Switching to Abilify from Risperdal--what to expect?

[CrazyRedhead]

New pdoc (3rd visit) took me off Risperdal 2mg and  I'm starting up on Abilify 5mg tomorrow.....He wants to eventually get me up to 15-20mg..

I was taking the Risperdal at night because it is somewhat sedating, but he says to take the Abilify in the morning, because it's activating.

To anyone who has experience with Abilify, was it sedating or activating for you?.........Also, he said it is weight-neutral, but I have seen some reports of it causing weight gain......I never gained anything on the Risperdal, but it was only 2mg.

I am worried about it making my insomnia worse, especially on starting it, if it's activating.....

Also, should I expect any additional side effects?

Edited June 13, 2018 by CrazyRedhead

[jt07]

I made the switch from 4 mg Rispedrdal to Abilify cold turkey, that is, I stopped the Risperdal one day and started the Abilify the next. I didn't have any problems due to the transition.

However, low dose Abilify gave me a lot of anxiety that didn't go away until I hit 10 mg and the med started working for me.  Unless you are in the smaller subset of people who find Abilify sedating, you will very likely suffer from insomnia. I got the insomnia, but I was also on Remeron which was so sedating that the Abilify insomnia was welcome.

I love Abilify. Other than Tegretol, it is the best psych med that I've ever taken, and it actually lived up to its commercial. It gives me motivation and an interest in life, and it offsets the anhedonia from my depression.

[CrazyRedhead]

27 minutes ago, jt07 said:

 However, low dose Abilify gave me a lot of anxiety that didn't go away until I hit 10 mg and the med started working for me.  Unless you are in the smaller subset of people who find Abilify sedating, you will very likely suffer from insomnia. I got the insomnia, but I was also on Remeron which was so sedating that the Abilify insomnia was welcome.

*SIGH*.......Hope I don't get the insomnia or the extra anxiety.......I have enough problems with both of those already.....

It's going to be a month before doc goes up to 10mg..........Hope it doesn't get too bad before it gets better.....When I don't get enough sleep I'm an absolute mess.....

I realize it might take awhile, so I'll do the best I can to tough it out.......

[jt07]

I'll bet you won't be sorry if you tough it out because when it works, it's amazing. The anxiety is temporary until you get to a high enough dose which might even be as low as 7.5 mg (for me it was 10 but I also take Tegretol which reduces Abilify in the blood).   As far as the insomnia goes, can you ask your pdoc for something? As I mentioned, Remeron killed the insomnia that I had from Abilify. By the way, I no longer take Remeron but I no longer have insomnia from the Abilify either.

[CrazyRedhead]

47 minutes ago, jt07 said:

  As far as the insomnia goes, can you ask your pdoc for something? 

Now, I take klonopin and trazodone for my insomnia and anxiety.......I could ask him for something else, but I've tried a lot of things for insomnia, so not sure what he would suggest.

I have tried Remeron, but didn't stay on it too long due to the weight gain it caused for me.

Edited June 13, 2018 by CrazyRedhead

[jt07]

I just mentioned Remeron because that's what helped me. I'm guessing that if you did need Remeron then you'd probably only be on it a short while so the weight gain would be minimal. There is also Seroquel - at 50 mg it is just an antihistamine (though strong one) and can help with sleep.

These are just ideas to talk over with your doctor if insomnia becomes a problem. Hopefully, it will not be a problem for you.

Good luck with the Abilify! I hope it helps you as much as it helps me.

[browri]

In regards to weight gain, they did find a lower risk than many other AAPs in pre-clinical trials, but post-marketing reports indicate that the low impact on weight gain isn't as low as we though it was for Abilify. Interesting thing to note though. Some of the weight issues caused by Abilify are likely mediated through its effects on 5HT_2C where it is a partial agonist. It activates when serotonin levels are low, and blocks when serotonin levels are high (to put it simply). In the Abilify trials for the MDD adjunct indication, they reported much higher weight gain than in the bipolar and schizophrenia monotherapy trials. This is because antidepressants increase the amount of serotonin in the synapse and likely render Abilify to be an almost pure 5HT_2C antagonist when used as an adjunct to an antidepressant. Blocking the 5HT_2C receptor is associated with hunger. Activating it is associated with feeling full (aka. satiety). So this can have a big impact on appetite, and it is possible that if you eat well you can avoid some of the weight gain from Abilify.

