Abilify wins.

I put up a tough fight, but in the end, with serious commitments looming, I decided to surrender and let Abilify have this match.

Titering down very slowly and using the every-other-day method really did work. I was down to 2.5mg every other day and had great results doing this for two weeks.  It was at day five of being completely off the med when I noticed the subtle withdrawal signs creeping in, and by day seven I made the decision to go back to the 2.5mg every other day until the end of next month.

I don’t want to discourage anyone  who is also trying to remove this drug from their regimen.  Keep at it, and do it safely.  This is just a really tough nut to crack.  For me personally, there were two extremely stressful events that occurred just two days apart shortly after I stopped taking Abilify altogether.  It was just bad timing.

Or, was it?

Let’s get technical; what I was sliding into was  a mild psychosis.  Racing thoughts, mild paranoia, mild emotional changes, mild personality changes.  Even my husband noticed.  Wait – isn’t this why my dose of Abilify was increased late last winter?  Why, yes, it was.  So, after I stabilized on 2.5mg every other day again, I researched whether or not antipsychotic withdrawal can provoke psychosis.  Lo’ and behold, an abstract with the exact title appeared among my hits.

Evidence for a rapid onset psychosis (supersensitivity psychosis) following clozapine withdrawal was found and weaker evidence that this might occur with some other antipsychotic drugs. Some cases were reported in people without a psychiatric history. It appears that the psychosis may be a feature of drug withdrawal rather than the re-emergence of an underlying illness, at least in some patients. Meta-analyses of withdrawal studies have suggested that antipsychotic discontinuation may also increase the risk of relapse over and above the risk because of the underlying disorder, but not all individual studies show this effect. Mechanisms may relate to brain adaptations to long-term drug use but data are sparse.

Not conclusive but there’s enough there to make one wonder, especially since I am so sensitive to Abilify in the first place.

Of course the big question is whether what I experienced was indeed withdrawal or my manic-depression rearing its ugly head again.  I am, after all, Bipolar I.  Antipsychotics reduce the level of dopamine so when the drug is cut off the brain needs to get used to making it again.  Quite a tall order for a brain that can’t regulate itself in the first place.  So, were the symptoms of mild psychosis due to my brain trying to kickstart dopamine production again?  It turns out there is a set of three criteria to determine whether or not the symptoms experienced are a result of withdrawal:

  • [Keeping in mind the half-life of the drug] The problems begin immediately after reducing or stopping the drug. (If the original problem has been treated, it should be some time before the symptoms come back, if ever.)
  • The symptoms disappear if you go back on the drug, or raise the dose.
  • You are experiencing new symptoms as well as some of those that were a feature of your original condition (flu-like symptoms as well as depression, for instance).

[The above information came from a wonderful pamphlet from www.mind.org.uk called, ‘Making sense of coming off psychiatric drugs.’  It is highly worth the read, covers many types of psychiatric drugs (not just antipsychotics) and can be downloaded as a PDF booklet for 1GBP here.]

Bingo.

Withdrawal.  Again.

As it turns out, the half-life of Abilify is 3.5 to 6 days, so the onset of my withdrawal symptoms completely fits the profile.  My symptoms disappeared after beginning the drug again and the personality changes and paranoia completely evaporated within 36 hours of my jumpstart, 5mg ‘superdose.’

Being armed with this knowledge makes me all the more anxious to cut antipsychotics out of my regimen entirely. I understand that should I be unable to manage mania or psychosis in the future I may have to return to using this class of drug.  The plan for now, however, is to return from an extended trip at the end of September, cut the 2.5mg dose every other day into even smaller slivers and take to my bed if necessary to quit Abilify once and for all.

The moral of the story is antipsychotics are very serious medications and should not be taken lightly.  Nor should the withdrawal some people experience.  Patients need to be their own advocates when making decisions regarding to take or not to take this class of medication and the Misuse and Abuse of Antipsychotics needs to be addressed.

As I said at the beginning of this post, if you’re reading this and trying to eliminate antipsychotics from your cocktail, do it smartly.  Consult with your physician, educate yourself about the drug you are taking, it’s half-life and the potential withdrawal symptoms.  Don’t rush.  And if it doesn’t turn out the way you hoped the first time around, don’t be afraid to surrender, regroup and try it again.

