Could Adding Abilify be Beneficial?
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Q:  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 side effects?

Last, do you know of any on-line bipolar support groups to help me not feel alone?

Thank you.
Michelle

 

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 -- http://www.dshs.state.tx.us/mhprograms/pdf/TIMABDalgos2005.pdf, 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 Antidepressant Controversies

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.

Dr. Phelps


 

Published January, 2009
 

 
 

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