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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Kimbersaur on September 21, 2008, at 18:13:42
I've been on Abilify for 17 days. About 4-5 days ago my obsessive and intrusive thoughts got way worse and continue to get worse. Could this be from the Abilify or just stress? Can side-effects wait a week or two to begin? All the other side effects I had were gone in the first few days.
Posted by desolationrower on September 21, 2008, at 18:26:52
In reply to Side Effects (specifically Abilify), posted by Kimbersaur on September 21, 2008, at 18:13:42
I don't have OCD but i noticed and i think most people notice very different effects from low and high dose of aripiprazole. How much are you taking? You may just need to increase the dose.
-D/R
Posted by Kimbersaur on September 21, 2008, at 18:37:51
In reply to Re: Side Effects (specifically Abilify), posted by desolationrower on September 21, 2008, at 18:26:52
Well I was taking 2mg until 3 days ago, when I switched to 4mg and I was planning on going up to 5mg tomorrow. I'm almost positive the problem with the intrusive thoughts started before the dose raise, but I'm afraid to keep taking it if it is just going to make the thoughts worse (they are worse than they have ever been).
Posted by Phillipa on September 21, 2008, at 19:53:06
In reply to Re: Side Effects (specifically Abilify), posted by Kimbersaur on September 21, 2008, at 18:37:51
Maybe you respond at very low doses some people do. Phillipa
Posted by Kimbersaur on September 21, 2008, at 20:00:54
In reply to Re: Side Effects (specifically Abilify) » Kimbersaur, posted by Phillipa on September 21, 2008, at 19:53:06
> Maybe you respond at very low doses some people do. Phillipa
So what are the implications of that? What does it mean?
Posted by med_empowered on September 21, 2008, at 20:20:29
In reply to Re: Side Effects (specifically Abilify), posted by Kimbersaur on September 21, 2008, at 20:00:54
hey. The thing about antipsychotics for ocd-type symptoms is...its not really a sure-fire deal. Sometimes symptoms get better or more tolerable; other times, antipsychotics can make OCD worse (or actually induce OCD--its happened with zyprexa, apparently).
How much worse are you thoughts now versus before abilify or early on during abilify treatment? Abilify makes some people more agitated than they were before treatment--in addition to akathisia, the partial dopamine agonism seems to make some people crazy.
Have you tried other meds, like benzos, stimulants, TCAs, etc.? I'm just asking because antipsychotics aren't really first line for OCD-type probs, and there are lots of meds out there that are safer, cheaper, and have more data behind them. There's also talk therapy and self-help and nutritional methods that you could explore.
One thought...I think Abilify takes about 2 weeks to reach a steady state in the blood stream; the effects you see after that time might be a better indication of how Abilify is going to work for you than the very early part of treatment. Also, if you're a slow metabolizer, your low abilify dose could be building up (thanks to the long half life of abilify)..there are a couple reports online of people getting toxic blood levels of abilify off of therapeutic doses b/c of slow drug metabolism......
apparently, since abilify is relatively free of EPS and other obvious side effects usually associated with antipsychotics, you can get high blood levels and not even know it.
Good luck!
Posted by Kimbersaur on September 21, 2008, at 21:34:49
In reply to ocd, antipsychotics..., posted by med_empowered on September 21, 2008, at 20:20:29
> hey. The thing about antipsychotics for ocd-type symptoms is...its not really a sure-fire deal. Sometimes symptoms get better or more tolerable; other times, antipsychotics can make OCD worse (or actually induce OCD--its happened with zyprexa, apparently).
>
> How much worse are you thoughts now versus before abilify or early on during abilify treatment? Abilify makes some people more agitated than they were before treatment--in addition to akathisia, the partial dopamine agonism seems to make some people crazy.Well when I first started taking the Abilify the thoughts weren't a huge problem and the Abilify didn't make any noticeable difference. It did (and continues to) help with the contamination OCD somewhat, but mostly it has had the pleasant effect of raising my moods and productivity. The intrusive thoughts now are worse than they were before I started the Abilify, although my stress level is slightly worse as well.
