Properties of Abilify 1

Running head: ABILIFY

Properties of Abilify in Treatment

Carolyn Frances

Argosy University, SFBA

PC6250

Arinn Testa

August 2009
 Properties of Abilify 2

Properties of Abilify in Treatment

Mental suffering has plagued the human race since ancient

times. Over the centuries many methods have been used to aid

those who were afflicted. Today more than 22% of Americans

suffer from some form of mental disorder (Orange County

Psychiatric Society). In modern times, medications have been

developed and discovered with varying levels of success to help

those in need. As time progresses, these drugs have become more

targeted in their action. This paper will focus on an atypical

antipsychotic, Abilify, which was discovered within the last

decade, its properties, and alternatives.

Antipsychotics were first used in 1952 as a sedative and

were discovered to have antipsychotic properties when used in

this manner for psychiatric patients (Preston, O’Neal, & Talaga,

2008). Because they blocked dopamine receptors globally,

initially their side-effects were neurological with a great many

extrapyramidal symptoms such as restlessness, muscle spasms, and

slowed movements (Preston et al., 2008). Atypical

antipsychotics received the label atypical because they

significantly reduced the extrapyramidal side-effects (Farah,

2005) by targeting specific dopamine receptors (Preston et al.,

2008).

Abilify (aripiprazole) is one of the newer atypical

antipsychotics. It was discovered by Otsuka Pharmaceutical Co,

 Properties of Abilify 3

Ltd. (Hitti, 2007; Medical News Today, 2007). The FDA

originally approved the medication for treatment of adults with

schizophrenia in 2002 (National Alliance on Mental Health,

2004). In 2004, it was approved for use with Bipolar I with

psychotic features and in 2005 without psychotic features, both

approvals being for treating adults (Medical News Today, 2008).

In 2007, it became the “first medication approved by the FDA as

an add-on treatment for MDD” in adults (Medical News Today,

2007) as well as being accepted for review of use with patients

aged 13-17 with schizophrenia (Medical News Today, 2007). More

recently, Abilify was approved for patients aged 10-17 with a

Bipolar I diagnosis in 2008 (Medical News Today, 2008).

Like other antipsychotics, Abilify blocks dopamine,

although it is a partial agonist, which puts it in the atypical

group. Unlike other antipsychotics, it also acts to block some

serotonin receptors and is an antagonist for others (Pae,

Serretti, Patkar, & Masand, 2008). As a result, there is a

change in “serotonin and dopamine neurotransmitter systems in

the prefrontal cortex” (Pae et al., 2008, p. 371). Specifically,

Abilify is a partial agonist at the following sites: 5-HT2A, 5-

HT2C, and D2. As a partial agonist at these sites, it decreases

serotonergic neuron firing, decreases the number of binding

sites for 5-HT2, and increases the release of dopamine (Pae et

al., 2008). Dopamine increase is also accomplished by the

 Properties of Abilify 4

antagonistic action of Abilify at the 5-HT2A, 5-HT2B, and 5-HT6

serotonin receptor sites (Pae et al., 2008). It also decreases

binding sites for 5-HT2.

Abilify has a bioavailablity of 87%, with peak plasma

concentrations being reached within three to five hours and

stable concentrations being obtained within 14 days (Mosby’s

Drug Consult, n.d.). This medication is metabolized by the

CYP3A4 and CYP2D6 enzymes through dehydrogenation,

hydroxylation, and N-delkylation (Mosby’s Drug Consult, n.d.).

Because these enzymes can be inhibited by other prescription

drugs, such as fluoxetine, dosages may need to be adjusted (Pae

et al., 2008). When these enzymes are inhibited, blood

concentrations of Abilify increase (Mosby’s Drug Consult, n.d.;

Pae et al., 2008). The blood concentration of Abilify can also

be affected by whether the patient is a poor metabolizer or

extensive metabolizer (Mosby’s Drug Consult, n.d.). Poor

metabolizers will obtain a higher concentration of the

medication than extensive metabolizers (Mosby’s Drug Consult,

n.d.).

