Could Adding Abilify be Beneficial?
Greetings, Dr. Phelps.
Currently, my medications are;
lexapro 30mg, trileptal 300mg, wellbutrin 300mg, ativan .5 PRN and unrelated
synthroid for hypothyroid.
Given the above mentioned medications, could adding Abilify 2mg be beneficial?
I am apprehensive to take Abilify. Should I be particularly concerned about
Last, do you know of any on-line bipolar support groups to help me not feel
Dear Michelle --
A couple of thoughts. First of all, Synthroid for hypothyroidism may not be
"unrelated", at least not entirely. See my essay about
Thyroid and Bipolar Disorder.
Secondly, if your diagnosis is indeed "bipolar disorder",
then your current medication regimen is somewhat unusual. Of course, it could
have evolved to the current arrangement in a very logical, well thought out
fashion. So I do not mean to criticize it. I just want to call your attention
to the option of learning more about standard approaches, in case they have not
been tried yet.
For some mood specialists, adding aripiprazole (Abilify)
would be a step toward a more conventional medication regimen for bipolar
disorder (relying primarily on mood stabilizers, and minimizing the role of
antidepressants, which is the current usual emphasis). However, the presence of
antidepressants in your current medication suggests that depression has been a
dominant problem for you in the past. Aripiprazole has not been demonstrated to
have an antidepressant effect in bipolar disorder, even though the manufacturer
gave it a good try. (References)
As you may have learned, the "mood stabilizers" with
well-accepted antidepressant effects are lithium, lamotrigine, and quetiapine (Seroquel).
Some mood specialists would add olanzapine (Zyprexa ) to that list. Some would
quibble with exactly how much antidepressant effect lithium has. Reference: the
state of Texas’ algorithm for bipolar depression --
see page 2 of that pdf.
Therefore one of the options you could add to the
aripiprazole approach now being contemplated would be to look for a mood
stabilizer that has well-demonstrated antidepressant effects, which might enable
you to taper off one or both of your antidepressants. The role of
antidepressants in the treatment of bipolar disorder is quite a controversy, but
I think most mood experts agree that evidence for their potential to complicate
things -- even to the point of making something like aripiprazole necessary --
is substantial enough to be concerning. I've summarized some those data, and
the discussion about this issue, on my webpage about
Third thought, then, after all that: aripiprazole clearly
has anti-manic effects, so if manic symptoms are the target, it is a reasonable
choice. However, the anti-manic dose is generally thought to be higher than 2
mg. Low doses have shown some antidepressant effects, but there's still a lot
we don't know about how to manage the dosing for this medication. On the other
hand, your psychiatrist could have figured out a lot that I haven't yet, and
have chosen just the right dose for you and your circumstances. I still haven't
used this medication very much (I'm a foot dragger).
Finally, as for support groups, I haven't looked lately
but the website right here, Bipolar World, used to be a very good source. So
start by surfing around this website. There are lots of other groups out there
but have not really checked them out for quality. In general, one of the most
reputable is the Depression and Bipolar Support Alliance, dbsalliance.org.
Good luck with all that.
Published January, 2009