> Have you tried other meds, like benzos, stimulants, TCAs, etc.? I'm just asking because antipsychotics aren't really first line for OCD-type probs, and there are lots of meds out there that are safer, cheaper, and have more data behind them. There's also talk therapy and self-help and nutritional methods that you could explore.
I've tried many SSRI's and SNRI's - all of them had sexual side effects (one's that are intolerable for me). I tried Anafranil but a million side effects hit me like a ton of bricks and I had to stop after just a few days. I do take inositol (a supplement) but it doesn't do a whole lot for me and I've made an appointment with a therapist. I may just try Cymbalta next time (it really helped my OCD), with Wellbutrin for the side effects.
> One thought...I think Abilify takes about 2 weeks to reach a steady state in the blood stream; the effects you see after that time might be a better indication of how Abilify is going to work for you than the very early part of treatment. Also, if you're a slow metabolizer, your low abilify dose could be building up (thanks to the long half life of abilify)..there are a couple reports online of people getting toxic blood levels of abilify off of therapeutic doses b/c of slow drug metabolism......
>
> apparently, since abilify is relatively free of EPS and other obvious side effects usually associated with antipsychotics, you can get high blood levels and not even know it.So the fact that the worse thoughts didn't kick in for two weeks does not negate the possibility that it is the Abilify causing them? That's very interesting! That's exactly what I wanted to know. I also have another possible side effect (digestive) that didn't kick in for a week so I thought it must be something else. Thanks for the info.
> Good luck!Thank you so much!
Posted by yxibow on September 22, 2008, at 2:11:51
In reply to Re: ocd, antipsychotics... » med_empowered, posted by Kimbersaur on September 21, 2008, at 21:34:49
> Well when I first started taking the Abilify the thoughts weren't a huge problem and the Abilify didn't make any noticeable difference. It did (and continues to) help with the contamination OCD somewhat, but mostly it has had the pleasant effect of raising my moods and productivity. The intrusive thoughts now are worse than they were before I started the Abilify, although my stress level is slightly worse as well.Which is why cause and effect aren't always what they appear to be -- the placebo effect and your own stress level can vary regardless of a medication that hasn't reached a blood level.
> > Have you tried other meds, like benzos, stimulants, TCAs, etc.? I'm just asking because antipsychotics aren't really first line for OCD-type probs, and there are lots of meds out there that are safer, cheaper, and have more data behind them. There's also talk therapy and self-help and nutritional methods that you could explore.
They're not first line but they are augmentative for severe OCD. Still, CBT, behavioural therapy, has been shown to be just as effective. But sometimes people have OCD that exceed the Y-BOCS measurement scale and augmentation of a small dose of a low potency neuroleptic may help.
> I've tried many SSRI's and SNRI's - all of them had sexual side effects (one's that are intolerable for me). I tried Anafranil but a million side effects hit me like a ton of bricks and I had to stop after just a few days. I do take inositol (a supplement) but it doesn't do a whole lot for me and I've made an appointment with a therapist. I may just try Cymbalta next time (it really helped my OCD), with Wellbutrin for the side effects.Its good that Cymbalta helped with OCD -- for me, I can't really say so, generally NE things seem to aggravate anxiety -- it did help to some extent major depression and I was on it for quite a while.
Wellbutrin for me would definitely aggravate OCD, that I know. But that's just my experience.
> > One thought...I think Abilify takes about 2 weeks to reach a steady state in the blood stream; the effects you see after that time might be a better indication of how Abilify is going to work for you than the very early part of treatment. Also, if you're a slow metabolizer, your low abilify dose could be building up (thanks to the long half life of abilify)..there are a couple reports online of people getting toxic blood levels of abilify off of therapeutic doses b/c of slow drug metabolism......
> >
> > apparently, since abilify is relatively free of EPS and other obvious side effects usually associated with antipsychotics, you can get high blood levels and not even know it.Relatively for some -- I had major akathisia with Geodon and a fair amount with Abilify (or was it the other way around -- I dont remember).
> So the fact that the worse thoughts didn't kick in for two weeks does not negate the possibility that it is the Abilify causing them? That's very interesting! That's exactly what I wanted to know. I also have another possible side effect (digestive) that didn't kick in for a week so I thought it must be something else. Thanks for the info.
