What is Abilify?
Abilify is classed as an atypical antipsychotic medication, with the generic name aripiprazole. It is approved for treating conditions such as schizophrenia, bipolar 1, major depressive disorder, Tourette’s, and irritability associated with autism.
Like virtually all antipsychotic medications, it is not approved for the elderly population suffering from dementia-associated psychosis.
Off label uses have included such conditions as borderline personality disorder, and as an alternative choice to medications that induced unwanted side effects such as hyperprolactinemia, where breast enlargement and the production of breast milk in either males or females.
Below will follow a discussion of what to expect during Abilify withdrawal, the timeline needed for safe cessation, and many related topics. Feel free to share the information with your prescriber.
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 of the adverse reactions reported led to the FDA placing a black box warning that restricted prescribing it to 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. The below list is taken from the drug manufacturer’s official site.24
Abilify is prescribed for these conditions:
- Schizophrenia (impaired perceptions of reality vs unreality, paranoia, difficulty in relating to others, delusions, hallucinations, 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’s 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.)
Common and Severe Abilify Side Effects
Some commonly reported adverse effects associated with taking Abilify may fade within a short time. However, if these reactions linger or worsen, immediate medical attention is warranted. Always seek medical guidance to deal with these, especially if lingering or intense. The lists given here summarizing Abilify drug-induced effects are sourced from the drug manufacturer’s official site,24 and taken from the FDA label information.7,22,23
Other Abilify side effects not listed here can be reported on the FAERS public reporting portal.
Some commonly reported Abilify adverse effects may include:
- Impaired driving, increased accident rates.23
- Agitation
- Low blood pressure, fainting
- Low white blood cell count
- Heatstroke, overheating especially after exercise
- Increased cholesterol, weight gain
- High blood sugar symptoms, such as thirst, hunger, confusion, nausea, fruity breath
- Dry mouth
- Indigestion
- Irritability
- Heartburn
- Lightheaded feeling
- Rash
- Restlessness, need to keep moving
- Tremors
- Sleepiness, fatigue
- Nausea, vomiting
- Constipation
- Fecal incontinence 26
- Insomnia
- Cold-like symptoms like runny or stuffy nose, sneezing, etc.
- Dizziness
- Stomach pain
- Shakiness
- Hyperventilation
- Sore throat
- Anxiety, fear
- Headaches
- Weight gain
- Blurred vision
- For any of the above seek medical attention, especially if lingering or severe.
Severe Abilify Side Effects
Reactions to Abilify that are more severe may be less common, but consumers and their caregivers should be aware that they may require medical intervention immediately should they occur. The FDA has required Abilify manufacturers to add a number of black box warnings. One was a warning about the increased risk of death for elderly patients with dementia due to the risk of stroke or other cardio events leading to fatality. Another black box warning was given for suicidal thoughts and behavior, in the under-25 age range, and another warning was required for causing compulsive behaviors such as pathological gambling, binge eating, compulsive shopping, and hypersexuality.21,22,23,26
Severe Abilify adverse reactions may include:
- Thoughts of suicide, and suicidal behavior, notably in the under-25 age range.
- Seizures
- Catatonia
- Aspiration (swallowing the tongue or other objects obstructing the airway)
- Gambling compulsive behaviors
- Sexual and other compulsive behaviors
- 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 or racing heartbeat)
- Loss of balance
- Sleepwalking
- 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, incontinence
- Lip-smacking, puffing of the cheek muscles
- Extreme tiredness
- Sudden loss of consciousness
- Akathisia, akathisia combined with suicidality
- Other involuntary muscle movements, repetitive movement disorders
- Tardive dyskinesia (very rare) usually irreversible 25
Aripiprazole is a third-generation type of antipsychotic medication, thought to be better tolerated than conventional or earlier antipsychotic drugs. Nonetheless, severe or persisting adverse reactions such as movement disorders should be given medical attention without delay if they manifest.1,25
Abilify Withdrawal Symptoms – Factors in Determining a Safe Withdrawal Timeline
There can be no cookie cutter approach to coming off Abilify. Abilify withdrawal can induce harsh symptoms and, as with any antipsychotic medication, it should generally not be abruptly discontinued unless there is a medical reason to do so. For example, where NMS or akathisia emerges, Abilify may need to be immediately stopped, with support in a medical or ER setting.7
The drug label lists no specific guidelines for discontinuing Abilify, except for mentioning abrupt discontinuation is not recommended. Each person has a unique profile and history, including age, length of time taking Abilify, general health, and dosage. However, research has uniformly confirmed the safest procedure is a slow reduction of the dosage over an adequate time frame.1,2,8-10,12,15,20,25
Abilify withdrawal symptoms include:
- Akathisia 12,17
- Tardive dyskinesia* and other involuntary movement disorders 2,10,12,13,17
- Psychosis, delusional thought, paranoia 10
- Nausea 2,18
- Feeling lightheaded 2
- Tachycardia 2,16,18
- Anxiety 2,18
- Diaphoresis (excessive sweating involving the entire body) 2,18
- Insomnia 10,18
- Headaches 15,18
- Tremors, shakiness 2,18
- Flu-like symptoms 2,18
A constellation of symptoms includes decreased concentration, irritability, agitation, sleep disturbances, and depression.18-20
*Tranter and Healy’s 1998 study reminded physicians of the very real movement disorders associated with withdrawal from dopamine-blocking agents, a subject that they felt had been neglected since the 1960s.
