Aripiprazole (Abilify)

What it treats

Aripiprazole is approved by the U.S. Food and Drug Administration to treat schizophrenia, to treat bipolar I disorder, and to be used as an add-on to an antidepressant for major depressive disorder. It is also approved for irritability associated with autism and for Tourette's disorder. This guide focuses on its use in bipolar disorder and as a depression add-on.

When aripiprazole is prescribed for depression, that does not mean the diagnosis has changed to psychosis. It is usually added at a low dose alongside an antidepressant that has helped only partway. Used this way, it is a booster, not a replacement, and the dose is well below what is used for schizophrenia or bipolar disorder.

How it works

Aripiprazole is an atypical antipsychotic, but it works differently from most of them. Nerve cells in the brain pass messages using chemical messengers, and dopamine is one of them. Most antipsychotics simply block dopamine activity. Aripiprazole is a dopamine partial agonist, which means it can both dampen dopamine activity and modestly support it depending on the situation.

That mixed action is part of why aripiprazole tends to be less sedating than many other antipsychotics and lighter on weight. It is sometimes described as a stabilizing rather than a purely blocking medication. How that translates into mood and symptom benefit is not fully understood, and it is worth being honest about that.

What to expect

Common side effects

Most people get some side effects. The common ones include:

• Restlessness or an inability to sit still. This is called akathisia, and it is a notable side effect of aripiprazole. It can feel like an urge to keep moving, pacing, or shifting in your seat.
• Trouble sleeping.
• Anxiety or feeling keyed up.
• Nausea.
• Headache.

Akathisia is worth flagging early, because it is treatable. A prescriber may lower the dose, slow the pace of increases, or add a medication to settle it. Many of the milder early effects ease within the first weeks. If a side effect is severe, or it is not improving, that is a conversation to have with the prescriber rather than a reason to stop on your own.

Serious side effects and warnings

Serious problems are uncommon, but a few are worth knowing.

Boxed warning. Like all antipsychotics, aripiprazole carries an FDA boxed warning that it increases the risk of death in older adults with dementia-related psychosis, and antipsychotics are not approved for that use. When aripiprazole is used as an add-on for depression, the antidepressant boxed warning also applies: antidepressants can increase suicidal thoughts and behaviors in children, teenagers, and young adults under 25, especially early in treatment or after a dose change. The early period deserves close attention, and any worsening of mood, agitation, or new thoughts of self-harm should prompt contact with the prescriber promptly.

• Metabolic effects. Aripiprazole can cause weight gain and rises in blood sugar and cholesterol. These tend to be less pronounced than with quetiapine, but they are still monitored over time.
• Tardive dyskinesia. A movement disorder linked to long-term antipsychotic use, involving repetitive involuntary movements, often of the face or mouth. The risk rises with longer use.
• Neuroleptic malignant syndrome. A rare but serious reaction. Signs include high fever, muscle stiffness, confusion, and an unstable heartbeat or blood pressure. It is a medical emergency.
• Problems with impulse control. Aripiprazole has been linked to new compulsive behaviors, including compulsive gambling, shopping, eating, or sexual urges. The FDA specifically warns about this. Any new compulsive behavior should be reported to a prescriber, because it often eases when the dose is lowered or the medication is stopped.

Sexual side effects

Aripiprazole has a relatively low rate of sexual side effects compared with some other psychiatric medications. It can still affect sex drive or function for some people. If that happens, it is worth raising with a prescriber rather than living with it, because there are usually options.

Weight, appetite, and sleep

Weight gain is possible with aripiprazole, but it tends to be smaller than with quetiapine and some other antipsychotics. Weight, blood sugar, and cholesterol are still checked periodically, since effects vary from person to person.

Aripiprazole can be activating, and trouble sleeping is one of its more common side effects. Because of that, it is often taken in the morning. If sleep problems persist, that is worth raising with the prescriber.

Starting and dosing basics

This section is general background, not a dosing instruction for any individual. The right dose is a decision for a prescriber.

Aripiprazole comes as tablets, orally disintegrating tablets, a liquid, and a long-acting injection given by a clinician. Doses for a depression add-on are lower than doses for schizophrenia or bipolar disorder. The prescriber chooses a starting dose and adjusts it gradually based on how a person responds and tolerates it. It can be taken with or without food.

Missed doses and interactions

If you miss a dose, the general guidance is to take it when you remember, unless it is almost time for the next dose. In that case, skip the missed dose and carry on. Don't take two doses to make up for one.

Some medications change how the body processes aripiprazole, which can raise or lower its level in the body. Because of that, the prescriber and pharmacist need a full list of your medications and supplements, including over-the-counter ones, so doses can be adjusted if needed. Alcohol is not formally prohibited, but it can worsen side effects and is generally best limited.

Stopping and tapering

Stopping aripiprazole should be gradual and planned with a prescriber. The body adjusts to the medication over time, and stopping suddenly can cause discomfort or a return of the symptoms it was treating. A prescriber can step the dose down over time in a way that fits the situation. Deciding to stop because you feel better is understandable, but it is still worth doing slowly and with guidance.

Pregnancy and breastfeeding

This is an area where individual circumstances matter and the decision belongs with a clinician. Untreated bipolar disorder and depression carry their own risks during pregnancy, and aripiprazole also passes into breast milk. None of that adds up to one answer that fits everyone. Anyone who is pregnant, planning a pregnancy, or breastfeeding should talk it through with their prescriber so the specific risks and benefits can be weighed for their situation.

Cost and generic availability

Aripiprazole has been available as a generic for years and is inexpensive. The brand name Abilify and generic aripiprazole contain the same active medication and work the same way. The long-acting injectable forms cost more than the tablets. Most insurance plans cover the generic tablets.

Common questions

Why is an antipsychotic being used for my depression? When aripiprazole is added for depression, it is usually a low-dose booster alongside an antidepressant that has helped only partway. It does not mean the diagnosis is psychosis. Using an antipsychotic this way is a recognized approach for depression that has not fully responded.

What is akathisia? Akathisia is a feeling of restlessness and an inability to sit still, often with an urge to keep moving. It is a notable side effect of aripiprazole. It is treatable, so it is worth reporting to the prescriber early.

How is it different from quetiapine? Aripiprazole tends to be activating and can cause trouble sleeping, while quetiapine tends to be sedating. Aripiprazole is also generally lighter on weight. The two are used for overlapping conditions but feel quite different to take.

What is the impulse-control warning? Aripiprazole has been linked to new compulsive behaviors, such as compulsive gambling, shopping, eating, or sexual urges. The FDA warns about this. Any new compulsive behavior should be reported to a prescriber, because it often eases when the dose is changed.

Will it make me gain weight? Weight gain is possible, but it tends to be smaller than with several other antipsychotics. Weight, blood sugar, and cholesterol are monitored over time.

Questions to ask your prescriber

• What are we hoping this treats, and how will we know it's working?
• Which side effects should I expect early, and which ones should I call about?
• What should I watch for in terms of restlessness or new compulsive urges?
• How long should I plan to take it?
• If we decide to stop it later, how would we do that safely?

Sources

This guide draws on current prescribing information and public health references. It is reviewed for clinical accuracy and updated as guidance changes.

• U.S. Food and Drug Administration. Aripiprazole (Abilify) prescribing information.
• MedlinePlus, U.S. National Library of Medicine. Aripiprazole.
• National Institute of Mental Health. Mental health medications.