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Abilify (aripiprazole) tapering may seem near to impossible while suffering from symptoms and side effects, but using gentle, strategic methods, with medical oversight, and careful observation our clients have had much success at Alternative to Meds Center.
We use proven methods to create customized tapering treatment plans based on the individual’s unique history and situation. Antipsychotics like Abilify, even if initially warranted, don’t always need to impose a life sentence of heavy medication.
Does Your Diagnosis
Alternative to Meds has 15 years of experience providing antipsychotic tapering treatment. Our published evidence clearly demonstrates the success of our clients. Were underlying issues missed? Testing and assessment can reveal if this was the case and if so, these are not life sentences, but conditions that can be relieved in non-toxic ways in most cases.
Watch this video of a young man who had an extensive history of psychosis and wreckage that seemed hopeless. Ryan recovered at ATMC, which astounded his family, friends, and former prescribers. He is now a mental health coach to others suffering from psychosis based upon his experiences.
15 Years Experience by Professionals Who Understand Your Journey.
Why Consider Abilify Tapering, (aripiprazole) Titration, and Weaning?
More people began to consider Abilify tapering when the FDA expanded the black box warning in 2016 to include pathological gambling and other compulsive behavior disorders caused by Abilify.8 The list of warnings, precautions, and adverse effects on the drug’s label is so long that it would be unwieldy to list it all here. A few of them are as follows: suicide, stroke including fatalities, Tardive Dyskinesia, seizures, convulsions, cognitive & motor impairment, akathisia, diabetes, salivary hypersecretion (drooling), and many, many more. Relatively recently, the drug became only available in the US as the generic aripiprazole, and possibly some extended-release versions under different brand names. Extensive testing on animals and humans has documented significant health risks that can affect all age groups and genders, autistic and non-autistic very young children, and even the unborn. Clinical trials show that improvements while on second-generation antipsychotics are often offset by their significant adverse effects.5,7 This FDA-sourced safety information may motivate one to seriously consider Abilify tapering (or its generic equivalent) and transitioning to safer alternatives for treatment.
First-generation antipsychotics have been compared to second-generation antipsychotics and have been found comparable in efficacy but still as problematic or sometimes worse when it comes to adverse effects. In a 3-year clinical trial from 2010 to 2013, published in The Lancet, Grunder et al found that second-generation antipsychotics caused adverse effects such as nervous system disorders, psychiatric disorders, increased weight, in over 60% of the participants. First-generation antipsychotics caused similar adverse effects in 45% of the comparison group.6 While neuroleptic drugs may provide certain relief from acute symptoms in the short term, they do not offer a cure, and often any benefits are obfuscated by their adverse effects. If a healthcare provider has not explored other options comprehensively, it may be helpful to explore non-drug-based treatments before settling for a lifetime of taking Abilify.
Abilify Tapering Guidelines and Schedule
Antipsychotic tapering is the most difficult drug class of all, in our estimation, more difficult than opiates and benzodiazepines. Please note the below is only given so as to share with your prescriber, most definitely not to act on without competent, compassionate support.
You may already be aware of how tapering Abilify without support can be disastrous, and we stress the importance of working closely with a prescriber, or even better, enrolling in an inpatient tapering program if possible.
Abilify Tapering Guidelines Include:
Begin your Abilify taper only if you are in a stable state, eating and sleeping well.
Choose someone you trust, i.e., a family member or close friend to be your contract for safety and who can and will help in an emergency. (See below for more information on this point.)
You must gather the support of a prescriber who can monitor and oversee the taper.
Avoid stimulants like coffee or other caffeinated drinks, recreational drugs, alcohol, stimulants.
Keep blood sugar levels even by consuming small protein-based meals throughout the day.
Breakfast should be protein-based and substantial.
Start regular cardio exercise for its physiologic benefits.
Arrange with your prescriber to use the lowest dose version of Abilify during the taper. (green oval-rectangle 2 mg tablet)
Discuss with your prescriber what to do regarding any other medications you take. (more information on this is provided below)
Take it slow. Expect the taper to last about a month, or so, for each year that you took Abilify.
You and your prescriber can monitor symptoms and sensitivity to better judge when to adjust the rate of the taper as needed.
Discuss with your prescriber withdrawal symptoms that are likely to occur so you are prepared.
Tell your prescriber if you are not sleeping or eating well or experiencing other behavioral changes such as mood swings etc. so the stabilizing period can be extended before further reduction.
Tapering generally can be most difficult at the end phase. Do not rush this phase.
