Aripiprazole: An Add-On Medicine for Major Depressive Disorder

What aripiprazole is

Aripiprazole is in a class of medicines called atypical antipsychotics. Abilify is the current tablet brand on DailyMed, and generics are available. Long-acting injected versions have separate labels and are outside this page.

The word "antipsychotic" can be startling on a depression plan. It names the class, and using one does not mean someone has psychosis. The National Institute of Mental Health (NIMH) says atypical antipsychotics are sometimes used to treat bipolar depression or depression in people who have not responded to an antidepressant alone.

What it is approved for

The Abilify label lists these approved uses:

• Adjunctive treatment of major depressive disorder.
• Schizophrenia.
• Acute treatment of manic and mixed episodes associated with bipolar I disorder.
• Irritability associated with autistic disorder.
• Tourette's disorder.

Exactly what the label says about depression

The depression approval is for adding aripiprazole to antidepressant treatment. The label's depression studies were two short-term, 6-week, placebo-controlled trials of adults who had an inadequate response to antidepressant treatment. It is not approved as a stand-alone treatment for depression.

The label says safety and effectiveness in children and teens with major depressive disorder have not been established. MedlinePlus says the medicine may be prescribed for other uses without naming them, so we list no off-label uses here. If an antidepressant has not helped enough, our guide to what can happen when a first antidepressant does not help explains the kinds of options prescribers discuss.

How it is thought to work, and what taking it can be like

The label says the way aripiprazole works in schizophrenia or bipolar mania is unclear, and that its effect could come from acting as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and blocking serotonin 5-HT2A receptors. The label does not give a separate explanation for depression. MedlinePlus says it works by changing the activity of certain natural substances in the brain.

For depression it is added to antidepressant treatment, so that antidepressant's effects remain part of the picture. MedlinePlus says it may take 2 weeks or longer to feel the full benefit, and says not to stop taking aripiprazole without talking to your doctor, even if you feel well.

A feeling of inner restlessness, or being unable to sit still, is worth mentioning quickly. In adults using it as an add-on for depression, the label lists akathisia, the medical word for this, along with restlessness, insomnia, constipation, fatigue and blurred vision, as the most common side effects.

Boxed warnings and other risks

The label has two boxed warnings, the strongest kind.

• Older people with dementia: older adults with dementia-related psychosis treated with antipsychotic medicines are at increased risk of death. Aripiprazole is not approved for dementia-related psychosis.
• Suicidal thoughts and behaviors: antidepressants increased these risks in children, teens and young adults in short-term studies. The studies did not show an increase in people over 24, and there was a reduction in people 65 and older. People of all ages starting antidepressant treatment need close monitoring, and families and caregivers should watch for changes. If you or someone you love is in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.

Other side effects and warnings

Beyond the boxed warnings, the label describes several serious risks to know about and report.

• Neuroleptic malignant syndrome: a rare, dangerous reaction with fever, stiff muscles, confusion and irregular pulse.
• Tardive dyskinesia: uncontrollable movements of the face, tongue or body, which can be irreversible.
• Metabolic changes: high blood sugar and diabetes, changes in blood fats, and weight gain.
• Compulsive urges: intense urges, particularly for gambling, have been reported. The label says people may not recognize these urges as abnormal, so tell your prescriber about any that are new or intense.
• Also on the label: dizziness when standing, low white blood cell counts, seizures, trouble staying cool in heat, and trouble swallowing. People who have had an allergic reaction to aripiprazole should not take it.

Can aripiprazole be managed online in Pennsylvania and New York

Video visits can cover mood, side effects and movement concerns, but the label calls for checks that happen in person, such as blood sugar and, for some people, blood counts. Ask how those would be arranged. Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our medication inquiry form. If you are pregnant, planning a pregnancy or breastfeeding, tell your prescriber.

A licensed psychiatrist on our team treats depression by secure video for people physically located in Pennsylvania or New York during each visit. See online depression treatment, online psychiatry in New York and our medicines list. Our therapists do not prescribe, and they see clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York. Ask us about fees and insurance.