Most people agree that Abilify at the lower doses (<10mg) is activating because it has a high intrinsic activity at the dopamine receptors (more activation than blockade). Higher doses begin to employ the blocking activity which is probably why the higher doses (10mg+) are more calming for most people.

[CrazyRedhead]

@browri,  thanks for the information, very helpful...............I started the Abilify 5mg just this past Thursday, and I have not noticed any increased appetite at all so far --in fact I have almost been too nauseated to eat.......I take it in the morning as soon as I get up...........I have to say that's it's been extremely stimulating for me, but not in a good way....I'm just sitting around all day, immobilized by anxiety.

The worst side effect I'm having now by far, is the increased severe anxiety and problems sleeping.......I'm not sure what  my doc could even give me for this since I've already tried almost everything under the sun for sleep, except Belsomra.......I'm fairly sure he's not going to give me any more benzo, since I'm already on Klonopin 2mg.

I'm calling him first thing tomorrow, because only 2-3 hours sleep a night for past three nights, is making all my other crazy stuff worse!!..

Before taking the Abilify I was getting 6-8 hours sleep.......I realize that these anxiety and sleep issues are probably just start up effects, but hope I can get moved up to 10mg ASAP.....Whew....

Edited June 17, 2018 by CrazyRedhead

[browri]

3 minutes ago, CrazyRedhead said:

@browri,  thanks for the information, very helpful...............I started the Abilify 5mg just this past Thursday, and I have not noticed any increased appetite at all so far --in fact I have almost been too nauseated to eat.......I take it in the morning as soon as I get up...........I have to say that's it's been extremely stimulating for me, but not in a good way....I'm just sitting around all day, immobilized by anxiety.

The worst side effect I'm having now by far, is the increased severe anxiety and problems sleeping.......I'm not sure what  my doc could even give me for this since I've tried almost everything under the sun for sleep, except Belsomra.......I'm fairly sure he's not going to give me any more benzo, since I'm already on Klonopin 2mg.

I'm calling him first thing tomorrow, because only 2-3 hours sleep a night for past three nights, is making all my other crazy stuff worse!!..

Before taking the Abilify I was getting 6-8 hours sleep.......I realize that these anxiety and sleep issues are probably just start up effects, but hope I can get moved up to 10mg ASAP.....Whew....

It is possible that you might need to be titrated up faster. The lower doses like 2-5mg are more reserved for MDD adjunct than for mood stabilization. When you're going for stabilization they usually start you on 5-10mg and titrate you up fairly rapidly but not too fast because it has a long half-life and things like akathisia can creep up slowly like a week after a dose increase.

[CrazyRedhead]

16 minutes ago, browri said:

It is possible that you might need to be titrated up faster. The lower doses like 2-5mg are more reserved for MDD adjunct than for mood stabilization. When you're going for stabilization they usually start you on 5-10mg and titrate you up fairly rapidly but not too fast because it has a long half-life and things like akathisia can creep up slowly like a week after a dose increase.

At first he said it would be a month before he moved me up to 10mg, but on Friday when I called and told him what was going on, he said make an appt in 2 weeks for the increase to 10mg.

Does that sound too fast to you?...

Edited June 17, 2018 by CrazyRedhead

[browri]

36 minutes ago, CrazyRedhead said:

At first he said it would be a month before he moved me up to 10mg, but on Friday when I called and told him what was going on, he said make an appt in 2 weeks for the increase to 10mg.

Does that sound too fast to you?...

What day did you start on the 5mg? It would seem that your pdoc is being cautious because of reported tolerability issues for some people with Abilify. For bipolar disorder in adults as monotherapy, the starting dose is actually 15mg, which is also the target dose. As an adjunct to lithium or valproate starting is 10-15mg with a target of 15mg as well. Maximum dose is 30mg

For depression on the other hand (as adjunct to an AD) starting dose is 2-5mg per day with a maintenance dose range of anywhere between 2-15mg. The prescribing information says that dose changes can be made in increments of 5mg at no less than 1-week intervals. So if you've been on 5mg for a week already, then going up to 10mg shouldn't be an issue. You may find it more tolerable.

