What is Abilify and what does it do?

One thing the commercials don’t mention is that Abilify is not an anti-depressant. Abilify is an anti-psychotic, marketed in the United States by Otsuka Pharmaceutical Co. and Bristol-Myers Squibb. Abilify has been approved by the US Food and Drug Administration to treat schizophrenia, bipolar disorder, major depressive disorder and for irritability in children with autism.¹

Anti-psychotics are drugs that are thought to block the movement of a chemical in the brain called dopamine. Dopamine is though to control the brain’s reward and pleasure centers and to regulate movement and emotional response.²

According to its manufacturer, “[t]he exact way ABILIFY (or any other medicine for Schizophrenia) works is unknown. It is thought that ABILIFY may work by affecting the activity of some brain chemicals — adjusting dopamine, instead of completely blocking it, and adjusting serotonin.”³

Does Abilify work? Can Abilify cure depression?

In 2007, Bristol-Myers Squibb announced that the FDA had approved Abilify as an “add-on” treatment for “major depressive disorder,” meaning that it could be taken with an anti-depressant, based on two studies.⁴

These two studies were done by Bristol-Myers Squibb. The two studies included two groups of patients: one which took Abilify with an anti-depressant and one group which took a placebo with an anti-depressant.⁵

In these studies, researchers used three methods to determine effectiveness of Abilify compared to the placebo, including patients' "self reports." Patients in both studies reported that adding Abilify wasn’t any better than the placebo. The authors of the reports chose to ignore the patient self reports and chose another of the three methods to report that Abilify was effective. Both studies also reported that Abilify was “well tolerated” by the patients when, in fact, a large number of patients experienced side effects during the study and a bit under half of those patients did not recover by the end of the study.⁶

Recent research has revealed that anti-depressants are not much more effective than a placebo,⁷ so it wouldn’t be surprising to find that a large number of patients and their doctors might conclude that anti-depressants weren’t “working” for them. What about anti-psychotics, such as Abilify?

In The Myth of the Chemical Cure,⁸ psychiatrist Dr. Joanna Moncrieff warned that antipsychotics do not work long term and also cause brain damage and other “vicious” side effects that triple a patient’s risk of premature death.⁹ In a US study of 64 schizophrenics, patients who were not on anti-psychotics had a much greater recovery rate than patients on anti-psychotics.¹⁰

Other research concluded that atypical antipsychotics weren’t helpful to patients who hadn’t responded to some kinds of antidepressants. Some doctors have concluded that no studies showed that drugs like Abilify provide a clear benefit for patients with major depressive disorder with psychotic features, and that evidence is conflicting for bipolar depression.¹¹

So, why are they doing it?

The percentage of people suffering from schizophrenia and bipolar disorder is estimated to be between 1% and 3%.¹² The percentage of people in the United States suffering from depression is estimated at about 10%.¹³

In 2008, Consumer Reports issued a video about the Abilify ad campaign. Their concern was that the campaign didn’t mention that Abilify wasn’t an anti-depressant, that it downplayed Abilify’s side effects (which are far greater than the side effects of an anti-depressant) and encouraged patients to try Abilify as a first choice, before trying adjusting their anti-depressant or trying another anti-depressant.

From Consumer Reports: “We totally get why Bristol-Myers Squibb is doing this. There are, after all, only so many people in the world who have schizophrenia or bipolar disorder. Depression, on the other hand, is a veritable cash cow among mental-health conditions. One in seven people will experience a depressive episode at some point in their lives. If you want to sell upwards of $2 billion a year of a drug, that’s the kind of market you need.”¹⁴

What should I ask my doctor about before deciding to take Abilify?

Anti-psychotics, including Abilify, have long lists of side effects, many of them severe and several life threatening, including conditions that can affect patients for the rest of their lives and even result in death.¹⁶

A 2011, a study in Finland found that patients taking an anti-depressant and an anti-psychotic had a much stronger chance of dying of a heart attack and recommended that this combination of drugs “should be avoided.” ¹⁶

What if I’m already taking Abilify?

If you’re already taking Abilify and you’re concerned, talk to your doctor. Do not stop taking any medication without discussing it with your doctor. Your doctor may suggest trying a different dose of your anti-depressant, another anti-depressant, therapy or other methods of treatment.

Learn everything you can about Abilify before you start taking it.

