Many of us at ATMC were misfits at one point, in fact, our founder at one time was diagnosed schizoaffective. The video attached here is our founder talking about Abilify withdrawal in a way that helps normalize the process. Antipsychotic withdrawal is characterized by upregulated Dopamine receptors getting overstimulated when the drug is reduced, and that this withdrawal can mimic mania.
Does Abilify Increase Dopamine?
According to a 2015 study prepared by NIMH, Aripiprazole may bind to certain receptors in the brain, and trigger a number of responses that modulate dopamine in various ways, sometimes increasing or even decreasing the transmission of dopamine (and perhaps other neurochemicals) along certain pathways. This “adaptive” mechanism of dopamine modulation relates in particular to the mechanism of Aripiprazole and not necessarily to other antipsychotic medications.
There is a theory of schizophrenia that overactivity of the area of the brain referred to as the “mesolimbic pathway” may contribute to symptoms of schizophrenia such as delusions and hallucinations. Therefore, a suggested corollary seems likely, that decreasing mesolimbic pathway activity (such as suggested by ongoing pharmacology research) can reduce symptomology associated with schizophrenia. 3
A 2005 study on mouse brain activity reported by NIMH showed that Aripiprazole increased dopamine and did not increase other neurotransmitters such as serotonin or norepinephrine. The 2015 study gives a more expanded and optimistic view of managing dopaminergic activity with Abilify. More research is needed in regard to continuing to make improvements in the treatment of schizophrenia.
Research on Dopamine, Abilify Withdrawal and Bipolar
On genetic studies we have performed clinically at Alternative to Meds Center, we have seen an association with the COMT (catecholamine methyltransferase) genetic polymorphism and certain conditions involving psychosis, mania, and features of high and low moods as described by the term bipolar.
A potential theory to explain this correlation could be due to the way that the biological pathways for catecholamines function. Catecholamines include dopamine, norepinephrine, and adrenaline, each of which performs an excitatory response to the limbic system, also known as the emotional brain.
Dopamine is associated with the perception of reward. A person with a low sense of reward may be attracted to stimulants, and a person with an overly high sense of reward may present as manic.
The enzyme COMT can degrade dopamine and other neurotransmitters. However COMT impairment inhibits its ability to break down dopamine. Where genetic testing shows the presence of COMT genetic polymorphism, it would stand to reason that the person could be suffering from a dopamine excess. Thus, genetic testing can provide valuable information that can assist in helping someone to normalize or regulate neurotransmitter function as part of Abilify withdrawal.
The methionine variant results in a more sluggish COMT enzyme, which may leave dopamine around the prefrontal cortex for a longer period of time. 6
More research studies are encouraged on this particular point, particularly considering that the aforementioned study is referring to the breakdown of dopamine in the prefrontal cortex as opposed to the striatum structures such as the caudate, putamen, and mesocorticolimbic regions.
Abilify is believed to have the capacity to deflect dopamine from the D2 receptor, and therefore, reduce manic symptoms. Unfortunately, most drugs have limitations due to the adaptations of the body. The body, perceiving a dopamine deficiency can then make more receptors for dopamine. This usually makes an antipsychotic withdrawal the most challenging of all drug classes, including heroin and benzodiazepines.[/su_spoiler]
What is Abilify (Aripiprazole) Used For?
Abilify is a third-generation atypical antipsychotic medication used in the treatment of adult schizophrenia, bipolar 1 disorder, Tourette syndrome, and in young children (age restrictions apply) presenting symptoms associated with Autistic Disorder, such as temper tantrums, mood swings and aggression. Abilify (Aripiprazole) research has accumulated a significant body of data from clinical trials on various age groups and populations over the time the drug was first developed in the late 1990s and released in the US in 2002. Some side effects of Aripiprazole led to the FDA placing a black box warning that restricted prescribing the drug within certain populations or age groups.6
The drug is used primarily in the treatment of schizophrenia, bipolar disorder, and major depressive disorder in adults. The FDA expanded approved uses to include acute mania and mixed episodes (a combination of manic and depressive symptoms), in adults as well as in children who are at least 10 years of age. Elderly patients with signs of dementia should not take Abilify, as stated in the FDA black box warning regarding an increased risk of death in that population.6
Abilify was also approved in 2009 for use in children aged 6 and up with autism. Studies show a reduction in irritability, hyperactivity, inappropriate speech, and aggression associated with autism, but an increase in weight gain, tremors, sleepiness, and drooling. There are no long term studies to show safety over long term use of Abilify in young children.
In the treatment of acute manic/psychotic episodes, Abilify is considered a maintenance medicine and is usually minimally prescribed for a period of 1-2 years.
