March 24, 2005

Aripiprazole and EPS?

Aripiprazole (Abilify) and Extra-pyramidal symptoms (EPS)

Aripiprazole (Abilify) is the newest drug in the class of atypical antipsychotics. It has a different mechanism than the other medications and for that reason there has been hope that it would have fewer problems with side effects. Extra-pyramidal symptoms are the typical side effects of antipsychotic medication that manifest as tremors, stiffness, shuffling gait, slow movements and/or severe restlessness (akathisia). Aripiprazole is called a "partial dopamine agonist" that means that it theoretically increases the amount of dopamine in areas where it is too low (and perhaps causing movement disorders and stiffness) and decreases it where it is too high (and maybe causing hallucinations/delusions.)

Two recent case reports have been published in which the authors describe patients that after starting aripiprazole, developing EPS. One patient was started on aripiprazole to target symptoms of hypochondriasis (elevated and irrational feeling of being ill) and the other was started to target symptoms of obsessive-compulsive problems and severe depression. Neither of these patients was considered psychotic or had schizophrenia, but the medication was used to try and target symptoms that were not responding to other, more conventional, therapies.

In the first report, the patient developed Parkinsonian symptoms (shuffling gait, absence of facial expressions, pill-rolling tremor, stiffness) after being on 15mg aripiprazole for two days. Within one week of discontinuing the medication the symptoms resolved.

The other patient had started 10mg of aripiprazole and shortly thereafter began having akathisia (severe restlessness such that a person feels like they are "crawling out of their skin"). His symptoms also resolved shortly after stopping the aripiprazole. Of note, his symptoms continued even after lowering his dose to 5mg and also trying benztropine (Cogentin) which is a medicine that is often effective in treating EPS.

What does this mean? Aripiprazole is still a new drug and we are learning about side effects with treatment. Generally, when started slowly, it is considered a safe drug though with little risk of severe side effects. However, these things do happen and one should pay attention as one should when starting any new medicine. However, this is a case report and therefore is merely one or two instances of this happening and not evidence of widespread problems. While it was theorized that these symptoms would be less of an issue with aripiprazole, because of the new mechanism of action described above, it is worth noting that these situations can still occur. It is less frequent than with many other medications though. It is also possible that the interaction with other medications may have prompted the side effect, or it could be something that is unique about these individuals. Regardless, side effects like these are taken seriously and should be reported to a physician if they are noticed after starting any antipsychotic medication.

Cohen S, Rulf D, Pies R: Extrapyramidal side effects associated with aripiprazole coprescription in 2 patients. J Clin Psychiatry 2005; 66(1):135-136.

Click here for the article on PubMed



Posted by: TODD MILLER at June 29, 2005 02:28 PM

I've been taking Abilify now for a couple of months. Never have I felt so restless in my life. Things I used to do no longer bring about any form of contentment. I cannot find comfort sitting, standing or laying down

Posted by: Joel Tegenkamp at October 5, 2005 12:13 PM

I have also been taking Abilify for 13 months and was diagnosed with Akathisia 3 months ago due to the fact that I was vert restless and had shaking in my leg. I was treated with Inderal 80mg and xanax 1mg 4 x daily and the symptoms are now under control.

Posted by: Matthew Forman at November 5, 2005 12:37 AM

I had the worst experience of my life after taking Abilify for 13 days. Immediately upon starting i I couldn't sit or lie down comfortably - I had to move. Things were suppressed by Valium for a few days but when that wore off I had restless/involuntary movement disorders to a horrific degree. These haven't completely disappeared.

Posted by: Tristan Hamilton at November 9, 2005 09:25 PM

The same i wrote on the intro.

Posted by: ANA AMARAL at February 13, 2006 02:09 PM

I know someone who is taking ablify at the age of fifteen for bipolar 1. but he smokes pot and he was wondering if it will interact in any way with the med.