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¹ http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview&DrugName=ABILIFY&CFID=1619757&CFTOKEN=d91913e8cd3b99e1-149CF3BF-FF84-7CDC-4DA90048B1B71A4C
² Psychology Today, “Psych Basics, What is Dopamine?”, retrieved 17 July 2012; http://www.psychologytoday.com/basics/dopamine
³ abilify.com, “How Abilify is Thought to Work, Otsuka America Pharmaceutical (2012); http://www.abilify.com/schizophrenia/aripiprazole/abilify-and-schizophrenia.aspx
⁴ Bristol-Myers Squibb, David M. Rosen, “FDA Approves Abilify … as the first medication for add-on treatment of MDD” (20 November 2007)
http://www.eurekalert.org/pub_releases/2007-11/bs-faa112007.php
⁵ J Clin Pyschopharmacol., Marcus RN et al. (April 2008); http://www.ncbi.nlm.nih.gov/pubmed/18344725; J Clin Pyschopharmacol., Berman RM et al. (June 2007); http://www.ncbi.nlm.nih.gov/pubmed/17592907
⁶ Clinical Psychology and Psychiatry: A Closer Look, “Abilify For Depression: I’m Not The Only Skeptic” (27 January 2009); http://clinpsyc.blogspot.com/2009/01/abilify-for-depression-im-not-only.html
⁷ The Daily Beast, Sharon Begley, “The Depressing News About Antidepressants” (28 January 2010) http://www.thedailybeast.com/newsweek/2010/01/28/the-depressing-news-about-antidepressants.html; huffingtonpost.com, Mark Hyman, MD, “Why Antidepressants don’t work for treating depression” (24 April 2010), http://www.huffingtonpost.com/dr-mark-hyman/depression-medication-why_b_550098.html
⁸ The Myth of the Chemical Cure, Joanne Moncrieff (Palgrave Macmillan, 2009)
⁹ The Guardian, Adam James, “Myth of the antipsychotic,” (2 March 2008) http://www.guardian.co.uk/commentisfree/2008/mar/02/mythoftheantipsychotic
¹⁰ The Journal of Nervous and Mental Disease, Martin Harrow, Phd and Thomas Jobee, MD (May 2007); http://journals.lww.com/jonmd/pages/articleviewer.aspx?year=2007&issue=05000&article=00007&type=abstract
¹¹ psychcentral.com, Rich Nauert, Phd, “Off-Label Use of Meds Questioned” (19 January 2007), http://psychcentral.com/news/2007/01/19/off-label-use-of-meds-questioned/557.html
¹² http://www.schizophrenia.com/sznews/archives/004552.html
¹³ Centers for Disease Control, “An Estimated 1 in 10 U.S. Adults Report Depression,” http://www.cdc.gov/Features/dsDepression/
¹⁴ Consumer Reports, “Adwatch: Abilify finds lucrative new audience” (30 July 2009)
http://news.consumerreports.org/health/2009/07/abilify-adwatch-prescriptions-for-antidepressants-direct-to-consumer-marketing-for-prescription-drug.html#more
¹⁵ touchneurology.com, Lannah Lua, Lin Zhang, “Development of Parkinsonism following exposure to aripiprazole, two case reports,” retrieved 16 July 2012, http://www.touchneurology.com/articles/development-parkinsonism-following-exposure-aripiprazole-two-case-reports; psychcentral.com, Patient forums; http://answers.psychcentral.com/Medications/can-abilify-cause-parkinsons-disease/fda.gov, “Abilify Dear Healthcare Professional Letter Mar 2004,” (25 March 2004); http://bipolar-disorder.emedtv.com/abilify/abilify-and-diabetes.html Archives of General Psychiatry, Beng-Choon Ho et al, “Long-term Antipsychotic Treatment and Brain Volumes,” (February 2011) http://archpsyc.jamanetwork.com/article.aspx?articleid=211084 fda.gov, “Medication Guide, Abilify,” http://www.fda.gov/downloads/drugs/drugsafety/ucm085804.pdf
¹⁶ News Medical, “Combination of antipsychotic and antidepressant drugs may increase risk of CV mortality” (16 November 2011) http://www.news-medical.net/news/20111116/Combination-of-antipsychotic-and-antidepressant-drugs-may-increase-risk-of-CV-mortality.aspx