Is it safe to use a Selective Serotonin Reuptake Inhibitor (SSRI) with Aripiprazole (Abilify)?

From the Guidelines

Using an SSRI with Abilify is generally considered safe, but it requires careful monitoring due to potential increased risk of side effects such as akathisia, weight gain, and metabolic changes, as well as a small risk of serotonin syndrome. When considering the combination of an SSRI with Abilify, it's essential to weigh the potential benefits against the risks. The most recent and highest quality study 1 provides guidance on the use of SSRIs in children and adolescents, which can be applied to the general population. Key points to consider when using this combination include:

• Starting with a low dose of Abilify (2-5mg daily) and gradually increasing as needed
• Monitoring for side effects such as akathisia, weight gain, and metabolic changes
• Being aware of the small risk of serotonin syndrome, particularly when combining multiple serotonergic medications
• Regular monitoring by a healthcare provider to assess effectiveness and manage potential side effects
• Educating patients on the potential risks and benefits of the combination, as well as the importance of reporting any unusual symptoms immediately. It's also important to note that the combination of an SSRI with Abilify is commonly used in clinical practice, and the benefits often outweigh the risks when used under medical supervision 1. However, the decision to use this combination should be made on a case-by-case basis, taking into account the individual patient's medical history, current medications, and potential risks. Ultimately, the goal is to prioritize the patient's morbidity, mortality, and quality of life, and to use the most effective and safe treatment approach available.

From the FDA Drug Label

Aripiprazole tablets and other medicines may affect each other causing possible serious side effects. Aripiprazole tablets may affect the way other medicines work, and other medicines may affect how aripiprazole tablets works Your healthcare provider can tell you if it is safe to take aripiprazole tablets with your other medicines. Do not start or stop any medicines while taking aripiprazole tablets without talking to your healthcare provider first.

The use of an SSRI with Abilify (aripiprazole) may be safe, but it is recommended to consult a healthcare provider to discuss the potential risks and benefits of combining these medications. Caution is advised when taking multiple medications, as they may interact and cause serious side effects. It is important to inform the healthcare provider about all the medicines being taken, including prescription and over-the-counter medicines, vitamins, and herbal supplements, to ensure safe treatment 2.

From the Research

Safety of Using an SSRI with Abilify

• The safety of using an SSRI with Abilify (aripiprazole) has been assessed in several studies 3.
• A post hoc analysis of a 52-week, open-label study found that the adjunctive use of aripiprazole with SSRIs or SNRIs was generally well-tolerated, with similar symptom improvement between the two groups 3.
• The most common treatment-emergent adverse events were fatigue, somnolence, and akathisia, with no unexpected adverse events reported 3.
• Another study found that the combination of bupropion and SSRIs can increase the risk of serotonin syndrome, a potentially fatal complication 4.
• However, this study did not specifically investigate the combination of Abilify and SSRIs.
• A review of the literature on SSRIs found that they are generally safe and effective, but can have adverse effects such as gastrointestinal disturbances, headache, and sexual dysfunction 5, 6, 7.
• The risk of adverse effects can be minimized by carefully selecting the SSRI and monitoring the patient for potential interactions and side effects 6.

Potential Interactions and Side Effects

• The combination of Abilify and SSRIs may increase the risk of certain side effects, such as somnolence and akathisia 3.
• SSRIs can also increase the risk of serotonin syndrome, particularly when combined with other medications that enhance serotonin activity 4.
• A review of the literature on SSRIs found that they can have a range of adverse effects, including gastrointestinal disturbances, headache, and sexual dysfunction 5, 6, 7.
• The risk of adverse effects can be minimized by carefully selecting the SSRI and monitoring the patient for potential interactions and side effects 6.