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Your Questions About Abilify Discontinuation Syndrome Answered

Last Updated on August 6, 2021 by Carol Gillette

Abilify Discontinuation Syndrome
Alternative to Meds Editorial Team
Written by Lyle Murphy Published August 4, 2021
Medically Reviewed by Dr Samuel Lee MD

In this short video featuring Lyle Murphy, Founder of the Alternative to Meds Center, questions are answered about Abilify Withdrawal, as well as some of the risks encountered when tapering Abilify.

Questions about Abilify Withdrawal, Risks of Taking Abilify, and Abilify Tapering Help


getting off abilify
Alternative to Meds has offered help to clients looking for antipsychotic tapering for over 15 years. Please see our published evidence regarding our success for more information. Underlying issues can in many cases be addressed without toxic prescription drugs. In many cases, we discover that medical conditions were missed or left unresolved, and other contributing factors were overlooked. Tragically, this often resulted in misdiagnoses. We can help.
Watch this video of a young man who had a tragic life in and out of psychiatric wards and persistent psychosis who, after ATMC methods, has gone on to be an international speaker, author, and model of what type of transformation can occur when using strategic holistic therapies. Gordie, featured in the video has been successful over bipolar and schizophrenia without even a hint of his diagnosis for 10 years.

What Is Abilify?

Abilify, also known under the generic name aripiprazole, is the second leading atypical antipsychotic medication in the United States, with over five million patients receiving prescriptions for it every year.1 First developed during the late 1990s, Abilify received FDA approval in 2002 for the treatment of schizophrenia and consistently ranks as one of the nation’s best-selling pharmaceuticals. Although it can offer relief for people with mental health conditions and mood disorders, discontinuing the use of Abilify can lead to harsh withdrawal symptoms, known as Abilify discontinuation syndrome. Because of the potential for developing this syndrome, withdrawal should only be initiated with guidance from a physician.

Consider the information below for answers to the most common questions about Abilify discontinuation syndrome, then contact Alternative to Meds to discuss how we can help you or your loved one navigate Abilify withdrawal. For over 15 years, we have offered patients comprehensive withdrawal management services based on evidence-based treatment and implemented with compassionate care.

Abilify

Abilify Discontinuation Syndrome

What Is Abilify Prescribed For?

Abilify is prescribed to treat adults and children experiencing symptoms of the following conditions:

  • Schizophrenia (children aged 13 years and older)
  • Bipolar I Disorder (children aged 10 years and older)
  • Borderline Personality Disorder
  • Tourette’s Syndrome (children aged 6 years and older)
  • Schizoaffective Disorder
  • Major Depressive Disorder (in combination with other medications)
  • Obsessive-Compulsive Disorder
  • Mania, Manic Episodes, and Psychotic Episodes
  • Post-Traumatic Stress Disorder

In 2009, Abilify was approved for use in children 6 years old and older to treat irritability-related symptoms of autism, such as aggression, rapid mood changes, emotional outbursts, inappropriate speech, and self-injurious behavior. Children and adolescents taking Abilify experienced reduction in irritability symptoms and hyperactivity, but a significant increase in weight gain, as well as tremors, drooling, and fatigue. Side effects vary drastically between patients, and there have been no studies that conclusively prove the safety of long-term use in children.

When Is It a Good Idea to Take Abilify?

Like most drugs, there are lots of ramifications and dangers associated with taking Abilify. However, if a person is experiencing sudden and severe psychosis, or is very likely to hurt themselves or be a danger to others, taking Abilify could be a good way to get the symptoms under control. At times, taking low doses of Abilify can provide the mechanics necessary to get the brain working properly again. If a person needs immediate treatment, Abilify could be the least dangerous of the possible antipsychotic medications available.

How Does Abilify Work?

Dopamine

Abilify is considered an atypical or second-generation antipsychotic, meaning it typically produces milder side effects than traditional antipsychotic medications. Compared to earlier antipsychotics such as haloperidol, this class of antipsychotics carries a lower risk of motor control issues. All types of antipsychotic medications operate according to the dopamine hypothesis, the idea that episodes of psychosis and mania occur due to an excess of dopamine in certain areas of the brain.

Dopamine is a neurotransmitter responsible for the feeling of anticipation experienced while waiting for a reward. In addition to controlling pleasure and reward-seeking behavior, this chemical influences motivation, mood, emotions, memory, alertness, focus, stress responses, and executive functioning. It is also involved in a wide range of other important neurological and physical functions, including blood flow, digestion, motor control, pain processing, sleep, and functioning of the heart, kidneys, and pancreas.

Extensive research indicates that impairment of brain functioning may cause symptoms of psychosis, so anti-psychotics focus on treating these symptoms by altering dopamine levels. Abilify moderates dopamine by reducing it in areas where it becomes too high and increasing it in areas where it dips too low. In patients with schizophrenia, dopamine dysregulation tends to occur in the mesolimbic region, prefrontal cortex, hippocampus, and amygdala. Overactive dopamine levels cause hallucinations and delusions, while underactive dopamine levels cause issues such as lack of motivation. Stabilizing these levels typically improves a patient’s thoughts, mood, and behavior.