These withdrawal symptoms may range from mild to severe, and a person may experience one or multiple concurrent symptoms when coming off Abilify. Withdrawals can also develop after the drug is discontinued, especially when done abruptly or too fast, and where withdrawal management has not gradually compensated for the neurochemical changes that transpire. Abilify has a relatively long half-life, which is suggested by Tranter and Healy, and Molesley et al, as a possible explanation for the lag time of emerging withdrawals.2,25
Abilify is sometimes used as an adjunct to antidepressant drug therapy. Both Abilify and antidepressant drugs can cause headaches when they are withdrawn.15,18 While Abilify is not classified as an anti-depressant, some Abilify withdrawal symptoms may be similar to other drug withdrawals, and these may overlap especially where Abilify was used concurrently with other drugs. Abilify withdrawals have not been as extensively studied as other drug withdrawals. However, some zebrafish studies, as well as Abilify studies on monkeys, have concluded that withdrawals from sedative-type drugs such as Abilify are observed after the drug is discontinued.7,19,20
Does Abilify Increase Dopamine?
According to a 2015 NIMH study 4 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.
One theory relating to schizophrenia is that overactivity of the brain’s “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.
A 2005 study on mouse brain activity 5 showed that aripiprazole increased dopamine and did not increase other neurotransmitters such as serotonin or norepinephrine. Although more research is greatly needed, the aforementioned 2015 study gives a more expanded and optimistic view of managing and treating schizophrenia.3-5
Abilify Addiction
Abilify is known to cause compulsive behaviors such as hypersexuality, change of sexual orientation, and pathological gambling, among others. In a case study authored by Mete et al, the patient’s compulsive behaviors ceased within 2 weeks of discontinuing Abilify and he soon after returned to a heterosexual state, and the hypersexuality ceased as did the compulsion to gamble.18,22
Aside from these compulsive behavior syndromes, no studies were found after an exhaustive search demonstrating drug-seeking behavior or that drug cravings have been observed, documented, or studied in the available medical literature.
Research on Dopamine, Abilify Withdrawal, and Bipolar
An association between 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 have been the subject of research.
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.10-13
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 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.6,14
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 the difficulties of withdrawal from heroin and benzodiazepines.
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:
- Aristada
- Abilify Maintena
- Aristada Initio
Abilify has not developed a 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. For natural alternatives to Abilify please visit our Abilify Alternatives page.
Recovery after long-term antipsychotic medication.
These considerations are especially relevant in cases where the medication has been relied upon for many years. Done well, certain dispositions can transition to being medication free or to the lowest possible dose that provides the highest quality of life successfully, which is our goal concerning Abilify withdrawal at Alternative to Meds Center.
When Abilify (aripiprazole) medication is taken over a long period of time, as is usually the case with such prescription drugs, dependence will likely have developed, resulting in many possible discomforts associated with cessation. It may be prudent to select an inpatient program that is well equipped both in understanding the unique problems with antipsychotic drug withdrawal and also can provide comfortable, personalized assistance while withdrawing from the drug.
Integrative therapies during Abilify withdrawal.
Antipsychotic withdrawal at Alternative to Meds Center is done meticulously, with gentle, careful, medical oversight. Our program involves multiple methods and therapies that can significantly reduce the stress that may otherwise make the process seem and feel more difficult and time-consuming than it has to be.
Using nutritional testing and support, toxic load removal, counseling, Qigong, physical exercise, colon hydrotherapy, equine therapy, and many other therapeutic approaches to support the gradual cessation process in a beautiful and restful setting, we can help the body to ease back to a healthier state and move toward the goal of normalizing the neurochemistry for better natural mental health. Contact us for more information on this important area of healthcare, and you may find you are closer than ever to being able to take the next step to full recovery. Abilify withdrawal can free you from dependence on antipsychotic medications in a safe, nurturing, and comfortable setting at Alternative to Meds Center.
