Skappy asked
My daughter is having strange side effects after taking only 1 mg of Abilify. She took it before bed last night and had extreme insomnia, restless leg, shaking, sweating, nightmares, increased anxiety, leg cramps, and feelings of mania. The next day, today, she was very energetic, able to function but had urges to clean like crazy and shop uncontrollably, and tired yet unable to rest. Is this normal after only 1 mg. Her doctor wants her on 2 and up to 5 but after 1 mg she is having such side effects she is scared to take it again. She is diagnosed anxiety, OCD and depression with an eating disorder.
Answer
Abilify (aripiprazole) has a complex mechanism of action with a wide range of effects. Before we get into specifics, it is important to know that many of the side effects you state your daughter is experiencing are well documented with use of this drug. Perhaps the most glaring issue you mention is the impulsiveness/restlessness that is occurring.
On May 3rd, 2016, the FDA posted a safety announcement in regard to Abilify causing impulse control problems. You may read the announcement via this link. In the announcement, the FDA warns that uncontrolled urges to shop, gamble, binge eat etc... have all been reported with Abilify use. These behaviors are usually seen within days to weeks of starting the medication or after a dose has been increased. The uncontrollable urges did stop once the drug was discontinued or the dose was decreased. It is important to try and understand if the drug is the culprit in your daughters situation so as to prevent or limit possible harm.
As mentioned, Abilify has a complex mechanism of action and works on no less than 8 different neurotransmitter receptors in our body including 4 different serotonin receptors, 2 different dopamine receptors as well as histamine receptions andothers. Abilify can be extremely effective in many patients for the treatment of mental health conditions such as bipolar disorder and schizophrenia. Unfortunately, there are many side effects associated with it too.
Many of the side effects you list on your question are well documented, as we mentioned above. Below, we list the general incidence rate in the population for these side effects from Abilify:
- Drowsiness/somnolence: 4-23% of clinical trial participants experienced some sort of drowsiness of somnolence.
- Insomnia: 18% of clinical trial participants experienced problems with insomnia.
- Uncontrollable urges: The overall incidence is unknown but is thought to be rare. This side effect mostly came to light during post-marketing (i.e. after the drug was released on the market).
- Core Body Temperature Changes: This was reported in clinical trials as well, which could be part of the reason for the sweating problems your daughter is experiencing. The overall incidence of the adverse reaction isn't known.
In addition to the side effects listed above, it is important to be very aware of uncontrolled muscle movements. As a class, atypical anti-psychotics (of which Abilify is a part of), are well known to cause this problem. It can be relatively common but it is extremely important to let you doctor know about them so your daughter can be monitored. These movements are sometimes referred to as extrapyramidal symptoms (EPS) and include uncontrolled muscle movement/spams and cramping. This may be the reason for your daughters cramping.
Very rarely, another movement disorder can occur. A serious condition known tardive dyskinesia can develop and is mostly associated with uncontrolled movements in the face, lips and tongue. Again, any sort of uncontrolled muscle movement should be reported to the doctor.
It certainly appears that your daughter may be experiencing many of the side effects Abilify is associated with. It is important to bring your concerns to her doctor so you may discuss them and come up with the best therapy for your daughters situation. Lastly, if you want to stop the medication, it generally is beneficial to do so in a step wise fashion and not immediately discontinue the drug as this can cause certain withdrawal reactions. Again, speak with your doctor regarding the best course of therapy.
