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Thread: Abilify - Success Stories? Adverse Experiences?

  1. #1
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    Default Abilify - Success Stories? Adverse Experiences?

    After much discussion, we have decided to try Abilify for our son, age 11. Currently his tics are so bad he cannot go to school. Vocalizations - non stop screeching, yelling and motor tics - kicking walls, hitting (gently at people, harder at things), and OCD.

    I was hoping to hear some experiences with Abilify. I was doing some research and found that since it is a partial agonist for some dopamine and serotonin receptors, it has more of a modulating effect.

  2. #2
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    Default Re: Abilify - Success Stories? Adverse Experiences?

    MomofX

    It can be unreliable to base the choice of treatment on anecdotal experiences of random individuals, because there is no way of knowing the circumstances of their successes or failures.

    One person's experience with any form of treatment is never a predictor of someone else's experience.

    Physicians always base their decisions on scientific evidence arrived at though established objective testing techniques.

    Your son's doctor is the best judge of what options might be best to try based on your son's medical and symptoms history.

    That being said, you may be interested in a recent Medscape article specifically on the use of abilify and Tourette Syndrome, for your information.

    A Treatment for Tourette Syndrome
    W. Wolfgang Fleischhacker, MD
    September 27, 2012

    Wolfgang Fleischhacker from the Department of Psychiatry and Psychotherapy of the Medical University in Innsbruck, Austria, for Medscape.

    Today, I would like to briefly discuss a treatment trial in patients with Tourette disorder, a disorder that usually starts in childhood or early adolescence.

    Tourette syndrome is characterized by motor and vocal tics and has been notoriously difficult to manage. In the past, the drugs that were most used to manage Tourette syndrome were strong dopamine D2-blocking agents -- antipsychotic drugs, such as haloperidol, for example, which is the drug that is approved for treating Tourette syndrome in most countries in the world. A number of other antipsychotic drugs, especially second-generation antipsychotics, have been used off-label in an attempt to manage this disorder.

    Because they are strong dopamine blockers, these drugs are always associated with a potential risk for motor side effects, effects that are especially difficult in this population of patients who suffer from motor tics. Therefore, alternative options have been evaluated and tried in clinical practice.

    Claudia Wenzel and her colleagues[1] from the University of Hannover in Germany have published a report in the August issue of the Journal of Clinical Psychopharmacology in which they describe a very large case series investigated in an outpatient clinic. This was a retrospective chart review of around 100 patients who were treated with aripiprazole, a third-generation antipsychotic.

    These authors chose aripiprazole to manage Tourette syndrome because this drug has a different profile from all the other antipsychotics. It is a partial dopamine receptor agonist. In addition, it has serotonergic properties that the authors believed could be helpful in managing some of the comorbidities of Tourette syndrome -- for example, obsessional traits or depression.

    The authors evaluated a sample of 100 patients between 8 and 59 years of age who were treated with aripiprazole monotherapy. Virtually all these patients had undergone insufficient treatment courses with up to 7 other antipsychotics before being tried on aripiprazole. The authors evaluated the efficacy of this treatment using a 4-point rating scale in which the treatment effects were characterized as either marked, which would be a 1 on this scale; moderate, which would be a 2; doubtful, which would be a 3; or poor or absent, which would be a 4.

    The main result of this study was that aripiprazole relieved motor tics in around 80% of all patients on various doses. In longer-term observations, meaning patients who had been evaluated for periods longer than 1 year, this number was reduced to around 50%. So 50% of people who were managed with aripiprazole over the course of more than 1 year showed either marked or moderate treatment response to aripiprazole.

    The doses ranged between 5 and 45 mg. Of the longer-term observation sample, about one half had moderate doses between 5 and 15 milligrams daily, and the other half needed doses between 20 and 45 mg daily. The dose was usually given as a single dose in the morning.

    With respect to tolerability and drug safety, the authors note that around 60% of all their patients experienced some sort of side effect. The most common side effects were agitation, weight increase, and sleep disturbance. A surprisingly low proportion, about 3% of patients, experienced nausea. The most troublesome side effects from the patient perspective were agitation and weight gain. These were also the most common reasons that people discontinued aripiprazole when they discontinued the drug for tolerability reasons.

    When putting their results into perspective, the authors cautiously note that these results are promising and in line with smaller case series and open clinical trials previously published. They also cautiously note that one needs to realize that in their sample, only 1 out of 3 patients did not respond or did not tolerate aripiprazole. This clearly begs the question of the prediction of both the tolerability and the efficacy of aripiprazole in Tourette disorder. Consequently, the authors call for larger-scale, well-controlled, prospective randomized trials in order to be able to truly evaluate the risk/benefit profile of aripiprazole in the management of Tourette syndrome.

    References
    Wenzel C, Kleinmann A, Bokemeyer S, Müller-Vahl KR. Aripiprazole for the treatment of Tourette syndrome: a case series of 100 patients. J Clin Psychopharmacol. 2012;32:548-550. Abstract



    A PDF copy of the transcript of this article is attached if you wish to print it for your doctor's reference
    Attached Files Attached Files

  3. #3
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    Default Re: Abilify - Success Stories? Adverse Experiences?

    Thanks Steve. You are right that I can't base our decision on others' experiences.

    Do you know, or have any information, if Abilify causes any changes in the levels of neurotransmitters?

  4. #4
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    Default Re: Abilify - Success Stories? Adverse Experiences?

    The best I could find for describing the mechanism of action of Abilify is: Mechanism of Action of Aripiprazole - Psychopharmacology Institute

    Aripiprazole is a dopamine D2 receptor partial agonist with partial agonist activity at serotonin 5HT1A receptors and antagonist activity at 5HT2A receptors (Source)
    This is highly technical, and you may want to discuss your interest and concern with a medical specialist who understands the neurology of Tourette.

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