Exactly, causality is not necessarily causation, although I question it at times when I know certain things have happen with medication, but it is one of the tenets of medicine in general.-- regards
Jay
Posted by Kimbersaur on September 22, 2008, at 12:29:35
In reply to Re: OCD, posted by yxibow on September 22, 2008, at 2:11:51
>
> > Well when I first started taking the Abilify the thoughts weren't a huge problem and the Abilify didn't make any noticeable difference. It did (and continues to) help with the contamination OCD somewhat, but mostly it has had the pleasant effect of raising my moods and productivity. The intrusive thoughts now are worse than they were before I started the Abilify, although my stress level is slightly worse as well.
>
> Which is why cause and effect aren't always what they appear to be -- the placebo effect and your own stress level can vary regardless of a medication that hasn't reached a blood level.
>
> > > Have you tried other meds, like benzos, stimulants, TCAs, etc.? I'm just asking because antipsychotics aren't really first line for OCD-type probs, and there are lots of meds out there that are safer, cheaper, and have more data behind them. There's also talk therapy and self-help and nutritional methods that you could explore.
>
> They're not first line but they are augmentative for severe OCD. Still, CBT, behavioural therapy, has been shown to be just as effective. But sometimes people have OCD that exceed the Y-BOCS measurement scale and augmentation of a small dose of a low potency neuroleptic may help.
>
>
> > I've tried many SSRI's and SNRI's - all of them had sexual side effects (one's that are intolerable for me). I tried Anafranil but a million side effects hit me like a ton of bricks and I had to stop after just a few days. I do take inositol (a supplement) but it doesn't do a whole lot for me and I've made an appointment with a therapist. I may just try Cymbalta next time (it really helped my OCD), with Wellbutrin for the side effects.
>
> Its good that Cymbalta helped with OCD -- for me, I can't really say so, generally NE things seem to aggravate anxiety -- it did help to some extent major depression and I was on it for quite a while.
>
> Wellbutrin for me would definitely aggravate OCD, that I know. But that's just my experience.
>
>
> > > One thought...I think Abilify takes about 2 weeks to reach a steady state in the blood stream; the effects you see after that time might be a better indication of how Abilify is going to work for you than the very early part of treatment. Also, if you're a slow metabolizer, your low abilify dose could be building up (thanks to the long half life of abilify)..there are a couple reports online of people getting toxic blood levels of abilify off of therapeutic doses b/c of slow drug metabolism......
> > >
> > > apparently, since abilify is relatively free of EPS and other obvious side effects usually associated with antipsychotics, you can get high blood levels and not even know it.
>
> Relatively for some -- I had major akathisia with Geodon and a fair amount with Abilify (or was it the other way around -- I dont remember).
>
>
> > So the fact that the worse thoughts didn't kick in for two weeks does not negate the possibility that it is the Abilify causing them? That's very interesting! That's exactly what I wanted to know. I also have another possible side effect (digestive) that didn't kick in for a week so I thought it must be something else. Thanks for the info.
>
>
> Exactly, causality is not necessarily causation, although I question it at times when I know certain things have happen with medication, but it is one of the tenets of medicine in general.
>
> -- regards
>
> JaySo, does this mean Abilify probably isn't working for me?
Thank you so much for your time!
Posted by med_empowered on September 22, 2008, at 13:04:41
In reply to Re: OCD » yxibow, posted by Kimbersaur on September 22, 2008, at 12:29:35
and also avoid other antipsychotics ("atypical" and otherwise) if at all possible. The potential side effects are pretty severe from both old and new antipsychotics...other drugs/treatments can help with fewer side-effects and lower costs....plus it sounds like you're not doing too well on abilify, and that's about as "clean" as the antipsychotics get.
Good luck.
Posted by Kimbersaur on September 22, 2008, at 13:29:56
In reply to id stop the abilify..., posted by med_empowered on September 22, 2008, at 13:04:41
> and also avoid other antipsychotics ("atypical" and otherwise) if at all possible. The potential side effects are pretty severe from both old and new antipsychotics...other drugs/treatments can help with fewer side-effects and lower costs....plus it sounds like you're not doing too well on abilify, and that's about as "clean" as the antipsychotics get.
>
> Good luck.
