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Abilify agitation at low dose versus higher dose?


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Hi, 

A few days ago I began a trial of Abilify at 1mg day. I am extremely sensitive to medications (and I understand that some people are on very low doses as well). My primary dx is PTSD and dysthymia. I am trying Abilify to see if it helps turn the volume down on my flashbacks.  

At this dose the Abilify is helping with both mood and flashbacks. However, I am also getting some jumpy anxiety feelings. I don't think it's akathisia -- it's not quite that extreme. But it's uncomfortable. 

I am planning to wait a few days to see if it improves. But I am also wondering whether a higher dose of Abilify might cause less anxiety/jumpiness? Has anyone found this to be the case? 

Thanks. 
 

Edited by TheTaoofPhil
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Not totally sure, as I couldn't get above 2mg for any length of time, but the anxiety never went away. Abilify just made my anxiety much more amplified while I was on it. It was a very frustrating side effect.

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1 hour ago, dtac said:

Not totally sure, as I couldn't get above 2mg for any length of time, but the anxiety never went away. Abilify just made my anxiety much more amplified while I was on it. It was a very frustrating side effect.

Yeah it's frustrating: this med is really helping in some ways. 

I noticed that you are taking Rexulti. That's supposed to be the successor to Abilify isn't it? Have you found it to be more tolerable?

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Abilify gave me severe anxiety until I hit 10 mg. Coincidentally, it also began to work for me at 10 mg. But getting to 10 mg was awful. I almost gave up on it because of the anxiety.

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33 minutes ago, notloki said:

Abilify is generally activating up to 15 mg then higher doses are more sedating. This makes sense as the antipsychotic effects become apparent above 15 mg.  

I am wondering whether the folks who take it at 2 mg as an adjunct to an antidepressant don't notice the anxiety because the anxiety is being reduced by the antidepressant.

Edited by TheTaoofPhil
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8 minutes ago, TheTaoofPhil said:

I am wondering whether the folks who take it at 2 mg as an adjunct to an antidepressant don't notice the anxiety because the anxiety is being reduced by the antidepressant.

I should have clarified that I WAS taking it with an antidepressant.

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I had exactly this anxiety.  I was still having it at 15mg and yesterday went up to 20mg and poof my anxiety is sooooo much better!!! Like I am so surprised.  I know that's a much higher dose than you're on but thought I'd let you know how it effected me. I'm hoping this isn't just a one day thing and it's cured my anxiety now. 

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3 hours ago, Eilatan said:

I had exactly this anxiety.  I was still having it at 15mg and yesterday went up to 20mg and poof my anxiety is sooooo much better!!! Like I am so surprised.  I know that's a much higher dose than you're on but thought I'd let you know how it effected me. I'm hoping this isn't just a one day thing and it's cured my anxiety now. 

 

Based on what I'm hearing, I will probably try going up to  2mg and see if that changes anything, knowing that it very well may not. I was willing to try Abilify at a small dose to reduce the intensity of my flashbacks. It does seem that it helps in this way. But I don't think I want to risk other side effects at a higher dose (e.g., weight-gain). Also I am very sensitive to medications in general, so I suspect that dizziness or something like that would be a problem at such a high dose. 

Thanks again for the information -- every little bit I learn is helpful.

 

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22 hours ago, TheTaoofPhil said:

 

Based on what I'm hearing, I will probably try going up to  2mg and see if that changes anything, knowing that it very well may not. I was willing to try Abilify at a small dose to reduce the intensity of my flashbacks. It does seem that it helps in this way. But I don't think I want to risk other side effects at a higher dose (e.g., weight-gain). Also I am very sensitive to medications in general, so I suspect that dizziness or something like that would be a problem at such a high dose. 

Thanks again for the information -- every little bit I learn is helpful.

 

I don't really understand your fear of weight gain. Many people find Abilify weight neutral and don't gain weight on it. Some people actually lose weight on Abililfy. But if you were to take a higher dose and did find yourself gaining weight, it's a simple matter to discontinue the medication. Nothing is etched in stone.

