Abilify for depression?

I’ve written about this before — the expanded use of antipsychotic medication for indications other than psychosis. These run the gamut from acute mania, where a solid rationale exists, all the way to simple insomnia, for which there is no good rationale. Somewhere in between, but closer to the insomnia end of the scale, is the FDA-approved use of Abilify for unipolar depression.

When I first heard the atypical antipsychotic Abilify (aripiprazole) was being marketed by Bristol-Myers Squibb and Otsuka for depression, I shook my head in disbelief. (You can watch the tv ad on the official Abilify site here.) To its credit, the commercial recites the major, sometimes disabling or even lethal, side-effects, including neuroleptic malignant syndrome, irreversible tardive dyskinesia, dangerously high blood sugar, akathisia, etc, in a nice slow cadence rather than an auctioneer’s rapid-fire staccato. But nowhere is it mentioned that Abilify is an antipsychotic. Nor that antipsychotics are traditionally prescribed by specialists (psychiatrists), not primary-care providers, due to the unique and considerable risks of this class of drugs. The manufacturers paint a picture that looks like this: A depressed-but-functioning patient seeks help from a primary-care doctor, who prescribes an SSRI antidepressant like Prozac or Zoloft. It doesn’t help enough, so the MD adds Abilify and voila, success!

This is a dangerous scenario on several counts. First, in my opinion, primary-care doctors should not prescribe antipsychotics for psychiatric disorders, period. This is not to disparage the skills of internists and family practitioners who see common psychiatric presentations such as depression and anxiety on a regular basis, and know how to treat them. In fact, most antidepressants in the US are prescribed by primary-care MDs, not psychiatrists. But it is one thing to diagnose depression and prescribe a relatively safe antidepressant, and quite another to handle treatment-resistant cases, to distinguish among bipolar disorder, schizophrenia, organic psychotic states, severe personality disorders, etc, or to know the complex risks and benefits of various mood stabilizers and antipsychotics. These are jobs for a specialist. Can a primary-care doctor treat depression with an SSRI antidepressant, and maybe try a second one if the first doesn’t work? Sure. After that, I’d suggest referral to a psychiatrist.

The next danger in the advertised scenario: Even in a psychiatrist’s hands, there are several safer and smarter alternatives than adding Abilify to an unsuccessful antidepressant. Increase the antidepressant dose. Switch to a different antidepressant. Augment the antidepressant with thyroid supplementation, lithium, buspirone, or another antidepressant. (All of these are more or less controversial, and I tend to avoid them, but all are safer than Abilify. See this article on augmentation.) And perhaps the best and safest option, add psychotherapy. While medications help many depressed people, in my experience they most commonly don’t work when the patient’s problem is of a sort better addressed by psychotherapy than chemical intervention. Of course, you’ll never hear about that in a drug ad.

Most concerning are the questions that have been raised about the scientific evidence for using Abilify for depression. This is a very expensive medication with potentially grave side-effects being promoted as treatment for a very common problem. When a patient suffers severe symptoms such as psychosis or acute mania, the benefits of treatment outweigh even considerable risk and expense. But non-psychotic depression? Abilify would have to do a fantastic job to justify the drawbacks. Apparently it doesn’t. These blogs critique the thin, and perhaps biased, evidence base for using Abilify for depression. An 11% improvement on average hardly seems worth it — unless you’re a pharmaceutical company aiming to capture part of a vast market.

48 comments to Abilify for depression?

  • Bingo! As they say in England. England is now in trouble as nobody wants to be a psychiatrist anymore.

    Thanks for visiting my blog: The Cockroach Catcher

  • Catrenia

    Abilify made me very very sick. Excellent post!

  • Sophie Just started Abilify, very apprenhensive, concerned, have moderate depression, should I be on this medication, I am in my 80,s

    • I can’t say. Everyone’s situation is different, and I haven’t seen you for an evaluation. Raise your concerns with your prescribing doctor, and if that leaves you unsatisfied, consider getting a second opinion. Sometimes specialists in geriatric psychiatry are available in larger cities. There are many medical causes of depression (and anxiety) that should be considered in someone your age, especially if the onset of mood changes is recent. Good luck.

