Abilify Review: Effective for Schizophrenia, Depression and Mania?

Abilify Review: Effective for Schizophrenia, Depression and Mania?


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Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.

Abilify is one of the most commonly-prescribed antipsychotic medications. It's FDA-approved for the treatment of schizophrenia, major depressive disorder (MDD), and acute treatment of manic episodes associated with bipolar disorder.

The generic name for this drug is aripiprazole, and we’ll use these two terms interchangeably throughout the article because they refer to the same active chemical compound.

But is Abilify really proven to be effective for all of these mental conditions? Does the drug have any concerning side effects? Does it cause weight gain? And how do real users describe its effects and downsides?

In this article we’ll answer all of these questions and more as we review clinical studies on Abilify to determine if it's effective for all of the conditions it's approved to treat. We'll document side effects of the drug, explain whether it causes weight gain, explain whether the generic version is as effective and share real, unsponsored user reviews of Abilify.

Is Abilify Proven to Work?

Abilify has been studied in many clinical trials for its effectiveness in treating schizophrenia, mania, bipolar disorder and depression.

A medical review published in the Clinical Therapeutics journal examined data from 11 clinical trials on Abilify for schizophrenia.

The study authors found that Abilify was effective as a monotherapy (use of one drug alone) to treat schizophrenia in both short-term and long-term trials. One of the studies lasted up to 52 weeks, and symptoms were controlled throughout. The drug was even found to be effective for treatment-resistant schizophrenia, which is defined as schizophrenia that did not respond to other pharmaceutical drugs.

A similar meta-study examined the efficacy of Abilify for treating acute mania. Ten clinical trials were included in the review.

Abilify was found to be effective for reducing mania symptoms short-term (3 and 4 weeks from start of treatment) but not long-term (6 weeks from start of treatment). The medication was equally effective to two other commonly-prescribed drugs for mania, lithium and haloperidol.

An extensive review published in 2017 examined results from 20 clinical trials on Abilify to treat bipolar disorder.

The review found that Abilify was effective for some characteristics of bipolar (acute mania, psychosis) but not others (depressive symptoms). It was concluded to be effective overall because it improved patient wellbeing when compared to placebo.

Abilify is only approved to treat depression as an adjunctive therapy, meaning it's used in addition to other antidepressants.

A 2009 clinical trial examined the efficacy of Abilify as an adjunctive therapy for patients who didn't respond to antidepressant monotherapy (taking one antidepressant alone). After 14 weeks, 36.8% of patients using Abilify experienced a partial or full reduction in their depression symptoms.

We will conclude that Abilify is effective for treating schizophrenia, mania, bipolar disorder and depression (as an adjunctive therapy). The clinical backing for Abilify as a treatment for schizophrenia appears stronger than the clinical backing for the drug to treat the other conditions it's approved to treat.

Abilify Side Effects

Abilify black box warning

Abilify has a "black box" warning on its label, shown above, indicating how the drug may increase the risk of death in elderly patients with dementia-related psychosis, and may increase the risk of suicidal thoughts and actions in children, adolescents and young adults taking antidepressants.

This type of warning is the most severe level of warning issued by the FDA, and is reserved for side effects that may be life-threatening. 

According to research, the most common side effects of Abilify are restlessness, drowsiness and nausea. These are clearly more mild than the more rare but serious side effects.

The FDA also published a concerning warning letter in 2016 documenting impulse-control problems associated with Abilify use. The agency explained in the letter how Abilify’s warning of problem gambling as a rare side effect wasn’t comprehensive enough, and that compulsive eating, shopping and sexual habits were also a risk.

Given the varied side effects that Abilify has the potential to cause, it's important that patients speak with their doctor about these risks before using the drug. For patients in at-risk groups like elderly patients with dementia-related psychosis and young adult patients or children taking antidepressants, it may make sense to speak with their doctor about alternative medications or treatments that do not confer such severe risks.

Real, Unsponsored User Review of Abilify

One of the most popular YouTube reviews of Abilify from a real patient is published by a creator named Sarah Rocksdale. She explains her experience using Abilify including pros and cons of the drug, and side effects:

Does Abilify Cause Weight Gain?

Patients are often curious about whether Abilify will cause weight gain, given that antipsychotic medications as a drug class are notorious for this side effect.