Posted by: Nick at March 9, 2006 07:27 PM

Make sure to take your Abilify and promptly incinerate it or throw it away. Make sure to speak with your psychiatrist first... Having taken Abilify for only a few weeks, I quickly noticed the feeling of a wheel rotating in my stomach (many people claim to experience this feeling a lot at the start of a new medication, such as anti-depressants, specifically Prozac.)Within days, I was so shaky, I could barely hold a pen.I was constantly grinding my teeth and clenching my fists. Imbibing any type of food or liquid, save for water was out of the question. It really began to worry me a lot when I awoke in the night several times (after having a series of nightmares) to cold sweats. My bones began to feel swore and I began to develop as i would describe; flu-like symptoms.I was not officially diagnosed with akithesia, however, i am quite aware that i experienced its effects.Eventually I went back the psychiatrist, who told me to immediately discontinue taking the medicine. This process was equally, if not more unpleasant because of the drug's accumulative effect(not to discourage stopping the medicine).It was similar to going through withdrawal.Having been on Seroquel prior to the Abilify, my psychiatrist increased the dosage(seroquel) from 200 milligrams to 600 milligrams nightly. Also, she described Paxil (one of the only anti-depressants I'd never tried) It's been months now since my relapse, and I am still taking the Seroquel with the Paxil. So far it's proved to be an effective combination of treatment with few side-effects. Though everyone's chemisty is different, there is a compatible combination out there. I suggest not giving up, and trying different combinations. Also, be honest about your symptoms, both mentally and physically. Hang in there.

Posted by: Joel Tegenakamp at April 28, 2006 01:59 PM

I have been taking abilify for 19 months, in the beginning I felt an improvement but the last six to nine months it has been negetive. I have been experiencing hallucinations of swasticas and crosses both here and abroad in the clouds and increase in voices. Only now it is beginning to subside. I have not experienced any more of thse positive symptoms. On the other hand the negetive symptoms have improve 90% since taking the abilify. One final thought is to study as much as possible about your experiences and symptoms, you won't know how much this can help in your recovery from this debility. A good website to visit is

Posted by: Dean Cunningham at May 3, 2006 12:37 AM

I don't fully believe that
schizophrenia directly attributes to visions of crosses and swastikas, i believe that's a mere interpretation of religious influence or spiritual stigma. Perhaps someone on the other side is giving you a message? It can be a blessing or a curse, our disease.For never dismiss the messages or the illusion.

Posted by: Joel at August 21, 2006 10:55 PM

Seroquel and Paxil, a compatible, combative treatment of schizophrenia and depression?After exploring the multi-colored galaxy of both anti-depressants and anti-psychotics, having tried everything from Depakote and Abilify, to Prozac, Zoloft and a medally of other uppers and downers. I have little faith in Cymbalta and Lexapro. Paxil was in fact the only anti-depressant I had never tried, following the diagnosis.As I posted before, Abilify can be a nightmare for many people, because of the undesirable intervals of its accumulative effects. I think the Akithesia from the Abilify was possibly the worst side-effect I have ever experienced, and I'm sure others will agree.I encourage you to keep trying, as the term stands clear, Medical Practice. There is a compatible combination out there. Also, I encourage you to look into Seroquel if your anti-psychotics have failed you. Good luck and feel free to contact me.

Posted by: Joel at September 12, 2006 01:34 PM

I have been taking abilify for the past year and have become very restless. I'm not able to keep my legs still. Also, I grind my teeth.

Posted by: Don at December 23, 2006 08:30 PM

My 13 year old daughter was prescribed Abilify for aggression/anger disorder (ODD). First day no problems at 10mg. Second day at 15 mg she began having shortness of breath, hot flashes, sore jaw, pain in her jaw, spasms in her jaw, stiff tongue and throat muscles and an increase fear that her mouth was closing shut permanently. I thought the antipsychotic was giving her a paranoid delusion. I did not give her the medication that night but resumed after one night off since I thought the increased dosage may have brought on the delusion. After that dosage she again experienced the symptoms and was in major pain and distress. I took her off and the doctor recommended another antipsychotic. I am leaning against giving my daughter meds that are not approved by the FDA for use for anger/aggression. Although my daughter may be bipolar since it has not been ruled out yet I think using kids as guinea pigs is unethical, immoral and unprofessional. We have a history of Parkinson’s disease in our family and I am 100% certain that the medicine caused some type of recessive gene reaction. I think the drug should only be used to control psychotic or manic conditions as specified by the manufacturer and the FDA.