30 thoughts on “Abilify Withdrawal – Round 3: Abilify Wins and Antipsychotic Dependence

  1. Excellent information. I think one should always assume there will be withdrawal symptoms and plan accordingly. Like you said, once you can “clear your calendar” you can make the necessary arrangements to prepare for the siege. Keep us posted!!

    1. Hi there! Yeah, clearing the calendar is the trick, isn’t it. I was hoping to be able to get back to reading blogs, commenting and writing posts next month but it may just take a little bit longer. So be it. Hope all is happy in your world 🙂

  2. Wow. Luckily, I stopped the Abilify not long after I took it, so no worries there. But now I want to get off of Seroquel, so I’ve got to try to do that gradually and taper down. My pdoc prescribed me a smaller dose of Seroquel for that purpose, but I can’t get it yet because I just refilled the other higher dose. It’s a bit annoying.

  3. I think that an answer can be found in the below post that I made on the Madinamerica site. Why isn’t the Mt Sinai report the “smoking gun”? Please see: http://www.sciencedaily.com/releases/2012/08/120813103250.htm. Although the intent of the research published in Nature Neuroscience was to make antipsychotics more effective or to suggest a new avenue for drug development, the implication of the findings is that chronic administration of antipsychotics creates a dopamine supersensitivity, and hence a vulnerability to psychosis on discontinuation, that is far more sinister and likely than anything I have seen to date. This report was released in August, but I don’t see the reaction I would have anticipated. If this report does not indicate that chronic administration of antipsychotics should never be used except in the most extreme of cases, I’m missing something. The findings, as I see them (I’m not a scientist) are that chronic administration of antipsychotics results in elevated HDAC2 which suppresses genetic expression of the mglu2 receptor. Glutamate dysfunction has long been suspected to be relevant to psychosis. Philip Seeman (the discoverer of D2), who is one of the most renowned researchers in pharmacology showed the dramatic effects of mglu2 activity in 2009: http://www.ncbi.nlm..gov/pubmed/19084908. In short, the the under activity of mglu2 (by implication…Dr Seeman was using mice with no mglu2) results in dramatically greater d2 recepors in high state. This is dopamine supersensitivity or tardive psychosis. Am i missing something? Why am I not seeing a mushroom cloud? Didn’t the Mt Sinai group provide the smoking gun for what Robert Whitaker has been suggesting? In a nutshell, even if you were never psychotic, if you try to discontinue antipsychotics, you are at a high risk of becoming so? Please make this an issue.

  4. The following is a comment from a gentleman named Ed who asked me to moderate / post myself so his privacy is protected:

    I think that an answer can be found in the below post that I made on the Madinamerica site. Why isn’t the Mt Sinai report the “smoking gun”? Please see: http://www.sciencedaily.com/releases/2012/08/120813103250.htm. Although the intent of the research published in Nature Neuroscience was to make antipsychotics more effective or to suggest a new avenue for drug development, the implication of the findings is that chronic administration of antipsychotics creates a dopamine supersensitivity, and hence a vulnerability to psychosis on discontinuation, that is far more sinister and likely than anything I have seen to date. This report was released in August, but I don’t see the reaction I would have anticipated. If this report does not indicate that chronic administration of antipsychotics should never be used except in the most extreme of cases, I’m missing something. The findings, as I see them (I’m not a scientist) are that chronic administration of antipsychotics results in elevated HDAC2 which suppresses genetic expression of the mglu2 receptor. Glutamate dysfunction has long been suspected to be relevant to psychosis. Philip Seeman (the discoverer of D2), who is one of the most renowned researchers in pharmacology showed the dramatic effects of mglu2 activity in 2009: http://www.ncbi.nlm..gov/pubmed/19084908. In short, the the under activity of mglu2 (by implication…Dr Seeman was using mice with no mglu2) results in dramatically greater d2 recepors in high state. This is dopamine supersensitivity or tardive psychosis. Am i missing something? Why am I not seeing a mushroom cloud? Didn’t the Mt Sinai group provide the smoking gun for what Robert Whitaker has been suggesting? In a nutshell, even if you were never psychotic, if you try to discontinue antipsychotics, you are at a high risk of becoming so? Please make this an issue.