  • Leah

    My Doctor wants to add Abilify because my depression develops psychotic components when I’m bottoming out. I’m already taking a number of other medications and even in combination they do not seem to be working. (Trazodone, Cymbalta, Lexapro, as well as other medications). I’ve taken nearly all the available SSRI’s, SNRI’s, and other antidepressants available and they work for a while as the dose goes up, then when I get to the max, eventually they fail. I seem to develop tolerance to these medications rather quickly. ECT was even suggested. Any thoughts or suggestions?

    • Hi Leah,
      My post aimed to caution readers about adding Abilify for common non-psychotic depression. Depression with psychotic features is a very different situation and far less common. Also, I assume you are being treated by a psychiatrist (not a general medical doctor), and you have already tried most of the antidepressants out there. You are in the relatively unusual situation where adding an antipsychotic medication like Abilify is probably a good idea.

      My only other thought is whether a mood stabilizer, e.g., lithium, has ever been added to your antidepressant(s). Atypical bipolar disorder can present as treatment-resistant unipolar depression sometimes, especially if there is a psychotic component. This would be more likely if you have a family history of bipolar disorder.

      Remember, I am only going on what you wrote, and can’t do a psychiatric assessment online. Talk to your doctor about the pros and cons of the different treatment options available, and take care.

  • peggy

    I’m on Pristiq and it has quit working for me (major depression), the Dr’s fix is adding abilify. I keep having to go up on the abilify. I’m very concerned about being on 10 mgs. I can’t seem to get the dr’s to change my antidepressant altogether. Very frustrated, what are my risk.

    • Hi Peggy,
      I’m not in a position to comment on an individual’s treatment. I don’t know you, or why your doctor chose this approach. Speaking for myself, I’m usually much more inclined to either increase the dose of an existing antidepressant, or switch my patient to another one, than I am to “augment” it with something like Abilify. Augmentation adds cost, complexity (remembering to take multiple medications), and the potential for additional side-effects and drug interactions. Nonetheless, I can imagine situations where augmentation would make sense, e.g., if my patient had already tried many antidepressants at high doses without success. I would tend to avoid neuroleptics such as Abilify even in these cases, unless (as with the commenter just above) the depression has psychotic features. Bottom line is that your doctor should be able to explain his or her reasoning. If not, you might consider looking for a different doctor.

  • Patient

    Yeah, um, the reason you have to keep increasing the dosages of anti-depressants is because the down regulate neurons. Eventually, they stop working if you are on them long enough and if you stop taking them you get horrible protracted withdrawal symptoms which are referred to euphemistically as “discontinuation syndrome”. I butted heads with a renowned psychopharmacologist who said that there was no evidence of the down regulating of serotonergic neurons to which I say BS! You can’t have your cake and eat it too. So every other addiction or withdrawal is caused by down regulation except for SSRIs? Hmm.
    I was given Abilify to try but I am refusing to take it for two reasons. One, it is clearly bad and it’s efficacy is questionable at best. Secondly, I have hormone deficiencies which I suspect are the real cause of my mental health problems, and I will address those first before I add any psych drugs. Maybe if I had been tested earlier I wouldn’t have had lost so much of my life to depression and side effects from medication that was never effective at treating it in the first place. That is the one of the biggest problems of the specialty. There is absolutely no differential diagnosis in psychiatry. You talk to a shrink for 20-30 minutes and they throw drugs at your symptoms. They do no testing at all. How many people with hypothyroidism get misdiagnosed simply because no one thought to do a simple blood test. It should be required by law that testing be done before any doctor is allowed to prescribe any psych drug. Anything short of that is malpractice, IMO.

    • Paula

      AMEN! I had to do all my own research, and finally found that adding low dose testosterone to my estrogen, along with thyroid medication, despite “normal” TSH, made all the difference in the world. Unfortunately I lost about 8 years of my life, too depressed to function, experimenting on one medication after the other.

