The Truth About Aripiprazole and Dopamine Partial Agonists
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- Опубликовано: 31 дек 2023
- When I was a resident working on the inpatient service, I hated Aripiprazole. I never thought it worked well for those who were frequently admitted to the hospital with schizophrenia or bipolar disorder. In today’s video will talk about the reason why this happens and what you need to understand before using a partial agonist such as aripiprazole in clinical practice.
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Abilify made me extremely paranoid and super anxious! 😬 I told my psychiatrist what it was doing and she didn’t believe me. As soon as I stopped the medication, the paranoia stopped…
As a retired nurse I believe we have over medicated due to pharmaceutical involvement in sales, production, and marketing.
Regrettably, we have psychiatric conditions in human beings that require some of these medications. I have seen them given to children and wonder if the medications didn’t make things worse.
Trying to control them rather than meeting their fundamental needs.
I hate abilify, severe akathesia. Seroquel made me a zombie. Zyprexa made me lost in space. Tried 4 antidepressants, no luck.
I have severe chronic GAD, anxious depression, racing thoughts etc.
The only combo that finally made my life much more bearable ( got at least 60% better) was sertraline+amitriptiline+perphenazine. All 3 in low doses. 50mg sertraline+40mg amitriptiline+4mg perphenazine. Seems that old school medication is better on many occasions. Do you agree?
Disclaimer to everyone. Always follow your doctor's advice on everything.
I HATE aripiprazole. 3 of my friends were on it. EVERY one of them would be incapable of listening to you in a conversation. They'd get sidetracked ALL THE TIME. I cant imagine living with an attention span like that.
I personally did not like Abilify. I was only on 2.5mg (which obviously changes things) but it made me restless, bored, and feel like I had to be constantly moving. If I had nothing to do at work I HAD TO pull out my phone and play a game otherwise the boredom would just be too painful to bear. I was constantly playing video games on abilify to keep myself busy; I was very much so a "busy body" during the time I was on it. I also didn't sleep all that well on it, I always woke up like 2-3 hours too soon and couldn't go back to sleep. Restless legs and a general inability to "settle down" in bed didn't help things either.
I felt significantly less irritiable and prone to anger on it though, and a bit less anxious, more mentally stable genrally, and did better socially. So there were so upsides to it. But the restlessness and boredom just killed it for me, Vraylar felt the same way. I stick with the fattening neuroleptics now (specifically Seroquel) because at least I don't have that squirming in my seat, jumping out of my skin feeling on them. I like just being able to sit down and do something and Abilify didn't allow for that unless I was playing a video game. Just hated being so damn bored all the time it was painful.
So the restless agitation you had is something called "akathisia." It is actually a common side effect of this type of medication and it can be so bad as to be life-ruining. It sounds like yours was relatively mild. There are people who get it that constantly have to pace back and forth around a room, feeling like they are going to jump out of their skin if they don't. Risperdal gave me akathisia and restless legs so bad that even though it made me SO tired, I couldn't fall asleep for hours because I couldn't stop moving my legs.
It's worth noting that studies are suggesting that cariprazine (Vraylar) is a partial D3 agonist instead of a partial D2 agonist, especially at low doses, so the effect is somewhat different. It's also worth noting that aripiprazole hits MANY different receptors at once per the k-values.
The context to this comment: I just graduated with my MSN to become a PMHNP - I'm pending licensure and boards (wish me luck!). I had two preceptors for between 550-575 clinical hours in my program thus far and worked very closely with a wonderful PMHNP at a private practice as an RN for 2-ish years prior to my current job, and did my first and most of my clinical hours with her. My other hours were with an MD. The MD is pro-aripiprazole in some cases, and the PMHNP is adamantly against aripiprazole always and forever and very pro-cariprazine. I thought I was going to be as well, but the MD has opened my brain up a bit -- I'm still working as an RN for the facility where the MD works, and during my clinical hours about two months ago, we started a patient on aripiprazole and saw marked results. On the same hand, the PMHNP has seen absolutely extraordinary results with cariprazine too. Both of these practitioners have similar populations - PMHNP is "higher functioning" autism for the most part and out-patient at her private practice, and MD is at a residential setting for children/young adults with autism and/or IDD. That is to say - I don't think it's the evil villain of medication that my OG preceptor made it out to be, but it's definitely worth treating the individual.
Thank you for making this video. I really appreciate 🙏🏼
Excellent video Doctor. Im going to subscribe.
Really enjoyed this. Novice provider and was always presented that Aripiprazole was a "god send" drug.
What do you meen about God Send drug ? Like I have been giving this because I had spirit attack in the past month.But I am anxius that If I take it, it will hurt me ?
It's going to be really awesome when we can do actual brain scans to better diagnose which medication to use based on their receptors. I'm really excited to be in this field over the next 30 years, and I can point out with PHYSICAL data each medication choice. Sometimes it feels like good outcomes in psych are down to luck. Thank you doctor.
