Many first- and second-generation antipsychotic medications have numerous unpleasant side effects. In particular, certain hormone levels are thrown out of balance as a result of taking these drugs for prolonged periods. In women, an increase in the levels of the hormone prolactin—a condition called hyperprolactinemia—may lead to side effects including, but not limited to, irregular menstruation, breast milk production, and infertility. In the past, the benefits afforded by these medications were seen to outweigh these side effects. More recently, however, a new class of drug called the “atypical antipsychotic” has shown as much, if not more, effectiveness at managing psychotic symptoms without so many unwanted side effects.
Abilify (aripiprazole) falls into the category of atypical antipsychotic medication. In a study of five women with schizophrena, Abilify was introduced as a replacement for their previous antipsychotic medication. Clinicians tapered down the current dosage of medications while simultaneously increasing the dosage of Abilify. Over the course of about 2 weeks, the older medication was gradually stopped, and Abilify dosage reached maintenance level. In each case, the patient showed no worsening of symptoms. There were no sudden psychotic episodes or hallucinations, and none of the patients was forced to discontinue the trial. Likewise, symptoms of excess prolactin all disappeared, and blood tests showed much lower levels of the hormone. Most promising of all was the fact that each patient showed measurable improvement on two scores of psychiatric well-being. It’s highly likely that the reduction in negative side effects directly correlates with the improvement in overall quality of life.
Switching antipsychotic medications is always a tricky proposition. When a medication is effective in the treatment of schizophrenia and other psychoses, there is a natural hesitancy to try something different, even in the presence of adverse side effects. It is true that patients may experience a sudden worsening of symptoms. The abrupt discontinuation of antipsychotic medications has even resulted in full-blown psychotic episodes. When the transition from one drug to another is gradual, however, there seems to be less chance of this occurring. Abilify offers the added benefit of being potentially more effective than older medications. More research is, of course, necessary to determine whether Abilify should move to the top of the order in terms of treating women with schizophrenia.
- Kuloglu, M., Ekinci, O., Albayrak, Y., Caykoylu, A. (2010). Benefits of switching women schizophrenic patients to aripiprazole: a case study and brief review of the literature. Archives of Women’s Mental Health, 13, 443-447.
- Serri, O., Chik, C. L., Ur, E., Ezzat S. (2003). Diagnosis and management of hyperprolactinemia. Canadian Medical Association Journal, 169(6). Retrieved February 23, 2012, from http://www.cmaj.ca/content/169/6/575.full
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