  • Beverly

    I agreed with your article fully until I got to the very end. “An 11% improvement on average hardly seems worth it”. I disagree. I have a 30 year history of episodic unipolar depression. Over the years, I have been adequately maintained on one SSRI and do OK most of the time. But there have been several episodes that have required augmentative treatment. I have been through all of your alternatives at one time or another and participate actively in psychotherapy. I am presently in a bad “episode” and my psychiatrist gave me samples of Abilify today. I don’t know if this will help or not. I am willing to risk all the possible negative side effects. The alternative is suffering through every hour of every day, wanting to stay in bed, avoiding people, possible loss of my job and straining valuable family relationships. I will be grateful if I am one of the lucky 11%.

    • As I’ve replied to other commenters above, I do see value in adding a neuroleptic such as Abilify in unusual cases. Your situation, as described, may qualify. I intended my original post to be critical of the marketing campaign for Abilify, not to say that it can never be useful. Directed to depressed patients, primary care doctors, and anyone with a television, Abilify ads imply that the drug is just another antidepressant, like the ones dispensed by the millions by non-psychiatric MDs. This is false and very misleading. The “11%” I cited refers to studies showing the rate of intolerable side-effects is greater than the rate of improvement in depressed patients. A situation such as yours is still possible, where it may be worthwhile to try it anyway. Nonetheless, it’s very shaky ground for an advertising campaign generically aimed at depression “not fully treated” by an SSRI.

      I hope you are one of the lucky 11%. Thanks for writing.

  • Dr. John

    As a practicing clinical neuropsychologist, who has also completed quite a bit of research in my day, I’d like to thank Dr. Reidbord for his caring, thoughtful analysis of this grave situation. Personally and professionally, I had near identical reactions to initial television advertisements that suggested using major neuroleptics (anti-psychotics) as a way to assist in the treatment of an individual suffering from depression. I’m even more saddened that in recent months advertisements have begun to leave out the “as a way to assist” part (see current Abilify and Seroquel ads). Anti-psychotic medication can be incredibly helpful for individuals who need it, but this is a rare need and I am astounded by the audacity of drug companies in their marketing push. Television ads are intuitively believed to be for common conditions, such as high cholesterol or asthma, which erroneously leads people to believe Abilify (and now Seroquel) are standards of care in depression, as Dr. Reidbord correctly noted. These are serious medications that can have long-term, permanent side effects, even when discontinued. In my opinion, they should only be used in rare cases related to rare forms of depression, and should be no where near virtually all individuals suffering from depression. I agree whole-heartedly with Dr. Reidbord and thank him for his important contributions.

    • Thank you for your kind words and for voicing your concerns about this marketing campaign. Readers should note that my original post is two years old now. My link to the “tv ad on the official Abilify site” now points to a landing page that promotes Abilify for depression, along with lengthy warnings about its safety and side-effects. There is still a video of a (different) tv ad if you want to see it. This wordy page repeatedly refers to “Abilify and medicines like it” without ever mentioning that “medicines like it” are antipsychotics. Worse, by including the black-box warning about antidepressants causing suicidal thoughts and behaviors in some patients, it strongly implies that Abilify is an antidepressant. This may be technically true if it is FDA approved as an add-on treatment for depression, but it is grossly misleading. Antipsychotics (atypical neuroleptics) have lately been shown to help some bipolar and major depressive disorders too. The problem is that they are far more dangerous than standard antidepressants — and much more expensive as well — so they should be last resorts, not mass marketed “antidepressants” to “ask your doctor” about.

  • dave crow

    I was in a severe depression for about six years and had tried all and was still taking many of the usual suspects. My depression was graded as refractory which I think is a polite word for incurable.

    Soon after abilify became available for treatment of depression, my psychopharmacologist prescribed abilify for me.
    Within 2 weeks my depression lifted and has stayed gone for 2 years up to and including today. I would say that I am roughly 90% cured and may or may not ever near being 100% o.k. . (I am still taking many of the usual suspects along with the abilify. We are trying carefully to reduce dosages of the drugs other than adderall to try to determine what is necessary for me to take–and what is unnecessary.