Optional: Your prescriber may feel it is helpful to give you Depakote as a bridge medication.
Avoiding repetitive stimulating music, tv, stimulating religious material, etc., is advised.
If you are taking an injectable form of Abilify speak to your prescriber about converting to an oral form for tapering purposes.
Be in a stable place when considering Abilify titration
An urgent transition from Abilify may be indicated in some persons because of certain genetic polymorphisms. Movement disorders, akathisia, tardive dyskinesia, metabolic disorders, or other severe reactions may require immediate cessation.5,6 At Alternative to Meds we specialize in slow, gradual tapering and do not deliver rapid withdrawal procedures. Discuss and plan with your prescriber the best resources available to you, should rapid taper strategies become needed.
Abilify tapering at Alternative to Meds is recommended only when the person is in a stable condition prior to Abilify titration. This means sleeping and eating regularly, exercising regularly, no stimulants, recreational drug use, and have family or friends as support. Consider some regular work activity of a non-stressful nature and a stable routine that will contribute to a condition of stability. We do not advise attempting Abilify tapering if your sleep is an issue. Discuss with your prescriber whether some non-antipsychotic medication can be given to help regulate your sleep and ease the tapering process.
Contracting for safety with a trusted person
Various types of contracts for safety and security can play an important and practical role in ensuring a successful recovery. SAMHSA published the book, “Approaches to Therapy” in 20049 which outlines several examples of contracting for safety that can be adapted to your unique situation or that of a loved one. As an example, during a manic episode, it may be difficult to follow directions, even from the trusted people closest to you. You may feel you are in an awakened state, and you are sure that your choices are correct, despite that you are altering the tapering regimen you have been following. The contract for safety established that the taper needs to continue in a methodical, slow process. Otherwise, sudden changes (like deciding to stop your medication) may make things go completely off the rails. The person or persons that you have contracted with, in concert with the prescribing doctor, would tell you to go back on the medication if you stopped, and your prior agreement will take precedence. If you put the commitment in writing, your contract person can show it to you later if you become manic & resistive to taking your medication. You would also be reminded that should you withdraw your agreement, the police or a hospital will get involved. While it may seem unbearable that your life appears to be ruled by this medication, the path forward is the slow path of gradual reduction. If this concept has been come to terms with and contracted for safety before beginning Abilify tapering, it will help the situation to come right again without excessive delay or stress. Abrupt cessation of Abilify is almost always a complete disaster and can be easily avoided by contracting for safety, put firmly in place in the beginning.
Medical support for your Abilify taper
An outpatient setting may not be ideal for Abilify tapering but sometimes it may be the only choice. There may be holistic psychiatrists near you who may be in the best position to assist you. Please share the information you find here with your healthcare provider, who may opt to utilize contracting for safety before beginning to help you.
Eliminate all forms of caffeine or other stimulants
We tend to think of caffeine as a mild stimulant, and roughly 65% of Americans enjoy it every day. While taking Abilify, coffee may have proved beneficial in lifting mood and counteracting the sedation from the medication. For a person tapering from antipsychotic medication, however, caffeine in coffee, tea, chocolate, or sodas loaded with stimulants can cause psychiatric symptoms to worsen because of drug interactions.10 The last thing a person wants is a dopamine surge during antipsychotic medication tapering.12 We cannot overstate the risks. Eliminate caffeine beverages and other stimulants to help ensure success for your Abilify taper.
Stop marijuana use
There has been much research showing possible links between marijuana use and psychiatric symptoms and disorders.13 According to a 2019 paper published in The Lancet, authors Di Forti et al found that the higher the potency and frequency of cannabis use, the greater the incidence of psychosis. First episode psychosis increased by as much as 5 X compared to never users.14 While you were taking Abilify, it is possible you were not in jeopardy, however, it is not the same when you are tapering Abilify. Drug interactions, a vulnerable genetic profile, and other factors may come into play which may worsen symptoms and throw you off course. The safest approach is to eliminate marijuana use to avoid these challenges.
Blood Sugar Info and Meal Tips
Glycemic balance is an important pillar for mental health. Hypoglycemia and to a lesser extent, hyperglycemia ( especially in the diabetic person ) are both associated with sudden-onset psychosis, delirium, confusion, and other symptoms.15,16 Food choice is a tremendous tool that is within reach to prevent psychiatric symptoms long recognized as linked to dips and spikes in blood sugar levels. You can help reduce stress, relieve depression, and enjoy increased energy and clearer thinking, by choosing protein, healthy fats, and fiber over sugars and refined carbs. Numerous small protein-based meals over the day, starting with breakfast, can stabilize blood sugar levels. Snacking as often as needed is recommended between meals to avoid blood sugar crashes and the symptoms that can go with that. Prepare some ready-to-go, low-glycemic snacks such as hard-boiled eggs, raw veggies and peanut butter, a protein shake, an apple, cheese & ham roll-ups, and so many other delicious grab-and-go choices.
