early response and akathisia 2
5. Titrate to 5-10 mg daily if tolerated and needed for full response 3, 2
6. Maximum dose 15 mg daily for most patients 4, 3
7. Continue indefinitely if maintaining remission 1