    1. Um, delayed reaction, sorry…what I meant was, have you tried using Seroquel as a buffer while weaning off Abilify? Benzos are lovely for some things, but they don’t help psychotic symptoms, while Seroquel might mitigate the dreaded Psy phenomena and get you through the tough parts. I find it’s good for quelling (I guess that’s how it got its name) the manic features. It does nothing for depression, so I have to take Lamictal for that. Handsful of drugs, drat! But that’s the hand we’ve been dealt, I suppose…Hey, my brain is addled even more from a recent head injury, and I’ve forgotten whether I have asked you, or you have contributed, an interview to my weekly Wednesday series, Breaking the Silence of Stigma: Voices of Mental Illness. If you have, sorry for the repeat invitation; and if not, would you be interested in being interviewed (on paper, not in person 🙁 )?

  5. First, I want to tell you how much I admire you for going about this in such a cogent, persistent way. Sending you much good juju to get through this in your own timeframe. Second, my son, who is a third-year Ph.D. student in Medicinal Chemistry, did a paper/presentation on Abilify for his first-year seminar group. In his words, “that shit fucks with your entire brain, and your entire body for that matter. It should never have come on the market.” Encouraging, eh? I take Seroquel myself, which is not much better, if at all. Present circumstances require my brain to be rock-steady, and Seroquel flattens it out so that I am able to feel neither joy nor pain, just cold logic. I’m very much hoping that when these circumstances are over I will be able to wean off the Seroquel, perhaps by means of upping my benzo doses temporarily, and then wean off the benzos (another Herculean task). A Yahoo support group on getting off of benzos gives a laborious yet seemingly effective method of weaning off that involves weaning down by tiny increments, staying at that increment until all withdrawal symptoms are gone and then a little longer to make sure, and dropping down again a teeny bit.

    Another question I have is: have you looked into using a second antipsychotic as a buffer, to take while weaning off Abilify? I am shocked at Abilify’s looooong half-life. Perhaps overlapping with a shorter half-life drug temporarily might get you off the Abilify, and then you would wean off the second drug? Is there any support for that in the literature?

    Take good care and be well–sending love and good vibes xoxo

    1. Hey there, SS: How are you doing? I read your last post…I hope the sting is wearing off. Feel free to mail me privately if you’d like to chat or just blow off steam. I’m right there with you.

      So this Abilify thing…in the end it took me eight months to wean off. Eight months using the weaning off method you spoke about above. The last two weeks were hell, too. Xanax was definitely my friend. Unfortunately, you can keep yourself in a benzo coma for only so many hours out of the day and have to be awake for things like eating and showering. That’s when the tears would start. I cried over *everything.* Your son is right. Abilify fucks with your entire being. Never again.

      I’ve known two people who quit Seroquel without the benzos and neither had a bad experience. At least the Seroquel seems to be doing its job for you. If your brain is flat then you can get your stuff done. Do you have any breakthrough anxiety? (Abilify was pretty lame with keeping anxiety out of the picture.)

  6. Yes, Seroquel seems to be fairly benign (so far) in the getting-off-it department. I’ve gone off a couple of times, since the reason I take it is to keep from killing myself when I’m around my mother, whose mere presence in the universe gives me severe attacks of PTSD.

    I’m so sensitive to drugs that the highest Seroquel dose I can tolerate is 50 mg, which is a drop in the bucket dosage-wise. Still, when it hits me I get so ataxic I had better be near my bed. Once it came on when I was in the kitchen and I had to CRAWL to bed (and there was someone else in it at the time, embarrassing)!

    I do have break-through anxiety from PTSD, not unexpected. I take both Ativan and Klonapine for that, which all adds up to 12-14 hrs of sleep per night, which is better than zero without the drugs but definitely cuts into my day. Can’t have everything, I guess, although it would be nice.

    Thanks, I would love to get together in the private email world, visit on Skype, etc.! We’ll have to work out a plan.