>
>Thanks! I'm also on a low dose of Seroquel (50mg), and this has been a concern of mine. I've been on Seroquel for years now and can't sleep without it.
Posted by bleauberry on September 22, 2008, at 17:00:17
In reply to Side Effects (specifically Abilify), posted by Kimbersaur on September 21, 2008, at 18:13:42
Ya know, most reputable drug reviews and sites will make it clear, that the justified use of anitpsychotics must be considered in light of their serious risks and side effects. It's all a game of benefit versus risk. You have to ask yourself is your condition so bad that it needs yet another antipsychotic? Is an antipsychotic the first line choice for the condition? Have the risks and side effects been clearly spelled out so you could make an informed decision? Did the doc just write out a script and say try this? I mean, hey, I guess I am saying, if you aren't outright out of control schizophrenic or manic, I would say ditch the stuff. 50mg seroquel is a longterm med for you, would be hard to get off, proves useful to you, and has low risk at that dose. Cool. Whatever your symptoms are, there have to be at least half a dozen other better, safer, and more appropriate choices to try than abilify.
Don't get me wrong. Abilify helps some people tremendously. If I sound anti-antipsychotics, well, I kind of am sort of in a way. But being a longtime antipsychotic veteran myself, now 2 years clean without them, I can feel that way if I want. Antipsychotics helped me a lot for 8 years until those serious risks started happening. They are powerful heavy duty meds that I think should be reserved for powerful heavy duty situations.
Posted by Kimbersaur on September 22, 2008, at 17:36:01
In reply to Re: Side Effects (specifically Abilify), posted by bleauberry on September 22, 2008, at 17:00:17
> Ya know, most reputable drug reviews and sites will make it clear, that the justified use of anitpsychotics must be considered in light of their serious risks and side effects. It's all a game of benefit versus risk. You have to ask yourself is your condition so bad that it needs yet another antipsychotic? Is an antipsychotic the first line choice for the condition? Have the risks and side effects been clearly spelled out so you could make an informed decision? Did the doc just write out a script and say try this? I mean, hey, I guess I am saying, if you aren't outright out of control schizophrenic or manic, I would say ditch the stuff. 50mg seroquel is a longterm med for you, would be hard to get off, proves useful to you, and has low risk at that dose. Cool. Whatever your symptoms are, there have to be at least half a dozen other better, safer, and more appropriate choices to try than abilify.
>
> Don't get me wrong. Abilify helps some people tremendously. If I sound anti-antipsychotics, well, I kind of am sort of in a way. But being a longtime antipsychotic veteran myself, now 2 years clean without them, I can feel that way if I want. Antipsychotics helped me a lot for 8 years until those serious risks started happening. They are powerful heavy duty meds that I think should be reserved for powerful heavy duty situations.Hey bleauberry thanks for sharing. It's scary that the major risks kicked in after 8 years! I always figured if a side effect of any particular drug doesn't show up in the first year than I must be immune to it.
Posted by yxibow on September 22, 2008, at 19:42:12
In reply to Re: OCD » yxibow, posted by Kimbersaur on September 22, 2008, at 12:29:35
> They're not first line but they are augmentative for severe OCD. Still, CBT, behavioural therapy, has been shown to be just as effective. But sometimes people have OCD that exceed the Y-BOCS measurement scale and augmentation of a small dose of a low potency neuroleptic may help.
This is the part I meant -- a small dose of a low potency neuroleptic, e.g. your Abilify may make SSRIs and other agents similar more effective. But as noted below, maybe it isn't Abilify for you, maybe it is another one you didn't give a trial for whatever reason.
> So, does this mean Abilify probably isn't working for me?Well perhaps I was being a bit technical with terms -- in general antipsychotics take more than a two week trial to see if they are going to work for you -- a month or so would be better.
But if you have such bad side effects that you cannot stand Abilify, and the benefits do not outweigh the risks in your mind and you have fears of the medication that outweigh everything which actually negate medications in a way, psychologically, then you're free to ask your doctor how to safely get off of it.So no, I wasn't saying it wasn't working -- but that maybe it required more time -- but that is up to you.
Its the best opinion that I can offer, because these decisions are not easy, as I have experienced.
-- best wishesJay
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