A 2018 meta-study analyzed data from over 25,000 patients that took Abilify, and documented an average weight gain of 3.40% baseline body weight after 180 days. This equates to a potential annualized weight gain of around 13.6 pounds for an individual weighing 200 pounds at baseline.

Another medical review compared the risk of weight gain and metabolic disorder from Abilify use with that from other antipsychotic medications, and found that while Abilify was associated with weight gain, it caused less weight gain than other drugs in the same drug class.

It appears that the risk of weight gain is not unique to Abilify but to atypical antipsychotic use generally, and that Abilify may be the best option in regard to minimizing risk of weight gain when selecting a drug for this type of treatment.

Even so, it may be worthwhile for overweight and obese patients to speak with their doctor about medications that may not be associated with weight gain, given that physical and mental health are so closely connected.

Is the Generic Version of Abilify As Effective?

The generic form of Abilify is called aripiprazole. Both drugs contain the same active chemical compound.

A medical review published in the PLOS Medicine journal analyzed data from over 1 million patients and found that on average, generic and branded drugs were equally safe and effective. This suggests that generic arpipiprazole should be just as effective as Abilify.

We would recommend that patients speak with their doctor about generic aripiprazole instead of Abilify. According to SingleCare, the average retail price of Abilify is over $1,000 at the time of updating this article, while aripiprazole can be purchased for $6 on Cost Plus Drugs (Mark Cuban's venture).

Abilify Dosage

According to StatPearls, which is a free medical database, the dosage of oral Abilify tablets tends to range from 5 milligrams (mg) to 30 mg daily.

Intramuscular Abilify (branded as Abilify Maintena) dosage ranges from 441 mg to 1,064 mg. The benefit of Abilify Maintena is it's a once-monthly treatment, so it may be more convenient and may improve patient adherence (it's easy to forget to take daily pills). Both forms of using the drug should be equally effective.

The dose used for treating bipolar and schizophrenia tends to start at 10 or 15 mg and work up to 30 mg, while a lower dose of 2-5 mg is often prescribed when Abilify is used as an adjunctive treatment.

Doctors will typically prescribe a medication at a dose on the lower end of the therapeutic range to start, to minimize the risk of bad reactions or side effects. If the patient is responsive, they can stay at that dose. If they're unresponsive, their doctor may slowly increase their dose until they've reached the maximum safe daily dose.

Can Abilify Ruin Your Life?

The term "Abilify ruined my life" gets over 2,500 monthly searches at the time of updating this article. Some of the discussions around the downsides of this drug highlight its potential to cause a gambling addiction.

A news channel Fox 9 Minneapolis-St. Paul documented a woman who claims Abilify ruined her life after she lost over $150,000 gambling while on the drug:

How Does Abilify Work?

Abilify is effective because it stabilizes dopamine and serotonin levels in various regions of the brain according to StatPearls. These neurotransmitters are essential to proper cognitive functioning, and often exist in sub-optimal levels in patients suffering from mental conditions.

More specifically, Abilify is a receptor agonist at the D2 and 5HT-1a receptors and an antagonist at the 5HT-2a receptor. An agonist is a compound that activates receptors to produce a biological response, while antagonists do the opposite: they bind to receptors and reduce their response.

Relative to more commonly-diagnosed mental conditions like anxiety and depression, the understanding of the medical community of exactly what causes schizophrenia and bipolar disorder is still early-stage, but this suggests that Abilify may normalize brain function in patients with mental conditions.

Our Mental Wellness Recommendation

We recommend a platform called Brightside to patients on a mental health journey. It's an online therapy and medication platform that connects patients with licensed therapists and doctors from the comfort of their home.

medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.

Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.

Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.

The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.

Interested patients can check out Brightside at this link to the brand's website.

Stay up-to-date on our research reviews

Conclusion

Abilify is effective for treating various mental health conditions. It has been clinically proven to treat schizophrenia, acute mania, bipolar disorder and depression as an adjunctive therapy.

The side effect profile of Abilify is relatively severe, including increased risk of suicidal thoughts in young adults and death in elderly patients with dementia-induced psychosis. The drug may also cause addictive behaviors according to the FDA.

Abilify is associated with weight gain, but may cause less weight gain than other drugs in its drug class.

We would recommend that patients speak with their doctor about generic aripiprazole rather than Abilify because it should be as effective but may be significantly cheaper.




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