    In the meantime take good care, and know I’m right there in the trenches with you!

  7. This has been immensely helpful. I’ve been diagnosed with borderline bipolar disorder. On 2 mg of Abilify I hit a gargantuan 285lbs. My uniformed pdoc had me come off cold turkey due to the “low dosage”. I am now in the middle of a weird withdrawal crisis with depression symptoms coming back four hours or so a day with suicidal ideation. Should I ride this out or go back on 1mg until we get back from a 7 month trip im about to go on? Any suggestions would be helpful…

  8. Dear AR:
    If you wre at 2Mgs for a long period of time (more than a month or two, as opposed to having recently reduced to 2Mgs) and if you came off Abilify less than a month ago; the observation of my son ‘s struggles with this med (individuals are different) I would think re-instating and using a far more conservative taper would be a good idea. If you haven’t switched to liquid Abilify to do this, please consider doing it. This is a very powerful drug. Most tapering guidelines from folks who have experience recommend a reduction of no more than 10%. For Abilify, with its long half life, tapers are a month or more apart. Please be very careful.
    Be well,
    Ed

    1. Ed – it’s so good to see you posting again. I’ve been offline for a few months but would love to catch up. Send me an email! If you lost my address let me know and I will contact you. All the best – Vivien

  9. Ed- I was on Abilify for over 2 yrs and quit two weeks ago. Going to see my pdoc monday and will prob take your suggestion. I believe these are withdrawal symptoms as opposed to being my bipola symptoms recurring. Or both. Thank you!

    1. Hi, AR: I’ve been offline for a few months. Were you able to come off of the Abilify? How are things going for you? I hope all is well – let me know how you doing. Vivien

  10. Wow, thanks! I am trying for the third time to stop taking abilify. 2 mg added to 300 Wellbutrin. I usually start having trouble around week two: no motivation, no joy, no sense of purpose, anxiety, extremely tired. Well it’s week two and here we are. I started having real issues three years ago after losing my dad. Finally found a concoction that worked which included Wellbutrin, abilify, Xanax, adderall and restoril. Needless to say, I didn’t want to be on this much medication for the rest of my life. First went the restoril ( prescribed for sleep disorder…too much REM, not enough restorative sleep), next Xanax (was taken daily, now only when needed. I’m not messing with the Wellbutrin. As I said, I quit two weeks ago after cutting the does to 1 mg for three months. First few days were fine, last couple of days, not so much. My conundrum, do I hang on or give up? Am I just suffering withdrawals or is the underlying issue coming back? The last two times I tried to quit, I started back on the abilify and felt immediate relief from uncomfortable symptoms. I appreciate the information you provided; I’m going to hang on, keep researching and hope that everyday gets a little better 🙂

  11. I don’t if this thread is still alive, but I’m taking my first stab at getting off Abilify by myself. I asked for my doctor’s advice how to back in Spring, but he wouldn’t tell me, as he would be “liable.” ANYHOW–I thought I could wing this, but after stepping down from 5mg/day to 2.5mg/day to 2.5mg/every-other-day all within 2-3 weeks (I wasn’t really paying attention), the past two weeks (sans any meds) have been: a fatigue sleep doesn’t relieve + mild depression (no crying jags, but definitely flat, hopeless, no motivation).

    I was really happy to come across this share, as well as some other resources. My main question (fear) is my want to step back up for a little while (prob 2.5mg/day again)–prob for a month–before trying to step down either by every-other-day or some smaller dose.

    I know I’ve seen it with my own eyes from others on here and elsewhere–but is there any danger in stepping back *up* after stepping down for a bit? I read ONE thing that went, “Don’t ever do that,” so now it’s lodged in my brain. And since i can’t consult my doctor about any of this, I’m afraid…

    Any experience/thoughts/ideas/feedback welcomed!

