Understanding Aripiprazole: Uses, Side Effects, and More with Dr. Syl

Summary

Dr. Cell discusses Abilify (aripiprazole), a partial dopamine agonist used in psychiatry for treating conditions like schizophrenia, bipolar disorder, and depression. Highlighting its unique mechanism as a partial blocker with fewer side effects than full blockers, the video covers its applications in various mental health disorders, its effects on positive and negative symptoms, and its role in managing side effects of other antipsychotics. The discussion also touches on dosing, side effects, and considerations for special populations, emphasizing the importance of medical supervision and individualized treatment plans.

Takeaways

• 💊 Abilify, known generically as aripiprazole, is a medication commonly used in psychiatry to treat conditions like schizophrenia, bipolar disorder, and depression.
• 🧠 It acts as a partial dopamine agonist, meaning it partially blocks dopamine receptors, which can reduce psychotic symptoms without causing severe side effects associated with full dopamine blockade.
• 💡 Abilify is often used as an augmenting agent in addition to other treatments, enhancing their effects and managing symptoms more effectively.
• 🏥 It's considered a first-line treatment for individuals experiencing a first episode of psychosis and is also used in the treatment of acute manic episodes in bipolar disorder.
• 🤔 The medication can help in reducing aggressive behavior in young people with autism, making it a multifaceted tool in psychiatric care.
• 📉 It has a role in managing metabolic issues that can arise from other antipsychotic medications, such as weight gain and high cholesterol levels.
• ⏱️ The effects of Abilify may take time to manifest, with a typical trial period of 4 to 6 weeks to assess its efficacy.
• 🚫 The script advises against changing or stopping medication based on the information provided in the video alone, emphasizing the importance of consulting with a healthcare professional.
• 🚨 Potential side effects of Abilify include postural hypotension, nausea, and akathisia (restlessness), but many side effects may lessen over time or with dosage adjustments.
• 💡 For individuals with kidney or liver disease, Abilify may be a suitable option as dosage adjustments are typically not required.
• 👶 The medication is approved for use in children as young as six years old for certain conditions, though its safety in pregnant or breastfeeding women is not well-established.

Q & A

What is Abilify and what is its active ingredient?

Abilify is the brand name for the drug aripiprazole, which is commonly used in psychiatry.

How does aripiprazole differ from other antipsychotic medications?

Aripiprazole is a partial agonist, meaning it partially blocks dopamine receptors, unlike typical antipsychotics that fully block them. This can lead to fewer side effects while still reducing psychotic symptoms.

What are the primary uses of Abilify in psychiatric treatment?

Abilify is used to treat schizophrenia, bipolar disorder, and depression with psychotic features. It can also be used to augment the effects of other medications.

Can Abilify be used to treat conditions other than psychiatric disorders?

Yes, Abilify is also used to treat aggression in young people with autism and can help reduce side effects like weight gain from other antipsychotic medications.

What is the typical time frame for seeing the effects of Abilify?

Some patients may see benefits within a week, but a general trial period is considered to be four to six weeks at a good dose.

What are some side effects associated with Abilify?

Potential side effects include postural hypotension, nausea, vomiting, and a condition called akathisia, which is an inner restlessness.

How does Abilify affect weight compared to other antipsychotics?

Abilify is considered to have a low risk of causing weight gain and can even help with weight loss in some cases.

What is the recommended dosing range for Abilify?

The general dosing range is 15 to 30 milligrams per day, usually given in the morning.

Is Abilify suitable for patients with kidney or liver disease?

Yes, Abilify does not require dosage adjustments for patients with kidney or liver disease.

What is the recommendation for using Abilify during pregnancy or breastfeeding?

Abilify has not been studied in controlled human pregnancy studies and is classified as a risk category C. It is also unknown if it is found in breast milk, so it is generally recommended to avoid breastfeeding while on the medication.

Is there an alternative form of Abilify that can be used for patients who have difficulty taking oral medications?

Yes, there is an intramuscular depot injection form of Abilify that can be used for patients who have difficulty with oral medications or who have a history of hospital admissions due to schizophrenia.