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19 hours ago, jt07 said:

I don't really understand your fear of weight gain. Many people find Abilify weight neutral and don't gain weight on it. Some people actually lose weight on Abililfy. But if you were to take a higher dose and did find yourself gaining weight, it's a simple matter to discontinue the medication. Nothing is etched in stone.

Thanks for mentioning that. I have been doing some googling that suggested the same thing. So I'll forget about that issue for now and just focus on finding the right dose.

As for the dose, the plot has thickened. Today is day 6 on this med. As of yesterday, the daytime anxiousness had calmed down a bit -- I felt actually relaxed and relatively calm. It's an amazing feeling.  

However, the past few nights the quality of my sleep has not been good. I am also on 375mg/trileptal (yes, a tiny dose, but for me it is the sweet spot between helping with sleep/mood and intolerable dizziness), melatonin, and phosphatidylserine. This is all helping me get to sleep, but I keep waking up every few hours, which is relatively new for me. I suspect that this is being caused by the abilify. I am taking the abilify 1st thing in the morning.

It occurs to me that it might take a number of additional days to know how it might even out further. Perhaps like the daytime anxiousness the nighttime agitation might subside?

Any opinions about how long to give it before increasing the dose?  

Thanks. 

 

 

Edited by TheTaoofPhil
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Insomnia is a well known side effect of Abilify. Sometimes it goes away, and sometimes it helps to add a low dose of a med like Remeron (mirtazapine) at night. I took mirtazapine and never had a problem with insomnia.

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I'd say at least a week but probably more like two due to the long abilify half life. I went up weekly but it was an emergency and I totally got screwed by it. Take it slow especially if your not using it for mania/psychosis or are sensitive to meds  

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5 minutes ago, Iceberg said:

I'd say at least a week but probably more like two due to the long abilify half life. I went up weekly but it was an emergency and I totally got screwed by it. Take it slow especially if your not using it for mania/psychosis or are sensitive to meds  

I am anxious to get to a good place with this stuff but am definitely not in a crisis. it's good to be reminded to proceed slowly. 

 

3 hours ago, jt07 said:

Insomnia is a well known side effect of Abilify. Sometimes it goes away, and sometimes it helps to add a low dose of a med like Remeron (mirtazapine) at night. I took mirtazapine and never had a problem with insomnia.

I'm guessing there's a delicate balance between Abilify and Remeron, with Remeron being _more_ sedating at lower doses and Abilify becoming sedating at higher doses. I guess I would need to get to a place that feels right with Abilify except for the sleep issues, and then adjust the Remeron accordingly. 

Thanks again. 

 

 

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1 minute ago, Iceberg said:

Yeah...patience is a virtue...and it sucks.

And then sometimes the med is working well in some ways so you don't want to give up but there's other things you're hoping will go away and so you have to keep waiting to see what happens. Throw in the anxiety making you hypersensitive to every little thing going on your body and it's, uhm, not so easy? 

So, patience . . . yeah. . .  :-) 

 

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They tried me on 5mg abilify as an add-on to AD. It gave me anxiety and felt really weird, they dropped the dose and dropped the dose, and dropped the dose. The pdoc couldnt understand what was going on. I didnt sleep for days on end, i dont remember weeks, i was so whacked out............all went away once that med was stopped, took some time for me to clear it out of my system though

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  • 4 weeks later...
On 8/19/2017 at 0:52 PM, jt07 said:

I don't really understand your fear of weight gain. Many people find Abilify weight neutral and don't gain weight on it. Some people actually lose weight on Abililfy. But if you were to take a higher dose and did find yourself gaining weight, it's a simple matter to discontinue the medication. Nothing is etched in stone.

Interesting thing. I can't find it now, but they were perplexed by Abilify's weight profile in studies. Basically, what they couldn't make sense of was the fact that there was in fact very little weight gain in the bipolar and schizophrenia trials but statistically higher weight gain in the depression adjunct trials. I think ultimately the weight gain in the depression trials was associated with Abilify's effect on 5HT2C. It's a partial agonist there, activating when serotonin is low and blocking when serotonin is high. But when you take Abilify with an antidepressant, the higher serotonin levels from the antidepressant basically turned Abilify into a 5HT2C antagonist and caused weight gain. So in fact Abilify's effect on weight could be dictated by its interactions with other medications.

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