[CrazyRedhead]

32 minutes ago, browri said:

What day did you start on the 5mg?

Started Abilify 5mg on Thursday, June 14......So it's only been 3 days.....Next appt is Thursday, June 28th, which would make it 2 weeks.......He says he doesn't feel comfortable going up on it any sooner than that........Just his personal opinion, I guess.

That means I have to tough this out for 11 more days.....**SIGH**

He says his target dose for me is at least 15mg, and maybe 20mg if my insurance will cover it.

He feels it will work better for me at the higher dose due me being extremely treatment-resistant....I've tried and failed with so many meds, so I hope he's right.

Edited June 17, 2018 by CrazyRedhead

[browri]

Just now, CrazyRedhead said:

Started Abilify 5mg on Thursday, June 14......So it's only been 3 days.....Next appt is Thursday, June 28th, which would make it 2 weeks.......He says he doesn't feel comfortable going up on it any sooner than that........Just his personal opinion, I guess.

That means I have to tough this out for 11 more days.....**SIGH**

Your pdoc feels that way for a reason. There are plenty of people who REALLY just can't tolerate Abilify and when it's bad it's bad. Some people get terrible akathisia across all dosages. My pdoc was also very conservative with Abilify, starting me on 2mg then we escalated over 10 days to 7.5mg, but I just couldn't hack it. Made me too agitated.

By contrast, Rexulti, which has a chemical structure very similar to Abilify is the total opposite. More sedating at the lower doses, and stimulating at the higher doses, with akathisia starting for some around 1-2mg but for most somewhere between 3-4mg. That being said, Rexulti had a statistically significant lower incidence of akathisia than Abilify overall. It also is more likely to cause weight gain than Abilify. I'm currently taking Rexulti with Depakote. And I'm titrating from Trintellix to Lamictal at the moment. But I like to think that the Vvyanse helps to keep the weight off lol. For me, Rexulti even had a very positive effect on my sleep hygiene and my anxiety at just 0.25mg. At 1mg, I'm seeing even more of the positive effects on my sleep, anxiety, and depression. This is in contrast to Abilify which made me feel like I was poisoning myself with dirty speed lol. To be fair, I was not in a very good place when I started on Abilify, and I was only taking Lamictal at the time. So I wasn't as stable as I should have been.

[CrazyRedhead]

18 minutes ago, browri said:

Your pdoc feels that way for a reason. There are plenty of people who REALLY just can't tolerate Abilify and when it's bad it's bad. Some people get terrible akathisia across all dosages. My pdoc was also very conservative with Abilify, starting me on 2mg then we escalated over 10 days to 7.5mg, but I just couldn't hack it. Made me too agitated.

I'm really going to try and give it a fair trial........No akathisia so far so maybe that's good...

If I get to 10-15mg and still feel this agitated, I guess I'll have to make a judgement call then.....But I'm trying not to judge anything right now when I'm just starting up.

If Abilify doesn't work out, my next step might be Rexulti.....I'm glad it seems to be working out well for you.

Edited June 17, 2018 by CrazyRedhead

[CrazyRedhead]

Update on my transition to Abilify.....(start date June 14)

The start up side effects seem to be getting less severe......Sleeping is better than last week, when I first started......Next week my Abilify dose will be increased to 10mg.......Guess I'll see what happens then.

So far, not noticing any improvement in my depressed mood, anxiety, or my obsessive/compulsive rituals....But it's only been a week, so it's too early in the game to draw any conclusions yet.

Edited June 21, 2018 by CrazyRedhead

[browri]

33 minutes ago, CrazyRedhead said:

Update on my transition to Abilify.....(start date June 14)

The start up side effects seem to be getting less severe......Sleeping is better than last week, when I first started......Next week my Abilify dose will be increased to 10mg.......Guess I'll see what happens then.

So far, not noticing any improvement in my depressed mood, anxiety, or my obsessive/compulsive rituals....But it's only been a week, so it's too early in the game to draw any conclusions yet.

Yeah it still needs more time. Aripiprazole has a half-life of like 75 hours and it's metabolite's is like 94 hours. This means it takes 2 weeks from each dose change to reach steady state. So you have time yet to adjust.