Outlines

00:00

💊 Introduction to Abilify (Aripiprazole)

Dr. Cell introduces Abilify, also known as aripiprazole, a medication commonly used in psychiatry. It is often utilized as an augmenting agent in addition to other treatments. Dr. Cell works with patients experiencing acute psychosis, which may be part of schizophrenia, and discusses how Abilify is also used for other mental health conditions. The video aims to educate viewers on the drug's mechanism of action, its role as a partial dopamine agonist, and its use in treating conditions like schizophrenia, bipolar disorder, depression, and autism. The doctor emphasizes the importance of consulting a healthcare professional for personalized advice and not making changes to medication based on the video alone.

05:00

🔍 How Abilify Works and Its Effects

Abilify's mechanism of action is explained, highlighting its role as a partial dopamine agonist, which means it partially blocks dopamine receptors, reducing psychotic symptoms without causing severe side effects associated with full dopamine blockade. The video discusses how Abilify can be effective in treating positive symptoms of schizophrenia, such as delusions and hallucinations, and may also improve negative symptoms and cognitive function. It touches on the concept of 'super responders' who have a significant reaction to the medication. Additionally, it mentions off-label uses, such as mitigating side effects from other antipsychotics, like weight gain.

10:01

🌡️ Starting and Monitoring Abilify Treatment

The script outlines the process of starting Abilify, including the importance of medical tests like blood tests, weight, height, and metabolic measurements before beginning treatment. It advises on the standard trial period for antipsychotics, which is four to six weeks, and the potential need for dose adjustments based on response. The video also covers the necessity of ruling out organic causes for symptoms before starting medication and the importance of ongoing monitoring, especially for patients with kidney or liver issues, elderly individuals, and those with autism.

15:03

👨‍⚕️ Special Considerations for Abilify Use

This section covers special populations for whom Abilify may be prescribed, such as children with autism and aggression, and individuals with kidney or liver disease. It addresses the dosing considerations for these groups, emphasizing the need for lower doses in the elderly due to slower metabolism. The video also discusses the lack of studies on Abilify's use during pregnancy and breastfeeding, recommending consultation with a perinatal psychiatrist for pregnant patients. Finally, it suggests that a depot injection of Abilify may be beneficial for patients with a history of hospitalization due to schizophrenia, as it can help reduce readmissions.

Keywords

💡Abilify

Abilify is the brand name for the drug aripiprazole, which is a medication commonly used in psychiatry. It is often used as an augmenting agent to other treatments. In the video, Abilify is discussed as a treatment for various mental health conditions, including schizophrenia, bipolar disorder, and depression. It is highlighted as a partial dopamine agonist, which means it partially blocks dopamine receptors, helping to reduce psychotic symptoms without causing the full range of side effects associated with complete blockade.

💡Psychosis

Psychosis is a mental health condition characterized by a disconnection from reality, often involving hallucinations or delusions. In the context of the video, psychosis is a symptom of conditions like schizophrenia, and Abilify is used to help manage these symptoms. The script mentions that Abilify can reduce the intensity of positive psychotic symptoms such as delusions and hallucinations, which are central to the discussion of its efficacy.

💡Schizophrenia

Schizophrenia is a chronic mental disorder that affects how a person thinks, feels, and behaves. The video discusses Abilify as a first-line treatment for individuals presenting with a first episode of psychosis, which is often associated with schizophrenia. The drug's role in managing both positive symptoms, like hallucinations, and negative symptoms, such as social withdrawal, is emphasized.

💡Bipolar Disorder

Bipolar disorder is a mental health condition characterized by extreme mood swings, including emotional highs (mania or hypomania) and lows (depression). The script mentions that Abilify is used in the treatment of bipolar disorder, particularly for managing acute manic episodes and as a maintenance treatment to prevent future episodes.

💡Depression

Depression is a common mental disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. In the video, it is noted that Abilify can be used to augment the action of other medications in the treatment of depression, especially when depression is severe enough to include psychotic features.

💡Autism

Autism, or Autism Spectrum Disorder (ASD), is a developmental disorder that affects communication, social interaction, and behavior. The video script references the use of Abilify in young people with autism, particularly to help reduce aggressive behavior, which is one of the challenges faced by individuals with ASD.