    I think your article, by emphasizing possible side effects, would have the effect of frightening people. If you’ve had major depression for many years,
    taking some risk with abilify seems like a puny risk indeed.

    I have no argument with your stating that people should see a psychopharmacologist (psychiatrist who specializes in treating mental conditions
    with drugs including drug interactions.) rather than their primary physicians. These are powerful drugs and require special knowledge.

    Good luck to all fellow sufferers; I hope you find a solution to your problem.

  • Helene Oakes

    Thank you for your wonderful post!

    As a retired nurse, I did notice that at no time does the maker of Abilify state the drug is actually an antipsychotic. I wonder how many people would be rushing off to the doctor for a prescription if they DID know? Then again, just hearing about side effects that might occur, almost as an aside, is much different than actually knowing what the ramifications of those side effects could be. As best I can remember, the ad does not go into detail about them.

    I cringe whenever the commercial comes on the air–advising patients to speak to their physicians about qualifying for a “free” week or two of Abilify. It’s a disgrace.

    Thanks, too, for letting me vent.

  • Anyone ever heard oaf getting a genomic assay test done? Specifically for antidepressants and antipsychotic medications. AssureRx is a lab that has these services.

  • Dyanne

    What is your opinion on a young adult with Asperger’s (while considered high functioning, does have the temperment of an autistic teenager) diagnosed with depression and is not having much success with antidepressants alone taking abilify as well?

    • As I’ve written above, I’m not opposed to adding Abilify or similar meds in selected cases of severe treatment-resistant depression, or in other complex psychiatric situations. My objection is to selling it with consumer ads that falsely imply Abilify is a harmless add-on for garden variety depression, perhaps treated by one’s family doctor. In the hands of a specialist, and in carefully selected cases, it may very well be a good idea. Thanks for writing.

  • Mary

    I’ve had unipolar depression for 25 years. I had a very serious episode lasting the past 8 months. My psychiatrist did add 2 mg Abilify to Cymbalta last week, and it’s like a miracle. I felt it IMMEDIATELY after taking it. My blood sugar has always been normal and and I’m now 51 years old. There were years I tried to live without an antidepressant, but depression and panic attacks always came back without them despite years of working with good therapists. I will not be going up on the dosage since it worked so well. Within one week, I feel like a new person, though I need a two level spinal fusion,am in terrible pain and have been off work for three months (I’m an academic and have generous sick leave.)

    For something to work so quickly at such a low dosage is just amazing.I did have the side effect of insomnia (terribly) for the first three days. Then I had one night where I slept for 12 hours after the insomnia resolved, and am now sleeping normally. It’s a miracle for ME. I’ve been on every antidepressant and increasing the dosage is a temporary help. I’m in therapy again since I’m going through all these challenges, and will stay in it, but therapy alone does not work for me. I’ve tried it many times. Neither does therapy and antidepressants, because they simply STOP working.I hope abilify never stops working.

  • Ginny

    The article on this subject makes some VERY valuable points. Even in the hands of a psychiatrist, problems can occur. I have treatment resistant depression, have used every SSRI out there, along with mood stabilizers, ECT, psychotherapy. I am very grateful that we have the medication arsenal we do for depression – I would probably not be alive today if we did not.

    I’d like to caution about a problem I encountered….I have been in situations where multiple medications/dosages/additions were being tweaked at the same time. This went on for over a year, and at one point Abilify was in the picture. I suddenly began slurring my speech, bumping into things, and at one point fell out of my chair at work. I called my GP, who scheduled me for a head CT. When it came back normal, he asked if I was taking any new meds. My reply was that I’m “always on a new med”…and so I called my psychiatrist who immediately knew Abilify could cause the symptoms and took me off of it.

    It hadn’t occurred to me that one of my meds could cause such serious symptoms. But I was always experiencing side effects of some sort and adjusments to dosage changes all the time. My thoughts now are that I never want to change/add/stop more than one medication at a time…..that way if there’s a problem it is a lot easier to identify the cause.