There are potential benefits for just about anyone from regular, well-planned cardio/aerobic exercise. Particular benefits may help persons who are preparing for or engaged in medication tapering and recovery. Antipsychotics dampen or block dopamine — blocking motivation, reward, pleasure. The resulting sedentary effects may contribute to weight gain, decreased muscle tone, as well as low motivation, low mood, and other health issues. Exercise, even of a mild nature, has been found to promote neuron regeneration and other important biological factors that can help support mental health in a natural way.18 This may be especially helpful during Abilify tapering, by helping the body to rebalance, during the transition back from these medication-related impairments.
Having the smallest milligram dose Abilify available to use for the taper
A practical approach is to ask your doctor to prescribe pills at the lowest dosage available, which is the green oval-rectangle 2 mg tablet. Please note, these will be used in tapering and that does not mean you would take only the lowest dose straight away. You and your prescriber will work down gradually and this is easier to configure using the lowest dose pills. For example, let’s say a person is on 30 mg Abilify. You would want to have the 2 mg version available so that for dropping down to 27 mg, one could cut the 30 mg in half, for 15 mg, and then add six of the 2 mg to equal a total of 27 mg. Your prescriber may choose to use the 10 mg and the 2 mg versions to make the math easier. Any of the Abilify versions can be halved as needed to configure the correct milligram dosing needed.
Managing concurrent medications
Speak with your prescribing physician about managing other medications you are also taking, prior to your Abilify taper. Both antipsychotics and stimulants affect dopamine but in opposite ways. Taking antipsychotics and stimulants at the same time can cause SAS or stimulant antipsychotic syndrome.19 SAS is associated with tics and other movement disorders. Part of a well-organized taper plan would include speaking with your prescriber about reducing the stimulant drugs prior to reduction of Abilify or its generic equivalent.
However, certain other drugs may be beneficial to stay on until the Abilify taper is complete, or at least until you are stable. For example, a mood-stabilizer like Lamictal may ease the Abilify taper. When the antipsychotic taper is complete, that may present a better opportunity to then taper off other medications. A person may be on multiple medications of conflicting classes so discuss with your doctor the safest strategy. Each person is a unique case, and these are important factors to discuss with your prescriber before attempting to reduce antipsychotic medication.
How long is my Abilify taper going to last?
Transitioning to being 100% medication-free may not be possible for everyone. Some will have an easier time than others. For those who are motivated despite the symptoms that they come into the program with, we aim to help each person as much as possible to achieve their health goals. Whether this takes 8 weeks, 3 months, a year, or longer, will depend on many factors. This is why each program must be designed and scheduled individually.
Percent of Abilify reduction and the duration between cuts
Timing and dosage cuts are entirely dependent on individual factors and circumstances, including symptoms. But as an example, after taking antipsychotic medication for 5 years, a person may expect to take 5 months, or perhaps longer, for the taper. A person on antipsychotics for 10 years might be looking at a period of 10 months or so for tapering. Your physician may start you off at a 10% reduction. Then after a stability period lasting 2 solid weeks of eating and sleeping well and maintaining a good routine, not angry and not manic, the next reduction might be introduced. For a person on antipsychotics for short time, for example, one month, your physician may begin a 10-25% reduction every few weeks, but the stabilizing period between cuts would need to be extended until you are no longer symptomatic at each new level. Eventually, the cut will amount to less than 2 mg Abilify, so your physician can cut the Abilify 2 mg in half giving you 1 mg, or even try to break it into four pieces to get .5 mg. The taper must be gentle and definitely not faster than can be tolerated. It should be well-monitored, and no further cuts should be attempted until symptoms at each level subside.