💡Dopamine

Dopamine is a neurotransmitter associated with the brain's reward and pleasure centers. In the context of the video, dopamine is discussed in relation to its role in psychosis and the mechanism of action of Abilify. As a partial dopamine agonist, Abilify partially blocks dopamine receptors, which is thought to help reduce psychotic symptoms without causing the full range of side effects associated with complete dopamine blockade.

💡First-Generation Antipsychotics

First-generation antipsychotics, also known as typical antipsychotics, are a class of medications that were developed earlier and primarily block dopamine D2 receptors. The video contrasts these with second-generation antipsychotics and Abilify, which is a second-generation antipsychotic with a different mechanism of action, being a partial dopamine agonist.

💡Side Effects

Side effects are unintended effects of a medication that occur alongside the intended therapeutic effects. The video discusses various side effects associated with Abilify, including postural hypotension, nausea, and akathisia (restlessness). It also notes that Abilify is less likely to cause weight gain compared to other antipsychotic medications.

💡Dosing

Dosing refers to the administration of a specific amount of a medication at a particular time. The video script provides information on the dosing range for Abilify, which is generally 15 to 30 milligrams per day, and suggests that starting with a lower dose and adjusting as necessary can help minimize side effects while maintaining therapeutic benefits.

💡Intramuscular

Intramuscular refers to a method of administering medication by injecting it into muscle tissue. The video mentions the availability of an intramuscular option for Abilify, which is a depot injection. This form of medication is suggested as a beneficial alternative for individuals with schizophrenia who have experienced hospital admissions, as it can help reduce the frequency of hospital stays.

Highlights

Abilify, known generically as aripiprazole, is a commonly used medication in psychiatry.

It is often used as an augmenting agent to other treatments.

Abilify is used to treat acute relapses of psychosis, often as part of schizophrenia.

The drug operates as a partial agonist, binding to receptors but not fully blocking them.

Abilify's partial blocking effect reduces side effects compared to full dopamine blockade.

It is also used to treat bipolar disorder, both in acute manic episodes and as a maintenance treatment.

Abilify can be used to augment the action of other medications in treating depression.

It helps reduce aggressiveness in young people with Autism.

The medication can take up to 4 to 6 weeks to show effects, with some benefit seen within a week.

Abilify can reduce positive symptoms of schizophrenia, such as delusions and hallucinations.

It also improves negative symptoms and cognitive function in patients.

About 15% of patients with schizophrenia are 'super responders' to Abilify.

Abilify is used to treat side effects of other antipsychotics, such as weight gain.

It is recommended to try one antipsychotic for four to six weeks before considering a change.

Blood tests and metabolic checks are necessary before starting Abilify.

Common side effects include postural hypotension, nausea, and akathisia (restlessness).

Abilify is less likely to cause weight gain and is not sedating, often taken in the morning.

The dosing range is typically 15 to 30 mgs, with some cost-saving strategies mentioned.

Abilify is suitable for patients with kidney or liver disease and can be used in the elderly with caution.

It is FDA approved for use in children as young as six for certain conditions.

The intramuscular option for Abilify can help reduce hospital stays for patients with schizophrenia.

Transcripts

So today we're talking about Abilify

which is the brand name for the drug

aripiprazol a very interesting

medication very commonly used in

Psychiatry and usually also used as an

augmenting agent to other treatments as

well if you're new here my name is Dr

cell I'm a junior doctor training to

become a psychiatrist so I work on

inpatient Hospital units and often I

will um treat people who are suffering

from an acute relapse of psychosis maybe

as a part of a schizophrenia illness and

at any one time I might be seeing you

know a handful of people with

schizophrenia a day that being said

Abilify is used in other illnesses as

well and we'll talk about that in this

video If mental health education content

is something you're interested in you

can consider subscribing to the channel

I'd really appreciate that but other

than that let's get into the video

[Music]

