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Abilify

Posted by med_empowered on June 30, 2005, at 22:51:39

In reply to Re: zyprexa once or twice a week? good or bad? » med_empowered, posted by 4WD on June 30, 2005, at 21:59:43

Abilify is the newest atypical so far on the US market, and it *may* be a whole new kind of antipsychotic/mood-stabilizer (I think we should hedge our bets on it being any sort of breakthrough for 5 years or so...see how things develop). Atypicals in general do a relatively weak D2 antagonism (70%or so, compared to 80-90% with old antipsychotics)...the also do some selective serotonin blocking, and some of them hit up numerous other receptors. The reduced dopamine blockade combined with the mild serotonin blockade (which, interestingly enough, causes an increase in dopamine activity) seems to lead to fewer side effects (EPS, tardive dyskinesia, etc.), improved tolerability, better effects on "negative symptoms" and so on. Now, Abilify may be different because it appears to not only work as a dopamine/serotonin antagonist, but also as a weak, selective agonist. This means that Abilify may be able to reduce dopamine/serotonin in parts of the brain that are hyperactive in that respect, and slightly elevate serotonin/dopamine in areas of the brain that are deficient or sub-optimal. This would make Abilify a true mood-stabilizer, because both neurotransmitters would be kept at ideal levels within the brain. Abilify does have the potential to cause tardive dyskinesia like other antipsychotics, and it has been linked to a few cases of neuroleptic malignancy syndrome, just like all other antipsychotics. It can cause your usual EPS symptoms--I developed tremors, for instance, that had to be treated with an increase in Klonopin and a couple tabs of Propranolol daily. It can also cause akathisia (inner restlessness/turmoil, accompanied by uncontrallable movement). But...Abilify is pretty much weight neutral (the long-term studies show minor increases in some groups of people; patients who crossover from long-term Zyprexa treatment usually LOSE weight). As for diabetes...Abilify does seem, like all the other atypicals, to cause some sort of metabolic weirdness in some people, but it doesn't appear to be as big a problem as it is with, say, Zyprexa, which is the reigning champ of Diabetes Inducing Atypicals. Personally, I found Abilify at low doses to be pretty pleasant for my psychotic depression/severe anxiety (part of a bipolar disorder). What's great about Abilify (for most people) is that its non-sedating for the vast majority of people. I took my dose all at once, in the morning, and didn't have any problems at all. Now, sometimes, the sedation that accompanies antipsychotics is desirable. Personally, I think that SEDATIVES are for sedation and ANTIPSYCHOTICS are best used for psychosis or severe mood disorders. The only problem with Abilify's non-sedating profile is that, for some people, it tends to be activating; there are reports of people developing mania and/or some characteristics of hypomania (especially increased anxiety) while doing Abilify treatment. Like all the other atypicals, there is interest in using Abilify as an "add-on" drug for depression, especially when it is severe or accompanied by anxiety, agitation, or psychotic features. There has also been some considerable study into using Abilify for PTSD; it works well, apparently. PRN use of Abilify doesnt seem as popular as PRN Zyprexa, in part because Zyprexa can sedate a patient while Abilify is usually non-sedating; as I said, I think using an antipsychotic for sedation is a misuse of medication. A friend of mine is borderline, and she takes Abilify PRN when she feels the need to cut herself...10mgs, along with 1mg Klonopin usually does the trick (the combo is better than either drug alone, apparently), although I seem to recall her going up to 30mgs during a severe episode. Abilify has a half-life of 75hours I believe. Good luck!


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