    I’d also like to add that my young nephew, age 8 and diagnosed with ADHD and possible Ausbergers, ended up in the ER after being on Abilify, also with slurred speech and balance problems. I kind of feel that it is one thing for an adult, but another for a child to be on such powerful, potentially dangerous meds on a “trial” basis. Is there any information on its long term effects for young children?

  • Sasha

    I completely agree with your analysis of the Abilify commercial. I too have done some further research and a study conducted by Berman et al.: The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study was the only study found with such constraint. Most of the other studies that http://www.abilify.com supports are a series of meta-analysis of placebo controlled trials including other antipsychotic drugs for adjunctive therapy (not solely aripiprazole). Because of this I propose that more evidence be collected through other randomized, double-blind, placebo-controlled studies in search for more significant results.


  • bev

    Abilify made me fat!! Im off it and on a diet now.

  • Amy

    Dr. Reibord…..Your article was written in 2009. Now that 5 years have passed, I am wondering if you have any updates in data and/or your opinion.

    I can echo a couple of the blog participants. I have unipolar depression….incredibly treatment resistant. Lots of water under the bridge, but to the point…have basically been in bed for three years while trying antidepressant after antidepressant. Wellbutrin added in and out over time. NOTHING has touched my depression…has been like drinking water. Lots of issues with anxiety and panic attacks developed.

    Finally, hit on a new antidepressant, Fetzima that touched it a little. Changed “out of bed time” from about an hour a day to maybe 2 1/2 or 3 if I really strive. When I went back to my shrink (I can’t spell psychiatrist.) last week, he was going to add Wellbutrin back in. That drug has never done anything for me, so even with all the scary side effects, asked him about Abilify. After long discussion with him over my concerns, not really his. He was more comfortable with it than I was. He prescribed it for me. THEN, also had long discussion with my pharmacist, who was also comfortable with it. He had just been to a conference where it was a major topic.

    They both said the same two interesting things to me. One…..the Abilify people have been more forthcoming with possible side effects than many of the drug companies have with their drugs. Two……it seems to either work right away or not. Only works on “some” people with same diagnosis.

    I don’t know what’s going to happen, but have been on it 6 days. Dear god, I hope side effects don’t start because, believe it or not, I started feeling better by day 3. I have 2mg tablets that I am cutting in half, so 1 mg a day so far. I can’t remember what feeling like a normal person is like, but this is SO much better. I’ve actually been out of bed for 6 hours today. Have completed two tasks. Laughed once this week. Cross your fingers for me.


    • Hi Amy,

      In the past 5 years I’ve heard of people, online and in real life, who improved after adding Abilify to their antidepressant(s). So I’m sure it helps sometimes, and I sincerely hope that’s the case for you too. I still have strong reservations about direct-to-consumer advertising for meds like Abilify that require subtle balancing of risks and benefits, and that should be reserved for unusual cases. This is not limited to psychiatry by the way: I’m also dismayed by ads I’ve seen selling esoteric add-ons for cancer treatment. As I’ve written more recently, the whole “ask your doctor” trope implies that patients need to advocate for themselves, because their doctors would not otherwise consider these meds. That’s a subtle putdown of doctors — and sly psychology on the part of the advertisers. Take care.

  • Amy

    Doc, thank you for your response.

    Although I was looking for the latest “good data” about ability, your comments,although not providing that… never the less intrigued me.

    If I am hearing what you said in the message, I got 3 things:

    1. You have a problem with direct to consumer med advertising.
    2. You have a problem with patients advocating for themselves.
    3. You feel that if a patient comes in and has a suggestion or questions a doctor that it is an affront.

    Did I get this wrong?

    Thank you.

    • Well, I didn’t see that coming. As before, I’ll take your comment at face value and try to respond the best I can.