What field is thus I'm interested. Im about to start college
Thanks
@@samanthadelbosque7630 this is the field of medicine with a specialization in psychiatry. You may also be interested in clinical neuroscience or psychology, but those do not involve medical school.
Bipolar II here. Rexulti works great and didn't make me gain weight but made it IMPOSSIBLE to lose any either.
This is very helpful! Are there certain types of patients that you find really benefit from this med from a clinical symptom perspective?
I appreciate your measured approach. I love aripirazole as an outpatient option but like you said we must choose wisely. A good rule of thumb is if a patient is struggling with sleep, aripiprazole is usually not the best choice. It is great for individuals with negative symptoms or those who struggle with lassitude.
Could you make a video about muscarinic antipsychotics (e.g., KarXT)?
I second this, I have been very intrigued by KarXT and the potential benefits to the negative symptoms in schizophrenia spectrum disorders.
I just started reading about This med. would love to have this compared to Abilify and Vraylar. Thanks!
To me, Abilify and Prozac I consider to be poison to me for very different reasons. Prozac made me manic for the very first time and since then my hypomanic episodes have never been the same. Plus, I have been manic a few times since. Not Prozac's fault, I'm sure, but I still blame it all on Prozac. With Abilify, my handwriting was chicken scratch, vision blurry and it felt like my brain and mouth was off when speaking. Plus, I was shocked that when I picked up my prescription after getting out of the hospital was an injection. Vraylar is interesting. The only side effect was that it affected my sleep, couldn't sleep more than 45 minutes a stretch and actually made me feel a little hypomanic in a good way. It has potential. But at that point in my life I wanted to be so far away from being elevated because I couldn't take it anymore. I do understand these medications are like magic for many people as lithium has been magic for me. Antipsychotics seems to contain my brain while lithium fixes my brain.
You mentioned you sometimes use this medication. My question is when do you?
Another thing. Do you advise someone who experienced ariprazole side effects to switch to risperodine
I’ve been on various antipsychotics over the years and currently on Aripiprazole which I have found to be the best it treats my symptoms well with minimal side effects.
What mg do you take ?
@@Adonis_Vallee I take 15mg
I HATED aripiprazole. It made my face twitch, my knees would shake every time I sat down and relaxed, and my mouth was so dry. So what did the Dr. do? Gave me a med to stop the shakes, which it did, but also made the dry mouth 100x worse. So glad when I was taken off. I had to try many drugs before settling on Vraylar, which has been a game changer for me.
Like you mentioned, it is used to treat antipsychotics induced hyperprolactinemia. However you also mentioned that you don't want to put a patient on Risperidone on aripiprazole because it may worsen their symtoms? So how is it supposed to be used in treating hyperprolactinemia caused by e.g. Risepridone? I would love to know.
My dr prescribed me Wellbutrin along with my Concerta , anything to be worried about ?
I heard you saying chronic bipolar disorder ? Is there a kind of bipolar disorder that is temporary? 😢
Drug induced mania after using THC, cocaine, shrooms.
Im on the Abilify needle now its bom lovely so far
Is taking 2.5 mg Aripiprazole daily causes weight gain and diabetes .Plz reply.
Can you please break down Invega MOA, just like this video. Thank you.
what did you take to get the below ↓?
I'm starting to worry that by the time I start Psych residency I will have already learned so much that my attending will think i'm a know-it-all
Oh no you moved!!!
Sorry, but you are wrong about antagonists. Antagonists have baseline neurotransmission, unchanged by proteins attached to the receptors. INVERSE AGONISTS are the opposite of agonists... they actually reverse action, reducing neurotransmission. Please go back to your psychopharmacology text.
Snake oil salesman.
Thank you for the video and clear explanations, Dr. Rossi. Would you please kindly share your experience on:
- Does low dosage of Abilify (2 - 5) usually prescribed for depression cause weight gain?
- Does it have energizing , stimulating, or sedating effect? it seems to be more energizing but is it going different from one person to another person?
- What SSRI/SNRI do you usually combine it with in case depression exhibits fatigue?
- How it is usually taken before stopping?
I am asking this because my main complaints is fatigue and low motivation and my family doctor has suggested Fetzima + 2mg of Abilify. But I am very afraid of the weigh gain side effect since Zoloft has already caused 25 lbs weight gain in 6 months. I have tried Zoloft and Trintellix so far. Currently only taking Wellbutrin 300 XL and had at least 50% of improvement.
I am a psychiatry resident in Mexico and aripiprazole is my favorite antipsychotic ❤ even if it takes a little longer to respond it's better in the long run. 💜🫰
I use it very often as well, it works well.
I'm a aripiprazole user 10mg daily praise Jesus Christ