What are the considerations for starting Abilify (Aripiprazole)?

From the Guidelines

Starting Abilify (aripiprazole) typically begins with a low dose that is gradually increased to minimize side effects, with a recommended starting dose of 5 mg p.o. or i.m. (immediate-release) stat, as suggested by the most recent evidence 1. For adults with schizophrenia, the usual starting dose is 10-15 mg once daily, which may be increased to a target dose of 15-30 mg daily. For bipolar disorder, treatment often begins with 15 mg daily, adjustable based on response. When used for depression as an adjunct therapy, a lower starting dose of 2-5 mg daily is common. Take Abilify at the same time each day, with or without food. You may experience initial side effects like drowsiness, dizziness, weight gain, or restlessness, which often improve over time. It typically takes 1-2 weeks to notice initial improvements, with full benefits developing over 4-6 weeks. Regular follow-up appointments are essential to monitor your response and adjust dosing. Abilify works differently from other antipsychotics as a partial dopamine agonist, helping to stabilize dopamine levels rather than simply blocking receptors. This unique mechanism often results in fewer side effects compared to older antipsychotic medications, as noted in studies comparing its effects to those of other antipsychotics 1. Some key points to consider when starting Abilify include:

• Monitoring for side effects and adjusting the dose as needed
• Regular follow-up appointments to assess response and adjust treatment
• Being aware of potential interactions with other medications, as noted in the guidelines 1
• Considering the patient's individual circumstances and medical history when selecting a treatment dose and schedule. It's also important to note that Abilify has been shown to have a lower risk of weight gain compared to some other antipsychotics, such as olanzapine and quetiapine, as discussed in the study on the practical use of pharmacotherapy for obesity 1.

From the FDA Drug Label

A syndrome of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with antipsychotic drugs Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. The risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase. Given these considerations, aripiprazole should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia Chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness that (1) is known to respond to antipsychotic drugs and (2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate In patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought.

Starting Abilify (aripiprazole) requires careful consideration of the potential risks, including the development of tardive dyskinesia.

• The risk of tardive dyskinesia increases with the duration of treatment and cumulative dose of antipsychotic drugs.
• Chronic antipsychotic treatment should be reserved for patients with a chronic illness that responds to antipsychotic drugs and for whom alternative treatments are not available or appropriate.
• The smallest effective dose and shortest duration of treatment should be used to minimize the risk of tardive dyskinesia 2.
• Patients should be monitored periodically for signs and symptoms of tardive dyskinesia, and drug discontinuation should be considered if they appear 2.

From the Research

Starting Abilify

• Abilify, also known as aripiprazole, is an atypical antipsychotic medication that has been studied for its effectiveness in treating various psychiatric conditions, including bipolar depression and major depressive disorder 3, 4, 5, 6.
• In a study published in 2012, aripiprazole was found to be one of the most frequently prescribed antipsychotic medications for bipolar depression, with 10% of patients receiving it as part of their treatment regimen 3.
• Another study published in 2014 found that aripiprazole augmentation therapy was effective in reducing psychiatric service utilization among patients with major depressive disorder, including length of hospitalization, number of admissions, and emergency room visits 4.
• A 2022 systematic review and network meta-analysis found that aripiprazole was one of the most effective augmentation agents for treatment-resistant depression, with significant improvements in response and remission rates compared to placebo 5.
• Aripiprazole has also been studied for its potential neuroprotective effects, with some evidence suggesting that it may reduce microglial activation and inflammation in the brain, which could be beneficial for patients with anxious mild cognitive impairment and early Parkinson's disease 7.

Potential Benefits and Uses

• Aripiprazole may be used as an adjunctive treatment for major depressive disorder, particularly in patients who have not responded to other treatments 4, 5.
• It may also be used to treat bipolar depression, either as a monotherapy or in combination with other medications 3, 6.
• Aripiprazole has been found to have a relatively low risk of extrapyramidal side effects and tardive dyskinesia, making it a potentially useful treatment option for patients with mood and anxiety disorders 6.

Comparison to Other Medications

• Aripiprazole has been compared to other atypical antipsychotic medications, such as quetiapine and olanzapine, in terms of its efficacy and safety profile 3, 4, 5.
• It has also been compared to other augmentation agents, such as lithium and thyroid hormones, in terms of its effectiveness in treating treatment-resistant depression 5.