      1. Like most things in life, direct to consumer advertising (DTCA) is neither all good nor all bad. While there are benefits to informing the public about new prescription meds or indications, on balance I believe the drawbacks outweigh the benefits. Most of the world seems to agree, as the U.S. and New Zealand are the only two countries that allow it. Among other concerns, I believe DTCA increases sales of expensive brand-name drugs over generic alternatives that may work equally well, but are not advertised. They paint an overly rosy picture of the products advertised, and because they aim for the largest possible market share, they hint at wider applicability than the science supports. In my opinion, this last point is clearly illustrated in the campaigns to promote Abilify and Seroquel for depression. While there are good reasons to use such agents in selected cases, it is grossly misleading to suggest their use whenever a standard antidepressant hasn’t “done the whole job.”

      2. “Advocacy”, like “consciousness-raising”, is a term that spans behavior from the noble to the obnoxious. Patient advocacy takes many forms. Political advocacy to fund community mental health clinics, or to make medications affordable, strikes me as noble. We Californians will vote this November on a new law to drug-test doctors and raise malpractice award limits. There are “patient advocates” on both sides of the debate. I.e., “patient advocacy” sometimes depends on whose ox is being gored. When patients feel the need to advocate for themselves in the exam room, there’s something wrong with the doctor-patient relationship. The doctor should be the patient’s advocate. And when antagonism between these health-teammates is fomented by moneyed pharmaceutical interests, that’s obnoxious in my book.

      3. An affront? Not at all. My patients do it all the time. But again, I’d point out the important difference between doctors and patients working together — and yes, questioning each other at times in a collaborative, civil way — versus a patient who feels the need to advocate for herself “against” her doctor. If that’s been your experience, please find a doctor on your side.

  • Bruce F

    I am very grateful for your blog. My wife has been on a cocktail of abilify, pristiiq, and cymbalta for over three years. She is a survivor of sexual abuse and suffers from periodic depression. In spite of that she has always been a very hands on loving mother. About two years ago she began to withdraw emotionally from me and our two sons. Earlier this year it was discovered that she was having an affair. Now she has moved out, interacts only a little bit with our boys and contemplates divorce. It is as if her spirit has left her body. Marriages can struggle of course, but motherhood itself? The only through line in all of this is the drug cocktail. Have you heard other stories of long term use of these drugs causing such dislocation of intimacy?

    • Bruce,
      I took the liberty of removing your last name from your comment. This isn’t a place to “out” your wife’s psychiatric issues or her affair.

      The possible reasons for her withdrawal are numerous, from the depression itself, to the affair, to her relationship with you, and so forth. It would be meaningless for me or anyone else to speculate online. Both antidepressants (Pristiq and Cymbalta) and neuroleptics (Abilify) have been reported to cause social withdrawal. This is often hard to tell apart from the original problem or other factors.

  • Bruce F

    Thank you for your reply and apologies for using my last name before. Your answer was helpful. Is there evidence that the emotional withdrawal that can come from the drugs in my wife’s cocktail is progressive, even if the dosage remains constant?

  • Ferritin

    I didn’t read the comments but have my two cents if considering ssris: test your ferritin levels. Take b complex . Get a hotel room for a few nights a relax at their spa and pool. Get a personal trainer for a couple weeks. The cost of these treatments is well worth avoiding the cost to your liver for taking any of these meds. Been there, not worth any of it. Psychotherapy helped tremendously.

    • What is this

      I hope since this is 5 years old you have figure out you know nothing of Major Depression as a legit diagnosis. your comment or 2 cents worth were patronizing , ignorant and unkind . Trust me, anyone who suffers this or any other mental health issue can not be cured fixed or otherwise massaged out of depression . They have tried all that BS. I hope you were just trying to start crap on here and o not ascribe to your own nonsense. If this is not your intent your dismissive response is juvenile .

  • Bruce F

    Turns out my wife has been abusing oxycodon. Things were getting tough for her with our kids, she went to her psychiatrist, and after saying whatever she said, he doubled her abilfy to 20mgs.

    I don’t think the possibility of drug abuse ever crossed his mind.