Symptoms during the taper
It may be difficult to tell what symptoms are from the withdrawal, and which ones might be a return of original symptoms. That is due to something called upregulation.20 Upregulation means the body adapts to the effects of the drug, in this case, the withholding of dopamine. This holding back of dopamine (think of starving) causes the receptors to become supersensitive (think of being ravenously hungry). In this state of upregulation, reduction of the drug causes a flood of available dopamine which hits very “hungry” receptors, and emotions, thoughts, and behavior can become volatile. This phenomenon of dopamine excess will eventually even itself out (downregulate) but it will take time to do so. It is during this rebalancing period that most of the questions arise such as how severe are these effects and is it necessary to increase the medication back up to prevent a real crisis? These are the kinds of things your prescriber/caregiver must be alert to while monitoring the situation. It is important to realize that while on Abilify (or its equivalent) thoughts are dampened. Interest is squashed. But when the drug is reduced, even slightly, unresolved questions about life, spirituality, past trauma, etc., can spring back into view and become troubling to the point of risking a compulsive or psychotic episode. If these new awakenings are being tolerated well, this is a green light for the taper to continue on safely. But if these red flags start to pop up, the person has now entered the danger zone, and the taper should be slowed until things even out again. Hospitalization may be required in some cases. This is not a failure. However, it may mean more supports are needed, and that in some cases, being medication-free is not realistic for absolutely everyone. Be patient with yourself, realize this is a difficult and time-consuming task and despite setbacks that may occur, with perseverance, your best success is still in reach.
“It is akin to driving a logging truck down a mountain with switchbacks on an icy road. You have to go light on the accelerator and go slow and be prepared to use your brakes. If you are a skillful driver, you get the truck down the mountain. If you try free-wheeling it, you crash and the result is a disaster. Trying to accelerate around the turns because it feels good can turn out the be the wreck that you would expect driving. There are similar laws of gravity and inertia involved in Abilify tapering. Go slow so you can get down the mountain; that is the over-arching axiom.” ~Lyle Murphy, Founder ATMC.
Last Abilify medication cuts … likely the most difficult
As you come nearer to the end of your antipsychotic tapering it is not uncommon for the stabilizing periods to last longer than before. You may want to increase the time between each cut, to allow adequate rebalancing. The supports you have been using, such as diet changes, supplements, counseling, and other therapies can help this transition phase substantially.
Bridge medications for Abilify weaning
At Alternative to Meds Center, we have found the use of bridge medications can be helpful especially if an impasse is reached at the very low levels of antipsychotic tapering. You can read more about how bridge medications and various other methods of tapering can be helpful.
Limiting stimulating media during Abilify Tapering
While tapering antipsychotic medications, excess dopamine surges are not your friend, despite how great they might feel. Things like stimulating music, movies, TV, gambling, even certain reading material or online pursuits can be too stimulating. In contrast, outdoor walks, gardening, photography, painting or sketching, yoga, and regular exercise could be the kinds of grounding activities that better support your transition to drug-free.
Before being tested on humans or coming to the consumer market, Abilify was tested in clinical trials on rats.1 The FDA legally requires drugs to be first tested on animals before human trials can be done, as a way to demonstrate or predict their safety for human consumption. Did you ever wonder why rodents like rats and mice are so often used in drug trials?
Rodents, for instance, can be quite easily cloned (manipulated reproduction) to pass on nearly identical genetic biomarkers and traits, and so testing results may be considered generationally more uniform within this type of protocol. They are also an inexpensive resource, especially when utilized on such a large scale. The genetic blueprint of rodents is likely very different than human detoxification traits. Rats can live in sewers with demonstrably superior detoxification genetics. Today, drug testing for safety on animals is common to virtually all new drugs before marketing them to humans. However, this may or may not increase one’s confidence when assessing the value of relying on animal testing. One concern, for instance, is that humans are not clones. Another is that humans do not subsist largely off of rotting food items procured from sewers or garbage dumps. It seems that drug testing can provide useful information, but cannot be heavily relied upon as predictive of safety in men, women, and children … an observably diverse population.
Does Drug Testing Ensure Abilify Safety?
We wish that we could say it did. Truly.
In 2019, Abilify drugmakers were sued by thousands of persons who were not informed the drug could cause compulsive gambling, sex, eating, shopping, thoughts of suicide, etc. The settlement was reached but kept confidential.21
Numerous other lawsuits can be researched, demonstrating that drugmakers are not as honest about protecting health as they sometimes claim.22
In the 1950s, a drug called Thalidomide was given the “green light” for human consumption, after much animal drug testing was done on the drug. Extensive testing was done on rats, mice, rabbits, hamsters, dogs, cats, primates, swine, ferrets, guinea pigs, and even armadillos. From these test results, researchers noted only occasional birth defects. So the drug was approved for human use, and with particularly tragic consequences, for pregnant women.