so I'd like to start my videos on

medications talking a little bit about

how it works now antis psychotics in

general people think of them as like

chemists and and doctors will think of

them in terms of dopamine blockers but

as you learn more about dopamine you

realize there's multiple different

receptors that the D1 and the D5

receptors are very different to the D2

D3 D4 receptors but if you want to keep

it simp simple it's fair to say that

there are a group of antis psychotics

the first generation antipsychotics that

are mostly D2 receptor blockers there's

a group of antis psychotics that are

mostly serotonin and dopamine receptor

blockers that's the second generation

and then there's this medication which

is a bit of a weird one because it's not

a full blocker it's a partial blocker

and we call these medications partial

agonists so the thinking is that in

psychosis there's lots and lots of

dopamine and that when you block the

dopamine you can help reduce the

positive psychotic symptoms in a

psychosis it's definitely more

complicated than that and I have videos

on on the kind of biochemistry and

neurobiology of psychosis you can check

out but aify doesn't block it fully

because when you block it fully what do

you get side effects that's right you

might be able to turn down the intensity

of symptoms of psychosis which is great

but there are some pretty uh

debilitating side effects to some of the

antis psychotic medic ation so that's

why abifi came in with this partial

blocking effect so what it does is it it

does bind to The receptors and it does

block The receptors but not fully okay

it's a partial Agonist so if you think

of you know 100% being blocked it'll

block the receptor at about 60% what

does this mean well it means that you

can have the reduction in the um

symptoms of psychosis which is the goal

but you you don't get all the side

effects associated with the full

blockade so you do get less side effects

now some psychiatrists um and from my

Clin clinical experience it can be uh it

can be it can be argued that it makes

the medication a little less effective

for treating psychotic Illness but as

with a lot of the other medications in

treating psychosis there's a bunch of

other receptors that Abilify Target and

these include other dopamine receptors

like the D3 receptor and serotonin

receptors too now we've spoken a lot

about psychosis but yes Abilify can be

used in other illnesses so let's go

through a bit of a list here so yes it's

it's indicated in the treatment of

schizophrenia it's actually one of the

first line treatments for someone who's

presenting with a first episode

psychosis it's also used in bipolar

illness both as a treatment for an acute

manic episode but also to keep the

remission stable so maintenance

treatment it can be used in the

treatment of depression but it wouldn't

be used alone it would be used to

augment the action of other medications

in the treatment of depression and it

can also protect from developing

depression with psychotic features so

you might not have known that but yeah

you can have a depression so severe that

people develop a psychosis like

delusions of poverty or delusions that

their body is rotting and it can get

very dangerous you know with risk of

suicide and things like that and it's

also used in uh young people with Autism

that have a tendency to be a little bit

uh well I guess to be aggressive so it

helps reduce aggressiveness in uh young

people with Autism and yes

aggressiveness is not a word I meant to

say aggression sorry about that now how

long until it works well it's you know

like with all antis psychotics it takes

a little bit of time some people do

start seeing a benefit within a week uh

but a general trial of an antis

psychotic is you know considered four to

6 weeks at a good dose and if there's no

effect after I don't know 3 to 4 weeks

maybe even 2 weeks depending on the

circumstances you would consider a dose

increase of course remember this is not

medical advice see the disclaimer in the

description this is just uh to provide

you information to discuss with your

doctor now if it is working it does seem

to reduce the positive symptoms of

schizophrenia what I mean by that uh the

symptoms like um delusions and

hallucinations particularly

hallucinations so it usually improves

them it rarely eliminates them 100% that

is the nature of you know this this

illness that it's hard to get rid of the

symptoms 100% with schizophrenia but

hopefully it helps reduce them to the

point where they have no functional

impact that people can go to work have

meaningful lives have relationships all

that good stuff and that the voices um

don't cause any debilitating functional

impairment now in terms of the negative

symptoms of schizophrenia it does seem

to improve those as well as as well as

improve people's cognition so they do

better on cognitive testing and and

mental alertness there is a subgroup of

people about 15% of people with

schizophrenia who will have a major

response to Abilify um that 60%

reduction of intensity these people are

called super responders and often they

have such a positive response that yeah

they can go and have a job and

relationships and Things by the way we

haven't really talked about it but