  • Kitkat

    Hi there

    I am going through an episode of severe depression and OCD and have been considering suicide. This is around the 5th episode in my life I’ve had (I’m 30, female) and it is by far the worst. I have never felt suicidal before, even though my functionality has been impaired (had to take 18 months off work 3 years ago; was convinced I was dying of CJD for 6 months – was really ‘just’ severe anxiety and OCD). I have also had short episodes of hypomania lasting from a few hours to a few days. Not sure if I may have bipolar II, or borderline personality disorder, or depression/OCD or some combination.

    Anyway – my question is – I am considering asking my psychiatrist about a very low dosage of abilify. Do very low dosages tend to have similar risks/side effects?

    I am currently taking 20mg fluoxetine and 150mg pregabalin. If I take a higher dose of fluoxetine I go hypomanic. I’ve been on several SSRIs before and am not sure if they have been particularly effective. I’ve also tried mirtazapine, which made me angry and irritable and I felt like I was having a personality change. Pregabalin makes me feel spaced out and not like myself. It doesn’t help with the depression.

    Any advice would be much appreciated.


    • I can’t diagnose or treat you from here, but I have a thought or two. Do you really get hypomanic, or is this akathisia or jitteriness from the antidepressant? They can be hard to tell apart. If the former, you and your doctor might consider a traditional mood stabilizer like lithium or Depakote. Or an atypical neuroleptic like Abilify. Most of the risks of Abilify are dose-dependent. Lower doses (and shorter treatment duration) mean lower risk. On the other hand, if what you’re calling “hypomanic” is really restlessness or a jittery reaction, Abilify isn’t likely to help that. It could, however, help with the depression itself. As I’ve repeated a few times now, I don’t object to using Abilify as an add-on for severe, treatment resistant depression. I only object to the falsely reassuring marketing campaign of its manufacturer, and to casual prescribing by my fellow doctors. I haven’t seen pregabalin work as an antidepressant; maybe it’s intended to lower your anxiety or irritability instead? Take care.

      • What is this

        I am glad to see an MD respond to these adverts . i always wondered why market aggressively about an addd on treatment or alternative treatment like breast cancer drugs and blood thinners all different types of drugs ???? I can bet you, if your MD is worth his weight in salt HE FREAKING WELL KNOWS ABOUT THESE DRUGS THAT BIG PHARMA IS PUSHING. I know for a fact they are being direct marketed to. They want us to get better. If they have a new drug they will tell you. I just never ran across an MD who was nit up to the minute informed on various treatments.

  • Marshall

    Its been a nice, long time since your original post, but…since I see the comments have still been coming in till recently, I thought I’d comment, also.

    I don’t know if this is happening everywhere, but where I live, docs are using Seroquel and Abilify on everybody and their Mama. I take Abilify for Bipolar I, which in my case includes psychotic depression. I can’t tolerate depakote or lithium, the other atypicals made me twitch, perphenazine made me sad and nervous, so…yeah…Abilify. Beats the other options, for me at least.

    The whole point of the atypicals is that severely mentally ill people can tolerate them better, there’s supposed to be less tardive dyskinesia, and they don’t cause as much cognitive and emotional blunting as, say, a hefty dose of Halol. They’re not wonder drugs, they’re cleaned up tranquilzers, and they come with their own set of nasty side effects.

    I guess since they’re more tolerable and there’s so much money being made and also being poured into ad campaigns and such, docs just think…why Rx (valium, buspar, lithium, anything) when I can just Rx AbiliQuel? Ridiculous. For me, the risks outweigh the benefits. The costs do, too, because mental hospitals cost $$$, lots of $$$ compared to Abiify.

    I think this won’t stop until/unless lawyers get involved. I mean, once enough people develop tardive syndromes, I bet there’s going to be expensive legal action, and then maybe this will stop. Or after most of the drugs go off patent, replaced by new wonder drugs.