    <3
    K

  12. After reading this post and the previous two posts it gave me a better sense of how to taper Abilify. I was on 15 mg Abilify and I am currently at 2mg Abilify. I read that 2.5mg Abilify is still considered a full dose. I don’t think it matters how high of a dose you were on before. You need to compound the dosage and get it in liquid form. I read on a thread that many people have a hard time getting off 1mg Abilify so the natural answer is to taper slower!!! Read what Melissa did in the post http://manicmuses.wordpress.com/2012/06/12/abilify-withdrawal-round-1/
    I was on Lamictal 200mg Abilify 10mg and Lithium 1200mg now back in September 2013. Now I am down to 2mg Abilify only and I realized I need to slow down.
    Here is my new taper schedule for Abilify:
    2mg for 3 weeks, then 1.66mg for 2 weeks, 1.33mg for 2 weeks,
    1.0mg for 2 weeks, 0.8mg for 2weeks, 0.6mg for two weeks,
    0.4mg for two weeks, 0.2mg for two week, 0.1mg for two weeks.
    Then I will hopefully be off all psychotropic drugs by Christmas break.

  13. I am trying to wean off of Abilify and it is a total nightmare! The lack of information on withdrawing from this drug only makes it worse. I appreciate the info on this thread, however. I feel like whether I take two years or two months to withdraw from this medicine, the result will still be total withdrawal hell and I will lose my job in the process! Nonetheless, I just found a new psychiatrist, who (hopefully) will be open to helping me get off this horrific drug.

    1. Hi Jarrett! So this is K.C. again, and as you can see I wrote at late July in the beginning of my journey to get off this fucker. Right now, I am finally going completely off of it, after a long while of stepping down by half increments per month. I’m tired, but I’m not killer tired like I was when I tried to get off in a shorter time frame. And I have no emotional bullshit going on at this point, save for being a little down–but it’s manageable because I can tell it’s just a light side effect vs. ‘what I’m doomed to feel forever’ sort of feeling.

      My piece of wisdom is to step off so so so so slowly and listen to your body. I’d still be taking some daily if my body didn’t start forgetting to take it in the morning–so I took that as a sign I was ready for the next phase. After failing to step off the first time quickly, I just went really slowly with half a tab for more than a month, then 1/4 a tab, then 1/8–each for a month or so–then finally 1/16th (I never got the liquid form).

      It is possible, it is rough, and it is good to find support, even if you can’t medically.

      Much luck to you! You’ll win in the end.

  14. Hi Kathryn, thank you for your kind and encouraging words! I see my new psychiatrist on Monday, and we will develop a plan for getting off this drug. I was extremely disappointed to learn that Abilify oral solution is going to be discontinued as of 5/15/2015. Those of us who wish to taper more slowly are going to have a much more difficult time doing so. You mentioned that you managed to taper without the liquid solution. I don’t know how it’s possible to cut pills in to 1/16th, at least with the pill cutter I use, but I’m very glad to hear that you are well on your way to freedom from Abilify!

    By the way, for anyone curious about the reference I cited for Abilify oral solution ending in four months, just go to Bing, type in “aripipiprazole” and click “News”. This just came out four days ago. Also the injectable form and the orally disintegrating tablets are being discontinued as well.

    1. I thought I would throw my 2 bits in because we have been changing my daughter’s Abilify. It was up to 30 mg per day at it’s max. It’s been about 3 years now and we are almost down to 5 mg per day. (Perhaps not relevent, but informative is that she was also up to 12 mg per day of Benzos: Lorazapam and Clonazapam; which I now think is absolutely insane; but we managed to slowly get rid of those over a two-year period). The point is, however, that she has been on a run of strict diets (GAPS, auto-immune paleo) that don’t allow refined sugars, and since we were worried that Liquid Abilify might be a problem for her diet, her doctor had us use a mortor and pestil to grind up 16 5-mg pills and rigorously mix and shake them in a jar with 27.5 tsps of coconut flour. We then have a concentration where we figure 1.75 tsp of this powder is pretty close to a 5-mg pill, and we have a collection of measuring spoons: 1, 1/2, 1/4, 1/8 (dash), 1/16 (pinch), 1/32 (smidgen), 1/64 (drop) and we have made tapering schedules with a column for each measuring spoon and a row for each subsequent change, so that we never have to make a change at any one time greater than 1/64th of a tsp of this powder, and we can write down the date of each change (and X’s showing which measuring spoons were used on each date) and keep a written record along with other written observations.

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