Abilify is also used to treat the side

effects of other antis psychotics so

things like weight gain can be reduced

so someone's on a second generation

antipsychotic like alanine respidon or

phine um which is arguably a bit of a

different medication altogether but I'll

just group it for second generation

antic psychotic at the moment if people

are on those they can also have an

augmentation with a bifi to reduce the

metabolic symptoms of those medications

so um for example if there's someone

who's getting a lot of weight gain on

lanzapine and you add Abilify that

weight gain will be reduced I have a

video about weight gain in psychosis and

because of antis psychotics and

treatment options for people to consider

if that's an issue for them so please

consider checking that video out now if

we follow the guidelines um the Royal

Australia the Royal Australian and New

Zealand College of Psychiatry guidelines

for treatment of psychosis the advice is

that you try one antis psychotic for

four to 6 weeks if not consider a dose

increase if there's no response but have

one good try of an antis psychotic if

that doesn't work try a second

generation antio um and if that doesn't

work go to closet a pain that is what is

suggested by the guidelines for you to

discuss with your doctor if you are not

finding a response it would be very

heartbreaking for me if anyone was to

stop their medications or change their

medications based off this YouTube video

please make sure you always talk to your

doctor before making any changes now in

bipolar this medication can be augmented

with other medications so things like

mood stabilizers I'm thinking of lithium

and valate and lrene they can be used

with Abilify benzo aines is a maybe you

got to talk to your doctor about if it's

right for you now before starting this

medication you've got to get it all done

you've got to get the blood tests you've

got to make sure you get your weight

height waist circumference um and

metabolic blood so that includes uh

things like the cholesterol level the

it's called

hba1c glycosilated hemoglobin uh so

diabetes screening that's what that does

uh you've got to make sure that your

doctor has tested for organic C causes

for the symptoms you're presenting with

cuz B like Mania can be a result of

thyroid problems psychosis can be a

result of pro problems in I don't know

copper metabolism that's called Wilson's

disease you've got to do the whole work

up before you just start the medications

um and once you've started you've got to

monitor so every 3 months at least when

you're starting with the um with blood

tests monitoring cholesterol and things

now let's talk a bit about the side

effects so some people with Abilify will

describe um um postural hypotension side

effects that what does that mean that

means like getting up from seated and

getting kind of laded and that doesn't

sound too sinister at first but it can

be pretty dangerous especially if you're

getting up very quickly and you lose

Consciousness and you have a fall with a

head strike that a brain bleed that kind

of thing so you've got to make sure that

you're getting up slowly it's pretty

easy to test if this is happening you've

just got to um do a blood pressure with

your doctor one lying down one standing

up and the reason this happens is it

does bind to what are called adreno

receptors and for the medical students

out there it's the alpha 1 adreno

receptor fortunately the postural

lightheadedness usually gets better over

time uh the other side effects well

nausea and vomiting is not infrequent

vomiting is infrequent but but nausea is

not infrequent some people can get

nauseous with these new medications

taking it with food might help a common

one is this thing called athesia now I

have a video on the extra paramal side

effects that's on my channel check it

out uh but aesia is this inner

restlessness uh also tends to get better

with time um as your brain gets used to

the medication but it can be really

severe and some people do have to change

medications because it's so severe some

people find it just very distressing

this inner sense of restlessness that

can never be um kind of uh appeased it's

just it's it's just Relentless but in

terms of weight gain um it's considered

one of the the it's considered unusual

to get any weight can on a billfire it

does happen rarely but it's usually a

medication that's helps with weight loss

in people with psychosis and it's also

not very sedative sedating so often it's

medication that's taken in the morning

cuz if anything it actually kind of

energizing now if you're getting side

effects just remember wait wait wait try

you know don't just automatically give

up there's not an unlimited option list

of options in treating psychosis so the

a lot of these side effects do get

better with time and it's worth just

trying to um kind of reduce the dose if

needed with your doctor uh but trying to

give this a good trial before you give

up on it the athesia and inner

restlessness can be treated um you can

the doctor can your doctor can consider

things like propanolol or Ben tropine or

any other anticholinergics those things

tend to reduce that uh at this you know

they do reduce athesia and if it's just

at the start um then then it should get