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What Are the Risks of Taking Abilify?Side Effects

Although Abilify does produce fewer side effects than earlier forms of antipsychotics, it does still involve a lengthy list of potential side effects that lead many patients to discontinue taking the drug.2 These symptoms range from mild symptoms that last only a few days or weeks, to severe symptoms that can linger or worsen and require immediate medical attention.

The most common side effects consist of:

  • Agitation or irritability
  • Anxiety
  • Fatigue, insomnia, or restlessness
  • Headaches
  • Dizziness or feeling light-headed
  • Hyperventilation
  • Drooling
  • Blurred vision
  • Low or high blood pressure or fainting
  • Heatstroke after exercise
  • Digestive issues, including heartburn, indigestion, nausea, vomiting, constipation, and stomach pain
  • Shakiness or tremors
  • Cold-like symptoms, including runny or stuffy nose, sneezing, and sore throat
  • Rash
  • Decreased white blood cell count
  • Increased cholesterol and weight gain
  • Impaired driving with a higher likelihood of automobile accidents

More severe side effects tend to be less common, but Abilify does feature the following black box warnings from the FDA3:

  • Increased risk of suicidal thoughts and behavior among patients under the age of 25 years old.
  • Increased risk of stroke and other cardiovascular issues in elderly patients with dementia that could result in death.
  • Increased risk of engaging in compulsive behaviors, such as binge eating, pathological gambling, hypersexuality, and compulsive shopping.

Other severe side effects of Abilify include:

  • Seizures
  • Catatonia
  • Stroke
  • Tachycardia, or racing heartbeat
  • Unusual urges, meaning the desire to do something you would not normally do or to do something in excess, such as gambling or binge eating
  • Inability to move
  • Loss of balance
  • Muscle stiffness, trembling muscles, or spasms
  • Involuntary, repetitive movement
  • Extreme fatigue
  • Sudden loss of consciousness
  • Sleepwalking
  • Aspiration, or swallowing the tongue or other items obstructing the airway
  • Speech difficulties
  • Swelling, tingling, or numbness in extremities
  • Joint pain
  • High fever
  • Rash, blistering rash, or ulcers in mucous membranes
  • Incontinence
  • Suicidality combined with akathisia, a movement disorder that makes it difficult to stay still and compels constant movement, particularly in the legs

In rare situations, patients can develop tardive dyskinesia, a rare but typically irreversible condition caused by long-term use of neuroleptic medications.4 This condition is characterized by involuntary, repetitive movement of face, body, limbs, or other muscles, such as grimacing, protruding tongue, pursing, puckering, or smacking lips, puffing cheeks, and rapid blinking. In some cases, these symptoms persist indefinitely even after discontinuation of the drug.

Abilify can also lead to serious interaction issues when taken with other medications. Hundreds of drugs have been found to interact with Abilify, including antidepressants, antihistamines, antifungals, HIV protease inhibitors, sedatives, tranquilizers, sleeping pills, and medications for anxiety, motion sickness, high blood pressure, Parkinson’s disease, irritable bowel syndrome, ulcers, urinary problems, or other mental health conditions.

Does Abilify Need to Be Tapered Off?

Empty Prescription Medicine Bottle

Due to the multitude of serious, debilitating side effects Abilify can cause, many patients who are prescribed this antipsychotic eventually choose to stop taking it. However, like any antipsychotic medication, discontinuation should not happen abruptly and must occur with the oversight and guidance of a physician. The safest method for reducing potential withdrawal symptoms is through tapering off of the drug, or gradually reducing the dosage over a specific time frame. The timing and dosage your physician will recommend depends on your unique circumstances, including the severity of your mental health disorder and the length of time you spent taking Abilify.

Does Abilify Have Withdrawal Symptoms?

According to a meta-analysis published in Frontiers of Psychiatry in 2020, 53% of patients demonstrated withdrawal symptoms after abruptly discontinuing antipsychotic medication. Even when patients carefully followed their physician’s instructions and discontinued Abilify by tapering off the medication, they developed severe withdrawal symptoms that became intolerable.5 This is referred to as Abilify discontinuation syndrome.

Abilify withdrawal must be carefully managed so the gradually tapering dosage can appropriately compensate for the neurochemical changes that result from this changed dosage. If withdrawal is not properly managed, or if the patient abruptly discontinues taking the drug without medical supervision, they can quickly develop withdrawal symptoms ranging in severity from short-term and mild, to severe enough to require hospitalization.