You have likely seen the pictures of some of the many thousands of children who were born missing limbs and with other deformities. Thousands more died due to the drug’s toxicity on the fetus. Mothers had been prescribed Thalidomide to reduce morning sickness during pregnancy. After the drug was recalled, animal testing was further done, but this time it was done on pregnant animals, which clearly demonstrated the toxic effect on animal offspring. The animal babies were also born with similar missing limbs or other deformities or suffered fetal deaths. As a consequence, legislation was passed in 1962 that required (more correctly, reinforced earlier legislation) that all drugs had to be tested on animals first. 3
The point is that Thalidomide WAS tested, extensively and it still killed and maimed thousands of innocents. Clearly, what passes as testing does NOT ensure drug safety. If Thalidomide was a drug designed to treat not morning sickness, but schizophrenia, perhaps a test on schizophrenic rodents or armadillos would have given a certain predictive advantage to the testing results. But of course, no such animal population is available for such testing. So instead, human Abilify drug trials were done on schizophrenic patients after testing on non-schizophrenic rodents showed the drug to be safe. One can observe that “testing” a drug, especially one that is designed for a specific population such as schizophrenia/psychosis patients, may not be able to predict safety as certainly as we might desire. What we can say with surety is that drug tests that are typically short in duration, that drugmakers can be selective in their reporting, and other factors leave a gapingly large safety gap. This saddens us greatly, but also affirms our resolve to help those who are struggling.
Drug Risks vs Abilify Weaning
The FDA is probably the best open-source of information on drug safety. In the FDA’s medication guide for Abilify, we are told that there is a high risk of death when prescribing Abilify to elderly dementia (memory loss) patients and elderly patients with psychosis (loss of touch with reality). The FDA also posts a “black box” warning on the drug for increased risk of suicidality (suicidal thoughts and actions) and expanded it to include compulsive behaviors and other health risks in those taking Abilify. The drug is also linked to worsened depression, especially in children, teens, and young adults or anyone diagnosed with bipolar or whose family has a history of manic-depressive symptoms, mania, etc.4
Also noted is that Abilify can leach into breast milk for mothers who are breast-feeding and that this can harm the baby.
Other risks listed are strokes that can lead to death, tardive dyskinesia, (an often irreversible muscle movement disorder), a frequently fatal condition known as NMS or neuroleptic malignant syndrome which is a toxic reaction of severity, and others. The FDA medication guide also warns against stopping Abilify too suddenly once you have been taking it, and that TD (tardive dyskinesia) can emerge even after the drug is stopped. We take the warnings to heart. Never abruptly stop Abilify or its equivalent antipsychotic medication.
About Abilify Tapering and Weaning
Abilify is a dopamine stabilizer, which means that it can block dopamine receptors, or take the place of dopamine in which case it lightly activates the receptor. To compensate for the starvation, the body begins establishing new dopamine receptors that crave dopamine, resulting in a person who may be craving stimulation. A person may seek this stimulation in various ways, such as caffeine, smoking, other drugs, or other avenues.
When Abilify tapering is attempted too quickly, there can be an extreme shock as a flood of dopamine is released into the CNS, and mania/psychosis type symptoms can result. This reaction could be overwhelming and may induce psychosis, hallucinations, or other symptoms that may or may not have been present, and may present more intensely than before the drug was initiated.
Therefore, Abilify tapering must always be done in an extremely cautious, exacting, and incremental fashion to avoid manic or other such reactions. We provide 24/7 care tailored to the needs of each individual. Nutrition, toxicity, and at times genetic factors are tested and addressed before and during tapering from antipsychotic medications to ensure the most successful outcome possible. A compassionate and competent staff is on hand to help the person through every step of the process with confidence and encouragement, furnished by medical practitioners familiar with Abilify tapering, including nursing staff, holistic prescribers, clinicians, therapists, and expert caregivers.
Alternative to Meds Center Can Help
We have been helping our clients for many years to deal with the intricacies of tapering from antipsychotic medications safely, as well as offering alternative treatments for schizophrenia, depression, insomnia, anxiety, or other symptoms. There is much to learn about psychosis and the drugs that are used to suppress symptoms. Our approach includes the use of lab testing for nutritional, genetic, and toxic sources for unwanted symptoms and actually address them in order to reduce or eliminate them without relying solely on prescription drugs. Ours is a safe and gentle approach, with many years of successful treatments for our clients.
Please contact us for more information for you or your loved one on how our inpatient Abilify tapering program could provide the answers you have been looking for in your quest for the recovery of natural mental health.
9. Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2004. (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 3 Approaches to Therapy. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64259/ [cited 2021 Mar 29]
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.