Abilify is prescribed for these conditions:
- Schizophrenia (impaired perceptions of reality vs unreality, paranoia, difficulty in relating or connection to others, etc.)
- Bipolar disorder
- Borderline personality disorder (an emotionally distressed state characterized by intentions to self-harm, fear of abandonment, intense mood swings, explosive anger, etc.)
- Tourette syndrome (characterized by vocal or muscle tics, repeating phrases, movements, etc.)
- Autism (a condition in children characterized by emotional outbursts, lack of speaking or ability to articulate, social withdrawal, etc.)
- Schizoaffective disorder (mood swings and disconnection from reality)
- MDD, or major depressive disorder (severe depression that lasts over a long period of time)
- OCD, obsessive-compulsive disorder (characterized by repeatedly checking or counting objects or other compulsive motions/actions, etc.)
- Mania/ manic episodes/ psychotic episodes (delusions, extreme euphoric state, impulsive behaviors that could involve harm to self or sometimes others)
- PTSD, or post-traumatic stress disorder (flashbacks or re-experiencing effects from past traumatic events triggered by present environment)
- Agitated State (unpleasant state of aroused negative emotions, confusion, etc.)
Abilify (Aripiprazole) Alternative Names and Slang
Abilify is a trade name for the generic drug, Aripiprazole, or Aripiprazole systemic. Other brand names for the drug include:
- Abilify Maintena
- Aristada Initio
Abilify has not developed any significant demand or presence as a street drug, with the exception in possible cases of diversion, a potential outcome that is shared by all pharmaceutical products in general.
Abilify (Aripiprazole) Side Effects
There are some commonly reported side effects of taking Abilify which may fade within a short time. However, if these reactions linger or worsen, they should receive immediate medical attention:
- Dry mouth
- Lightheaded feeling
- Restlessness, need to keep moving
- Cold-like symptoms like runny or stuffy nose, sneezing, etc.
- Stomach pain
- Sore throat
- Anxiety, fear
- Weight gain
- Blurred vision
- Any of the above if severe or lingering needs medical attention.
Possible Severe Side Effects
Side effects that are more severe can less commonly present, and require medical intervention immediately should they occur, including the following:
- High fever
- Blood pressure fluctuations, high or low
- Difficulty with speech or articulation
- Rolling tongue
- Sweating (profuse)
- Drooling, excess salivation
- Swelling of hands, feet, bloating in the limbs, etc.
- Tachycardia (pounding heartbeat, racing heartbeat)
- Loss of balance
- Joint pain
- Tingling or numbness in the extremities
- Inability to move
- Rash, blistering rash or ulcers that develop in mucous membranes
- Trembling muscles, jerking motions, spasms
- Muscle stiffness, rigidity
- Uncontrolled facial motions
- Twisting body or limb motions (involuntary)
- Loss of bladder control
- Lip-smacking, puffing of the cheek muscles
- Extreme tiredness
- Sudden loss of consciousness
- Akathisia combined with suicidality
- Other involuntary muscle movements, repetitive
- Tardive dyskinesia (very rare) usually irreversible
Aripiprazole is a third-generation type of antipsychotic medication, thought to be better tolerated than conventional or earlier antipsychotic drugs. Nonetheless, severe or persisting side effects should be monitored carefully and given medical attention if needed, without delay. 1
Abilify (Aripiprazole) Withdrawal Symptoms
Abilify is associated with some adverse withdrawal effects and should never be abruptly discontinued. Slowly reducing the dosage over an adequate time frame is the recommended process for coming off the drug. 2
According to studies published by NIMH, withdrawal symptoms for Abilify can include the following:
- Feeling lightheaded
- Diaphoresis (excessive sweating involving the entire body)
- Tremors, shakiness
- Flu-like symptoms
These withdrawal symptoms may range from mild to severe, and a person may experience one or multiple concurrent symptoms during cessation or tapering Abilify.
Discontinuing/Quitting Abilify (Aripiprazole)
Discontinuing or quitting Abilify (Aripiprazole) can be best done by gradually tapering off the drug, with medical oversight and guidance. Symptoms may develop to a severe and intolerable level. The preferred approach if possible would be to taper while in residential care.
Aripiprazole has a half-life of 75 hours, and the half-life of its active metabolite “dehydro-dripiprazole” is 94 hours. It was at one time thought that due to the drug’s long half-life, that withdrawals would not likely emerge on abrupt cessation, but this was not always found to be the case in more recent trials and research. Sometimes even on abrupt cessation there is a delayed onset of symptoms, which can nonetheless be quite hard to tolerate unless proper support is in place. Therefore the medical recommendation is to taper gradually from antipsychotic medications. 2