Posted by: Shannon at January 19, 2007 02:36 PM

The people that give these meds should try some themselves. There's nothing they could study or read that could give them the slightest idea of the subjective experience. Until they take haliperidol themselves for a couple of weeks they really don't know what they're doing, even the one's who are convinced they know everything. I'll never trust another psychiatrist again in my life!

Posted by: tom at March 14, 2007 10:43 PM

I hear that, Tom. They are far too quick to diagnose and prescribe medication. It is impossible to adequately describe the effects of a drug to someone that's never experienced the perception-shift.I think everyone in the psychiatry profession should be forced to take these meds first.

Posted by: Joel Tegenkamp at March 18, 2007 01:39 PM

I guess this is a success story for Abilify. I've been on it a year now and I have had absolutely no side effects. Just wanted to let people know that it is possible to have a positive experience with Abilify

Posted by: Carol at April 10, 2007 05:35 PM

Lithium Carbonate, Paxil, Seroquel. Recently some of my old symptoms returned without any warning. I found it very, very difficult to cope with. Though they only lasted for about 3 weeks. Eventually I went back to the psychiatrist and told him pretty much everything that i was experiencing. I probably told him more in 10 minutes than I had in some years. I was really apprehensive about taking more pills. I hate to take too many. You just feel,well, poisoned.Anyway, he told me to increase the Seroquel, again, from 400mg to 600mg and recommended I start taking Lithium. It had been recommended several years ago, but everyone felt I was doing better.Anyway, since I've been taking the Lithium (900mg daily)I've felt a lot calmer and my depression seems to have lifted significantly.I've been taking it now for about 5 weeks and haven't experienced any noticeable or negative side-effects. I've also been able to function at work and hold a job, which I was unable to before. If you're experiencing severe bouts of depression and mania and cannot cope, i recommend talking to a psychiatrist about lithium. If you haven't already, do a little research on its uses and history. It's interesting.

Posted by: Joel Tegenkamp at August 23, 2007 10:57 AM

It really sounds like this Abilify has hurt a lot of people. I was recently on it and when we upped the dose to 20mg, the akithesia set in. It was absolutely horrible. I ended up inpatient on medicine to control a racing heart and ativan a couple times a day, which my psychologist generally does not want me on because I also have addiction issues. But even since getting out of the crisis unit, I have felt on edge. I do not know if it is "left overs" from the Abilify or what... Anyway, akithesia is the worst feeling I have ever felt. I wanted to die so bad, and have a schizophrenic-like combination of disorders, it is a wonder I am still here.

I read a lot about the success stories with Abilify and was hopeful. I am glad that it works for some, but I think doctors need to monitor patients more closely for its side-effects.

Posted by: Shandy at December 10, 2007 05:57 PM

The first few weeks on Abilify were wonderful. I thought I had discovered, finally, something that works after having tried celexa, prozac, seroquel, risperdal, lamictal and more. I was genuinely interested in people, places, and things and just felt good. Really good. Then....I started feeling restless , was unable to read or relax or concentrate, and became a little paranoid. It was like crashing on speed or something horrible. I remember feeling nightmarishly desparate, but kept taking it for awhile in hopes that the good effects would come back, but they didn't, even after a lowered dose by the psych. Now I'm trying lamictal again, even though it does nothing.

Posted by: jb at January 30, 2008 11:46 AM

I had severe akithesia on Geodon, which I was taking for delusional disorder. When I complained to my psychiatrist, he let me stop taking the drug. Quite frankly I can function quite well with my delusions. I couldn't function with chronic restlessness. I also took Abilify for a while, which caused severe insomnia. In my experience, anti-psychotic meds are a total nightmare. I never met an anti-psychotic I liked.

Posted by: Gary Freedman at May 13, 2008 09:19 AM

Just a short note to say I have suffered akithsia on abilify, risperdal and clopixal etc. It is the WORST and it does not go away EVER. These people are right you cannot function when you cannot sit or relax. The dosctors dont care or have any empathy for this and it results in extreme discomfort for patients. the only choice you have is zyprexa or clozapine and hideous weight gain.

Posted by: justin at June 7, 2008 05:18 PM

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