better with time now in terms of the

dosing range uh everyone has their own

dose for their symptoms some people can

tolerate less and get better some people

need more the range is generally 15 to

30 migs given um in the morning uh a way

to save a bit of money is to get the

higher dose and and cut the pill in half

uh and then so if if you're in 15 migr a

day you get the 30 milligram tablet you

break that in half and then you get you

know a packet of 30 milligram tablets

will last you twice as long CU you're

just cracking them in half and having

one a day um I'm not suggesting you

should half your dose if that's not what

you've agreed with your doctor please

don't do that now if changing antic

psychotic that's something that your do

your doctor should guide in terms of uh

cross titration and if stopping it just

I mean your doctor will guide you it

just needs to take time you know don't

rush it it'll you know reduce it over

the course of four 6 8 weeks um each

doctor uses their own thing and it's and

it's kind of done to the patient um

tolerability tolerance

uh to make sure they're not getting any

withdrawal effects so in terms of um

unique populations uh this is a pretty

good medication for people with uh

kidney disease or liver disease they

don't have to change the dosage um

usually you can tolerate a high a good

dose of Abilify even if you do have

renal or liver disease and even for you

know people in the elderly group um

there is a you know a tendency to use

the low end of the dose uh you know my

motto is always used the least the

lowest dose that gives you the enough

effect it's it's not complicated but um

yeah with people who are more elderly

with slower metabolic rates this

medication has a long half life so uh

you would try a lower dose in children

it is you know FDA approved to be used

in children as young as six um if they

have autism irritability and aggression

to help reduce that aggression uh you

know that's a really difficult situation

but if it's what's needed it's what's

going to happen in pregnancy it has not

been studied in controlled studies in

humans so it's cons considered a risk

category C uh which means some animal

Studies have shown adverse effects but

not formally proven in humans um with

all pregnancy discussion around

medications you have to understand it's

about the risk of uh the medication

versus the risk of not taking any

medication and psychosis like

schizophrenia even bipolar illness these

things are at increased risk of getting

worse during pregnancy because of the

hormonal changes in the body and so if

there's a history of mania or psychosis

it's extremely risky to be on no

medication in terms of breastfeeding it

is unknown if this is found in breast

milk which surprises me I I wouldn't

have thought that a study to look for a

bifi or arerol in breast milk would be

that hard I would have thought chemists

have had a way to do it if you're a

chemist and you know why this hasn't

been shown in literature or if you know

this is out of date and you have updated

studies showing that it is found in the

breast milk please uh send put it in the

comments below um it is just generally

recommended that if someone is on antis

psychotics and and um has a young child

uh that they they don't breastfeed that

they use bottle feeding uh but that

needs to be discussed with your doctor

or of course changing medications to

something that is safe in breastfeeding

you should also check in your state um

whether and you might have to ask your

GP or your family doctor whether there's

a perinatal psychiatrist that you can

talk to for advice uh they generally

know very good and safe medications to

use so yeah in this closing section of

this talk I just wanted to say that this

is a pretty powerful medication it's

useful in um treating of of

schizophrenia for both positive symptoms

but also negative symptoms cognition

emotional stability um it's used in in a

bunch of other illnesses things like

autism things like um uh Mania as well

it's really useful for people who might

have problems with their blood

cholesterol or diabetes who also have

these illnesses because it can help

reduce those and it's also very really

useful for people who are feeling

sedated uh with their current medication

this is kind of an activating medication

so it's less sedating the final thing to

say is that there is a intramuscular

option available for this uh medicine

and it is uh my opinion and supported by

the evidence that if someone has

schizophrenia that they spend less time

in hospital if they are on a Depot

versus an oral tablet um for multitude

of reasons so it's my strongest

recommendation to be on a Depo if

someone has a schizophrenia that's

resulted in Hospital admissions it just

keeps people out of hospital and that's

not where you want to spend your life

you know but uh but if it needs to

happen it needs to happen that's okay

and we just take things one day at a

time okay everyone um thank you for

listening into this video I hope you

found it helpful if you have any

specific questions please leave comments

down below and I wish you all a

beautiful day full of love and

connection call a loved one tell them

you love them and uh but yeah I'll see

you all in the next video bye for now