How in the heck is a placebo giving about 1 in 20 people akathisia? I've never heard that before. It doesn't make sense.

This is indeed troubling. Over on Psych Central there's a very troubling piece entitled "Can Doctors Be Happy" http://psychcentral.com/blog/archives/2008/11/05/can-doctors-be-happy-part-1/

It's troubling because it explains that unhappiness is normal!!! on a mental health blog page. So when a doctor is unhappy, that experience is validated, s/he's told that unhappiness is normal and to practice mindfulness, but when a patient comes to a doctor ans says s/he's unhappy, s/he's told s/he has a brain defect and given drugs and treatments that lead to horrible side effects and make suicide more likely. It's sick!

I love Abilify. Invega, too. Over the past month, I've been acutely manic, and while it's kind of fun, the elation causes distressing agitation, and too many pressured thoughts. They put me on Tegritol, but it did absolutely zip for me, so my Invega was increased and over night I felt so much better; the next day the mania had been subdued by miles. And then they increased my Abilify a few days later -- and now the mania has pretty much disintegrated. It's really, really good; I love Abilify and Invega!! :-)

Philip--What do you know re: Abilify and the other standard antipsych side effects (TD, EPS & metabolic problems)? I was looking some of this stuff up today, and was getting mostly papers reporting minimal TD, EPS and metabolic risk, and thus that it was a "safe" add-on for depression, but I have trouble buying it (and yes, good to know about the ridiculous akathisia risk). Apologies if you've already done such a post, I didn't find one with a quick search.

The people touting Abilify for depression should be strung up by their toenails and twirled around a few times. Akthisia is an awful condition and much more common amongst those who take anti-psychotics than is reported. If you are a doctor reading this, PLEASE do not subject your depressed patients to this! I realize anti-depressants were not all they were cut out to be -- but really, an anti-psychotic is NOT the solution.

Dear Philip:

"Abilify Is Likelier To Cause Akathisia Than Treat Depession".

OK, what exactly is DEPESSION? Is that like peeing into a fan or something?

Yours Truly,
Stan

Abilify created mania (awake 10 days)in my daughter in 2005 when she was 17 (before it's approval for use in kids under age 18).

*
PS--typo alert in title word "depression"

And these dismal results are from two studies sponsored by the makers of Abilify! The first study has seven authors -- the first six are all employees of Bristol-Myers-Squibb or Otsuka. The second study does not post its "disclosures" online, but at least 3 are the same as in the first study -- including the lead author. When the carnival barkers themselves cannot hawk their wares better than this, beware.

Here are the proud authors of Study #1:

Drs. Berman, Marcus, and Corey-Lisle and Mr. Swanink are employees of Bristol-Myers Squibb, and Drs. Berman and Corey-Lisle are Bristol-Myers Squibb shareholders. Drs. McQuade and Carson are employees of Otsuka Pharmaceutical Development & Commercialization, and Dr. McQuade is a former employee of Bristol-Myers Squibb and a current Bristol-Myers Squibb shareholder. Dr. Khan has been the principal investigator of over 200 clinical trials sponsored by more than 40 pharmaceutical companies.

I guess Dr. Arif Khan is the token independent -- and he is affiliated with a private "clinical research center" in Bellevue WA, not a university.

If only psychiatrists would say to patients what Bremner says, "Abilify is more likely to make you want to jump out of your skin than it is to cure your depression. An 11% improvement over placebo is not that great and is set off by the fact that Abilify has a lot of nasty side effects and doesn't work better than other treatments of refractory depression like lithium (which also can have nasty side effects)." They could follow this up by saying, "Now, would you like to go ahead and try it anyway?"

There are a couple of people posting who are glad they're on Abilify, and I fully support their right to take it. However, my concern is for the majority of patients who will take this drug (those who do not fall in that 11%). Don't they deserve to be told the truth?

Arif Khan does run a med trial clinic; a person can get paid cash to do it, as a matter of fact that's all they do there is drug trials.

I will only note that if the side effects were as bad as everyone says they are, you'd expect to see a much higher discontinuation rate than what was reported -- 2.2% (compared with placebo, 1.7%). Apparently the beneficial effects of the drugs were better than the side effects people experienced while on them. So despite the hyperbole, people who took this drug felt well enough on it not to discontinue it. Spin it however you want, but it's a stat not reported in either blog entry and one that is relevant to the discussion.

From the research I have done on the history of antipsychotics it seems that the genesis of this class of drugs has it's roots as a chemical dye compound and as a pesticide.

It is not medicine in the sense of the word used to describe concoctions that one would take to heal ailments or illness. This stuff causes ailments and illness.

Although it's hardly the first insecticide to be used to cope with personal problems for those familiar with smoking cigarettes.

It is amazing how we bullshit ourselves into believing that we need to be dependent on self harming in order to cope. They don't call it mental illness for nothing.

It's still alarming that an antipsychotic can be rx'd out to patients by a PCP for depression and not know it's an antipsychotic created for psychosis/schizophrenia. As long as patients are fully informed that's great, but most ppl don't research for decades or longer, and they trust doctors, and the FDA. Oh, that's another topic.

Dear Sanguine Harry:

Are you a complete idiot, or just so out of touch you’re in orbit Sanguine? They pull many of these people (test subjects) off the streets; as in homeless, and/or indigent populations, and pay them cash to do these studies! They have built in incentives not to complain and complete the studies no matter what the side effects are (thus low dropout rates). One of the many reasons why these clinical trials and studies should be regulated and overseen with standardized protocols by completely independent bodies, and is considered voodoo medicine, invalid, bad science, as well as skewed statistically.