Symptoms of Abilify discontinuation syndrome include:

  • Akathisia
  • Tardive dyskinesia or other involuntarily movement disorders
  • Psychosis, including hallucinations, delusions, and paranoia
  • Decreased concentration
  • Anxiety, depression
  • Irritability, agitation
  • Insomnia or other sleep disturbances
  • Nausea and vomiting
  • Headaches
  • Tremors, shakiness
  • Vertigo or feeling lightheaded
  • Diaphoresis, or excessive sweating of the entire body
  • Flu-like symptoms

In cases involving severe Abilify withdrawal symptoms, the best approach is to seek treatment from a residential care facility that offers constant medical attention.

Residential Care

What Happens When You Stop Taking Abilify?

Tapering must be completed in a cautious, precise, and incremental manner. Typically, your physician will begin the process of Abilify discontinuation by tapering your dose with a 10% reduction. Before the dosage can be further reduced, you must experience a stability period of a full two weeks in which you are no longer symptomatic, meaning you eat and sleep properly, maintain a regular routine, and do not demonstrate anger or mania.

After this stabilizing period, your physician will continue to taper the dosage by making another “cut,” after which you must spend another full two weeks without withdrawal symptoms. This process continues until the cut equals a small enough dose that your physician can cut the drug in half or break it down into smaller pieces. The taper must be gradual and carefully monitored to ensure no additional cuts are attempted before symptoms subside.

Understanding Withdrawal vs. Symptoms

Unfortunately, it can be difficult to distinguish which symptoms are occurring due to withdrawal and which symptoms were original to your condition and are now returning due to the decreased dosage of Abilify. When you take this medication, you undergo a process called upregulation, meaning your body adapts to the effects of the drug, specifically the change in dopamine levels. Blocking dopamine over an extended period of time causes the dopamine receptors to become supersensitive.

When the drug is reduced, these supersensitive receptors can cause a sudden flood of excess dopamine that overloads your system. This can lead to an overwhelming reaction and produce volatile emotions, thoughts, and behavior that were previously absent or cause them to present more intensely. This phenomenon will eventually even out, or downregulate, but your physician should be monitoring your condition carefully throughout the entire process.

How Long Does Antipsychotic Discontinuation Syndrome Last?

The length of time you experience symptoms of Abilify discontinuation syndrome depends on individual factors, and some people have a more difficult time ceasing the medication than others. The longer you take Abilify, the more severe your withdrawal symptoms may be and the longer it may take to reach full discontinuation of the drug. For example, a patient who takes Abilify for five years may expect their tapering to take five months or more, while someone who takes Abilify for ten years would likely require a taper that lasts ten months or more.

In the meta-analysis mentioned above, researchers found that withdrawal symptoms begin approximately one week after an abrupt discontinuation of the medication, then subside gradually for one to four weeks.5 However, some severe symptoms, such as hyperkinesia, may persist for months.

Along with the physician guiding the tapering process, experts suggest making a safety contract with a trusted friend or family member, who will assess your behavior and help you navigate any potential feelings of mania that may arise in the future and make you resistant to taking your medication. Signing a contract establishes expectations and gives your contracted person the authority to contact the police or a healthcare provider if you suddenly stop taking your medication or experience increasingly severe withdrawal symptoms.

How Can Alternative to Meds Help Me?

If you or a loved one is currently taking Abilify and want to initiate the tapering process, contact Alternative to Meds today to speak with our team. After years of experience helping patients with Abilify discontinuation syndrome, our experts at Alternative to Meds have discovered that antipsychotic medications are the most difficult to taper. However, an Abilify prescription is not a life sentence. Even if the antipsychotics you were prescribed did originally help you to manage your symptoms, you do not need to take these medications for the rest of your life.

Alternative to Meds offers Abilify tapering to patients in stable condition, meaning they are eating, sleeping, and exercising regularly, consuming no stimulants or recreational drugs, and have a strong support system of family members or friends to help them through this process. We employ gentle, strategic methods supported by careful observation and medical oversight and create a customized tapering treatment plan for every patient based on their unique history and circumstances. Consult our website to find out the best reasons for tapering Abilify, then contact us today.

Sources:

1. Kane SP. Aripiprazole, ClinCalc DrugStats Database, Version 21.1. Updated December 1, 2020. Accessed 2021 May 18.

2. Abilify Official Site, Important Safety Information [ [cited 2021 May 18]

3. FDA label Abilify (aripiprazole) [published online 2014 Dec] [cited 2021 May18]

4. FDA label Abilify (aripiprazole) [published online 2014 Dec] [cited 2021 May18]

5. "Antipsychotic Withdrawal Symptoms: A Systematic Review and Meta-Analysis" SYSTEMATIC REVIEW article Front. Psychiatry, 29 September 2020


Other Sources:

https://clincalc.com/DrugStats/Drugs/Aripiprazole
https://www.medicalnewstoday.com/articles/abilify#about
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552943/
https://www.alternativetomeds.com/blog/abilify/
https://www.news-medical.net/health/Dopamine-and-Psychosis.aspx https://www.alternativetomeds.com/blog/abilify-tapering/
https://www.alternativetomeds.com/philosophy/evidence-based/


Your Questions About Abilify Discontinuation Syndrome Answered
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.

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