Can Abilify Be Taken With Paxil?
Yes, Abilify (aripiprazole) can be safely taken with Paxil (paroxetine), and this combination is specifically studied and used in clinical practice for treatment-resistant depression. 1, 2
Evidence for Combined Use
The combination of aripiprazole with paroxetine has been directly evaluated in clinical trials and shown to be both effective and well-tolerated:
A head-to-head comparison study demonstrated that paroxetine augmented with aripiprazole was equally effective and well-tolerated in patients with refractory major depressive disorder. 1
A large double-blind, placebo-controlled trial (N=1,147) specifically included paroxetine controlled-release as one of the antidepressants used with aripiprazole augmentation, showing clinically significant improvements in depressive symptoms with low discontinuation rates due to adverse events (6.2%). 2
The combination achieved a two-fold higher remission rate (36.8%) compared to antidepressant monotherapy with placebo (18.9%), with high completion rates (83%). 2
Clinical Context for Use
This combination is primarily indicated when:
Patients with major depressive disorder show inadequate response to paroxetine monotherapy after an adequate trial. 1, 2
Aripiprazole is added as augmentation therapy, typically starting at 2-5 mg/day and titrating up to 20 mg/day as needed. 2
Safety Considerations
Monitor for serotonin syndrome risk, though this combination has been well-studied: While paroxetine is a serotonergic agent (SSRI), aripiprazole's unique mechanism as a partial dopamine agonist rather than a pure serotonergic agent makes this combination relatively safe. 3, 4
Watch for extrapyramidal symptoms (EPS): Aripiprazole can cause EPS, particularly with long-term use, though it has a lower risk profile compared to other antipsychotics. 5, 6
Consider metabolic monitoring: The aripiprazole-SSRI combination presents a lower risk of metabolic side effects compared to other antipsychotic combinations, but baseline and periodic monitoring of weight, glucose, and lipids is prudent. 6
Be aware of weight effects: Paroxetine is associated with weight gain among SSRIs, and aripiprazole can also cause weight gain, particularly in younger patients. 7, 5
Practical Implementation
Start aripiprazole at low doses (2-5 mg/day) and titrate slowly while maintaining the established paroxetine dose. 2
Assess response within 4-6 weeks of adding aripiprazole, looking for improvements in depressive symptoms using standardized scales. 1, 2
Common side effects of the combination include sedation, akathisia, and gastrointestinal symptoms, but discontinuation rates due to adverse events remain low. 2