Because Abilify effects the neurotransmitter Dopamine,

which “strongly influences both motor and thinking areas of the

brain” (Carver, 2002), side effects are primarily extrapyramidal

in nature. Although akathisia and tardive dyskinesia may occur,

Abilify may be a preferred choice because it is generally well

 Properties of Abilify 5

tolerated, safe, and is associated with a higher level of

patient compliance than earlier medications (Pae et al. 2008).

Another possible, but infrequent, serious side effect is

Neuroleptic Malignant Syndrom (Mosby’s Drug Consult, n.d.).

Abilify is not recommended for those patients, such as the

elderly, who are susceptible to seizures or aspiration pneumonia

(Mosby’s Drug Consult, n.d.). Caution should be used when there

is a cardiovascular disease, cerebrocascular disease, or

hypotention (Mosby’s Drug Consult, n.d.). It is unknown how

this medication affects the human fetus during pregnancy,

although Abilify is excreted in breast milk (Mosby’s Drug

Consult, n.d.) therefore caution should be used if a patient is

pregnant or considering becoming pregnant.

Although Abilify has been approved for BiPolar disorder,

Major Depressive Disorder, and Schizophrenia, there are

alternative and adjunctive therapies available for these

conditions. Various forms of movement have been used for these

conditions. “There is a relationship between motion and emotion

that supports integration and growth” (Leahy, 2004, p. 115). A

patient can engage in dance, yoga, or exercise to involve the

body in movement. Physical exercise has been shown to have an

inverse relationship to depressive symptom scores and any level

of physical activity will alleviate depressive symptoms (het

Rot, Collins, & Fitterling, 2009). In addition, exercise does

 Properties of Abilify 6

have an impact on both serotonin and dopamine levels in the body

naturally (het Rot et al., 2009). Movement itself can assist

clients with schizophrenia in developing “a sense of internal

stability and external separateness” (Leahy, 2004, p. 116).

One specific form of exercise is dance. In one study on

dance movement therapy (DMT), depressive symptoms decreased

significantly in comparison to the control group.

“The literature suggests that DMT produces both subjective

and objective improvements including redefining and

strengthening body image; clarifying ego boundaries;

providing an outlet for relief of physical tension,

anxiety, and aggression; reducing cognitive and kinesthetic

disorientation; increasing the capacity for communication,

pleasure, fun, and spontaneity; and support for therapeutic

medical goals.” (Jeong, Hong, Lee, & Park, 2005, p. 1713)

In this study, there were also “significant changes in the

levels of serotonin and dopamine” (Jeong et al., 2005, p. 1717),

the two neurotransmitters effected by Abilify.

Movement, in the form of Yoga, has also been studied for

Schizophrenia. In Duraiswamy, Thirthalli, Nagendar, &

Gangadhar’s 2007 study, after four months, yoga participants had

“significantly less psychopathology” and “greater social and

occupational functioning and quality of life” (p. 226). There

were no serious adverse events for participants in either the

 Properties of Abilify 7

yoga or physical exercise groups during this study. However,

the changes in symptoms were significant in comparison to just

physical exercise, in particular a reduction in negative

symptoms. Yoga tames the anxiety response and “decreases

physiological arousal” ("Yoga for anxiety and depression," 2009,

p. 4). In another study, for “patients with bipolar disorder,

major depression, and schizophrenia … average levels of tension,

anxiety, depression, anger, hostility, and fatigue dropped

significantly” ("Yoga for anxiety and depression," 2009, p. 4).

Research suggests that “mental and physical health are not

just closely allied, but are essentially equivalent” ("Yoga for

anxiety and depression," 2009, p. 5). As a client begins to

change their lifestyle to improve their overall health, it is

conceivable that the need for medication may decrease.

Abilify seems to be a promising medication with multiple

applications. When “there is evidence to suggest that [a]

person’s problems are due to some form of biologic disturbance”

(Preston et al., 2008, p. 15) it may be a good choice to target

the symptoms expressed. It should be remembered, however, that

other non-chemical methods exist which could possibly alleviate

symptoms in less serious cases without medication or if used in

conjunction with medication could speed recovery.

 Properties of Abilify 8

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 Properties of Abilify 9

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