  • Dear Dr. Reidbord––

    While I appreciate your cautious criticism of atypical antipsychotics, I’m finding it difficult in agreeing with your proposed alternatives to treating depression sans atypicals. Increase antidepressant dosage? Okay. During the 7 years I was deteriorating due to drug-induced adverse reactions and those first 6 psychiatrists that wound up putting me on various combos of 35––THIRTY FIVE––psychotropic medications…
    [lengthy anti-drug story deleted – SR]

    • I’m sorry you were put on 35 psych meds. I would never do that. However, I don’t share your opinion about psych meds in general, and my blog isn’t an invitation to post anti-psychiatric rants or to engage in adversarial “debate”. There are plenty of more suitable places on the internet for that. You are free to disagree with my proposed alternatives to adding Abilify, which included other meds but also psychotherapy (the bulk of my practice). I’m glad you appreciated the point of my post: criticism of Abilify marketing.

  • a b

    I have been digonsed with depresion. I was on 2mg of abilify and it helped a little. would it make sense to go up to 5mg thanks for your reply

    • Would it make sense? I imagine it could. Can’t really say given your one-line description, and the fact that you’re a complete unknown to me. Advice regarding your particular case has to come from a doctor who has evaluated you personally. Good luck.

  • Sam

    I am from the Netherlands. Depression for over 5 years. Unable to work for 3.
    Tried lots of ad and augmentations incl. Stimulants.Even tried buprenorphine.(1 week great releif)
    All to no succes. Back on 50mg parnate which once helped.
    Could low dose abilify be an option with maoi.

  • Linda

    I have had MDD for over 30 years. I have tried nearly all the SSRI’s an SNRI’s and some TCA’s, all of which lead to worsening of my depression. Augmenting with lithium and atypical antipsychotics were of little to no benefit. I had many ECT’s, estimate 250-300 treatments which were helpful temporarily, but had to be discontinued due to two episodes of anesthesia awareness. I am now in the 5th week of a MAOI trial with Nardi (45mg three times a day). I have experienced very few side effects, but have not received a therapeutic benefit yet. I am severely depressed, suicidal intrusive thoughts and socially isolated. My psychiatrist just added 1mg of Abilify. Do you think this could be helpful or will it likely worsen my depression?

    • For a depression history as severe as yours, it may make sense to try adding Abilify (aripiprazole) to Nardil (phenelzine). There are no controlled trials of this drug combination, but there are case reports. I can’t say what it is likely to do, but it’s not an obviously bad idea. Good luck.

  • Matt

    Question- I have been on SSRIS, SNRIS, mood stabilizers and MAOIs but none seem to have an impact on my depression. Diagnosed with treatment resistant depression and GAD. Now, my doctor wants to prescribe 2 mg of abilify and rightnow I’m not on anything, curious of your thoughts? Also, in the past, two other psychs I had wanted to add abilify to an antidepressant I was on at the time. I have always been fearful of the side effects of abilify but as time goes on and nothing else works, I’m beginning to lean towards trying it.

  • Michelle H

    Hello, I have panic and depression and I have tried ssri drugs thus resulting in serotonin syndrome. My dr wants to try 1mg abilify due to how sensitive I am to the meds I’ve tried….I’m lost…can you give me
    Your opinion?

    • Michelle (and also to Matt, whose comment is just above yours),

      I can’t give you personalized treatment advice. You’re not my patient, and I don’t know your detailed history of depression and its treatment. What I can say is that atypical neuroleptics like Abilify (aripiprazole) are widely used as an add-on to antidepressants — and that there are alternatives, both medication and non-medication, that neither of you mentioned. E.g., tricyclic antidepressants (TCAs), transcranial magnetic stimulation (TMS), ketamine, … and psychotherapy. I mention these without any idea if they would be appropriate for you personally.

      My original post from over a decade ago warned against the “casual” promotion and use of Abilify and similar medications for depression. I never said it was always wrong to use them. In fact, I’ve prescribed Abilify myself to rare patients with severe depression. The more complex or “treatment resistant” a case is, the more it makes sense to consider doing this. Conversely, I still believe, as I did back in 2009, that the much more common mild-to-moderate depression doesn’t warrant the risks and side-effects of Abilify and similar drugs, especially as a first (or early) treatment approach.

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