Now, why don't you go pop some SSRI's and then some Abilify on top of it; give it a few weeks if you haven’t crashed by then; and come back here and tell us all about side effects you dirt bag.

Until that time, shut your pie hole, since you sound a whole lot like the notorious Herbie of many names and faces, including want-2-be Dr. TF!

In the real sane world, if a dangerous drug only showed an 11% improvement rate, and adverse side effects showed a much higher rate; you would logically think the FDA would not allow its use, or approve it for consumption in humans.

Yours Truly,
Stan

harry: i determine what's relevant to post about and what details to use. if you don't like it, go away and start your own website.

When I experienced akithisia I didn't know what it was until 2 years after I discontinued antipsychotics. I thought it was one of my mental health issues that were worsening in spite of my compliance with everything all my therapists were telling me to take and do, if they ever told me to do anything besides take pills. Mental "illness" is purported to be a permanent "disease" which is incurable and has a downward path. Many patients experiencing terrifying side-effects from medication think they are merely going off in another direction. We are told hopeless, bullshit "facts," and we are punished for suffering from treatment. It is very lucky, and hard work as well, to extricate oneself from such an unfortunate circumstance.

When people throw these trial percentages out there, all I can think of is Traci Johnson.
There is no mention of cases of suicide on the Cymbalta label. Yet, she committed suicide during a trial.
Why isn’t Abilify approved to treat depression alone? Perhaps they performed trials and the discontinuation rate was too high. In which case, you’ll never see the %’s of that study. I wonder how many studies have been started and aborted.
Why don’t the drug manufacturers try to gain approval for other uses? Why all the off-label promoting? I have to think it’s because failed trials happen all the time.

P.S. “discontinuation” may be low due to “patients” not knowing what is happening to them since the drug is affecting there mind. The incidents of adverse events are far greater than 2.2% but people aren’t told to stop taking the drug.
In one study, 23% developed akathisia, 14% “restlessness”… unless I’m interpreting it wrong.

This is from an Abilify Phase 3 trial for Depression Adjunctive therapy: (it's 1 of 14 trials for 9 indications). I don’t get how they came to the conclusion of; “efficacious and well tolerated” WHAT?!???

Adverse events (AEs) that occurred in > or = 10% of patients with adjunctive placebo or adjunctive aripiprazole were akathisia (4.5% vs. 23.1%), headache (10.8% vs. 6.0%), and restlessness (3.4% vs. 14.3%). Discontinuations due to AEs were low with adjunctive placebo (1.7%) and adjunctive aripiprazole (2.2%); only 1 adjunctive aripiprazole-treated patient discontinued due to akathisia. CONCLUSIONS: In patients with MDD who showed an incomplete response to ADT, adjunctive aripiprazole was efficacious and well tolerated.

I started experienced Akathisia in 10/07, it continued until I took myself off Cymbalta in 2/08. I didn’t know I was experiencing it until 8/08 when I started trying to figure out what happened to me. Notes I wrote in 10/07 while I was struggling to keep my sanity include; “I can't stop moving at work; cleaned desk, drawers, went to the kitchen 5-6 times, was talking really fast…” along with even more off the wall statements I didn’t recognize as off the wall until the drugs were out of my system. At that time, I gave the notes to the doctor; she thought a stimulant would help. I don’t remember much after that. I do know my son moved out "because I was too mean".

I took Abilify for a month in 2005. I ended up in the hospital with a horrendous bout of akathisa. The doctors didn't recognize it and thought it was mania...upped my dose. I wanted to die. I have had suicidal ideation before but I really did want to die this time. I couldn't sit still, I had to walk or I thought I would explode. Then they put me on Geodon which also gave me severe akathisia. And they wonder why the mentally ill think these drugs are poison. I'm on Seroquel now, which, interestingly, doesn't cause akathisia but does cause my anxiety to increase a bit. It has also given me cataracts at age 37. But it did bring me down from a mania.

I agrree, akathisia all the way. It also gave me terrible, terrible anxiety to the point where I couldn't even go outside. After about two weeks off it, I was fine again..

Abilify sucks, straight up.

When I was a teenager, I was put on Abilify. Within a few days I developed really and akathisia. I became extremely restless and felt like I couldn't stop moving. I had no idea what was going on, I was a teenager in high school. I had to miss a lot of school because of the akathisia caused by Abilify. It was scary, I thought it would last forever. I had generalized anxiety disorder. The akathisia was so scary. It's kind of funny, at the high school I went to, we would have to write notes as to why we missed school and the note said I was "Sick". It would have been much better if it had been writte missed school do to akathisia from antipsychotic. Akathisia is really ctazy, especially if you experienced it as a teenager who had no idea this was being caused by a medication. I remember I thought I had developed a disease and was trying to look up if anyone else had it on the internet, but I didn't know what it was, so I basically typed the jitters, restless legs to figure out what happened. I wish I had known then what was going on, it would have been help. It happened durign this very day a long time ago. Akathisia was scary, I couldn't sit still. It's fun looking back on it, but it was scary at the time.

So...does that mania caused by Abilify eventually wear off after the first few weeks? Isn't is more of a temporary side effect? I am on week 2 (5mg) and I can't sit still and feel very uncomfortable in my skin. The only reason I am trying to stay on it, is because I was lead to believe that once the theraputic effect kicks in, in a few week, this restlessness will fade away? Any feedback, please?