I started writing a bang-up post with every intention of publishing before I departed for three whole weeks of vacation. I just didn’t get around to finishing it. But, I’m going on vacation anyway. :)
Manic Muses will be on a posting (and reading) hiatus until the end of September.
I hope everyone is well and has a great end to their summer!
Abilify wins.
I put up a tough fight, but in the end, with serious commitments looming, I decided to surrender and let Abilify have this match.
Titering down very slowly and using the every-other-day method really did work. I was down to 2.5mg every other day and had great results doing this for two weeks. It was at day five of being completely off the med when I noticed the subtle withdrawal signs creeping in, and by day seven I made the decision to go back to the 2.5mg every other day until the end of next month.
I don’t want to discourage anyone who is also trying to remove this drug from their regimen. Keep at it, and do it safely. This is just a really tough nut to crack. For me personally, there were two extremely stressful events that occurred just two days apart shortly after I stopped taking Abilify altogether. It was just bad timing.
Or, was it?
Let’s get technical; what I was sliding into was a mild psychosis. Racing thoughts, mild paranoia, mild emotional changes, mild personality changes. Even my husband noticed. Wait – isn’t this why my dose of Abilify was increased late last winter? Why, yes, it was. So, after I stabilized on 2.5mg every other day again, I researched whether or not antipsychotic withdrawal can provoke psychosis. Lo’ and behold, an abstract with the exact title appeared among my hits.
Evidence for a rapid onset psychosis (supersensitivity psychosis) following clozapine withdrawal was found and weaker evidence that this might occur with some other antipsychotic drugs. Some cases were reported in people without a psychiatric history. It appears that the psychosis may be a feature of drug withdrawal rather than the re-emergence of an underlying illness, at least in some patients. Meta-analyses of withdrawal studies have suggested that antipsychotic discontinuation may also increase the risk of relapse over and above the risk because of the underlying disorder, but not all individual studies show this effect. Mechanisms may relate to brain adaptations to long-term drug use but data are sparse.
Not conclusive but there’s enough there to make one wonder, especially since I am so sensitive to Abilify in the first place.
Of course the big question is whether what I experienced was indeed withdrawal or my manic-depression rearing its ugly head again. I am, after all, Bipolar I. Antipsychotics reduce the level of dopamine so when the drug is cut off the brain needs to get used to making it again. Quite a tall order for a brain that can’t regulate itself in the first place. So, were the symptoms of mild psychosis due to my brain trying to kickstart dopamine production again? It turns out there is a set of three criteria to determine whether or not the symptoms experienced are a result of withdrawal:
- [Keeping in mind the half-life of the drug] The problems begin immediately after reducing or stopping the drug. (If the original problem has been treated, it should be some time before the symptoms come back, if ever.)
- The symptoms disappear if you go back on the drug, or raise the dose.
- You are experiencing new symptoms as well as some of those that were a feature of your original condition (flu-like symptoms as well as depression, for instance).
[The above information came from a wonderful pamphlet from www.mind.org.uk called, 'Making sense of coming off psychiatric drugs.' It is highly worth the read, covers many types of psychiatric drugs (not just antipsychotics) and can be downloaded as a PDF booklet for 1GBP here.]
Bingo.
Withdrawal. Again.
As it turns out, the half-life of Abilify is 3.5 to 6 days, so the onset of my withdrawal symptoms completely fits the profile. My symptoms disappeared after beginning the drug again and the personality changes and paranoia completely evaporated within 36 hours of my jumpstart, 5mg ‘superdose.’
Being armed with this knowledge makes me all the more anxious to cut antipsychotics out of my regimen entirely. I understand that should I be unable to manage mania or psychosis in the future I may have to return to using this class of drug. The plan for now, however, is to return from an extended trip at the end of September, cut the 2.5mg dose every other day into even smaller slivers and take to my bed if necessary to quit Abilify once and for all.
The moral of the story is antipsychotics are very serious medications and should not be taken lightly. Nor should the withdrawal some people experience. Patients need to be their own advocates when making decisions regarding to take or not to take this class of medication and the Misuse and Abuse of Antipsychotics needs to be addressed.
As I said at the beginning of this post, if you’re reading this and trying to eliminate antipsychotics from your cocktail, do it smartly. Consult with your physician, educate yourself about the drug you are taking, it’s half-life and the potential withdrawal symptoms. Don’t rush. And if it doesn’t turn out the way you hoped the first time around, don’t be afraid to surrender, regroup and try it again.
The drug companies aren’t very happy, and we Bipolar patients shouldn’t be either.
According to an article in PharmaTimes, there are more atypical antipsychotics going generic, enough for a monetary, ‘precipitous decline’ to be felt within the drug class (although the article did not detail which drugs or when). But, with a decline in sales to just over $3 billion by 2021 in the seven major markets, (down from 6.3 billion in 2011) that’s bad news for Bipolar sufferers, because it means there isn’t much in the pipeline for us in the way of new and / or innovative treatment. In fact, there are only two new antipsychotics the article called out as becoming imminently available, Latuda (lurasidone) and cariprazine (RGH-188).
The article goes on to point out the area where the greatest financial gain is to be had. It may seem callous (or obvious) that big pharma is out for the big bucks in uncharted bipolar treatment territory, but their greed can perhaps be beneficial to us sufferers.
The study points out that more effective remission of bipolar depression is the largest unmet need in bipolar disorder, with experts consistently stating few therapies currently achieve sufficient efficacy in this market segment and that, therefore, this presents the greatest commercial opportunity in bipolar disorder.
The treatment of bipolar depression has long been a stubborn and controversial one, and alternatives to traditional antidepressants are truly needed. As someone who was sent spiraling into mania through the careless use of traditional antidepressants, I can only hope the researchers and drug companies are listening.
If this resource truly has an accurate, overarching view of the immediate future of Bipolar pharma, it’s not very encouraging. With the ‘treatment algorithm of bipolar largely unchanged,’ (lithium, mood stabilizer and atypical antipsychotics) it looks like we have a good news/bad news scenario playing out over the next decade. More drugs will going generic (great for the consumer) but not much in the way of new and perhaps better treatments to choose from (bad for the patient).
As a Bipolar I sufferer, I have been on the anti-seizure medication Trileptal (Oxcarbazepine) for over a year and have spectacular mood stabilization results to report.
