Abilify was developed to treat schizophrenia — but only 1% of Americans have schizophrenia. A few years later it was approved for use in bipolar disorders, which about 1.5% of all Americans have. It was never going to be a blockbuster drug for its owner, Bristol-Meyers Squibb, with such a small pool of potential patients. When the FDA approved Abilify as an add-on drug for depression, Bristol-Myers Squibb started advertising to the public and the drug shot up to the top of the sales charts.
How much Abilify? $6.5 billion worth in 2013. I asked Dr. Candida Fink: Why are people taking so much Abilify? Are people that depressed? Dr. Fink (pictured above) is an expert in bipolar disease, who is a board certified child and adolescent psychiatrist specializing in several areas including mood and anxiety disorders and dual diagnoses of developmental disabilities and mental illness. She pointed out that 16 million people have depression; it’s a significant and lethal disease.
Video Q&A with Dr. Candida Fink: How Does Abilify Work?
My interview with Dr. Fink is on video in 2 parts: Part 1, How Abilify Works, above, and Part 2: What Are The Side Effects of Abilify (to be published on Nov. 11). Below is some of the information from Part 1, paraphrased and shortened. I urge you to watch the 2 videos — together they paint a picture of a dangerous drug that needs to be carefully monitored and used only as part of a total mental health program.
One of my major concerns when researching Abilify was if consumers are swayed by the $121 million of advertising Bristol-Myers Squibb spends on promoting it each year. When I asked Dr. Fink about the role of advertising, she admitted readily that “the advertising is everywhere,” adding, “The effects of the advertising are very vivid to me, I see it all the time. I talk to my patients about making the best decision for them and not rely on advertising. But that’s certainly a big part of why Abilify is selling as much as it is — because of the advertising.”
Monitoring for Side Effects
The laundry list of side effects runs by so quickly on TV and is so hard to read in the package insert, that I wondered which side effects does she see regularly. “One of the most common is akathisia … motor restlessness, the feeling that you’re going to jump out of your skin… That’s one of the more common reasons we stop it.
“Another important side is effect is changes to your metabolism. Changes to how we use glucose and insulin and our cholesterol. It creates some increased risk of developing type 2 diabetes. And it definitely carries some risk of weight gain, less than some other drugs, but it is significant and it is real. Other concerns that come up – sometimes people feel a little sedated or on it, often that comes and goes within a few weeks of starting the medication but it can persist.
“Like any medication used for depression we do watch for development of suicidal thoughts. Pretty much any intervention for depression and early treatment including psychotherapy can lead to increased rates of thinking about suicide. We don’t know why that is, but we to be aware and we have to be monitoring.”
Crazy Dreams, Paradoxical Effects, Shaking
Internet research supplied some indications of frequency of side effects. Gastrointestinal side effects have included nausea (14% to 16%), dyspepsia (15%), constipation (10% to 13%), vomiting (11% to 12%), dry mouth (5%), abdominal discomfort (3%), and salivary hypersecretion (2%).
Other side effects have frequently included headache (31% to 32%), asthenia (7% to 8%), accidental injury (5% to 6%), fatigue (6%), vaginitis (6%), urinary tract infection (5%), pain (3%), fever (2%), peripheral edema (2%). Many of these side effects resolve after a few days of taking Abilify.
By cruising around chat rooms on the internet, I found people who were taking Abilify complaining about the following side effects:
- Crazy dreams
- Paradoxical effect – creating agitation rather than calmness
- Increased production of saliva
- Lightheadedness or vertigo
- Sexual dysfunction
- overheating more easily and having trouble cooling down after activity
Side effects like headaches, feeling spacey, drowsiness/fatigue, insomnia and nausea generally go away in a couple of weeks.
Tardive dyskinesia (TD) is a side effect that develops with prolonged use of antipsychotics, though the incidence is lower with Abilify and second generation antipsychotics as compared to the first generation.
A very unusual side effect was explored in a study listed in PubMed (part of the NIH). It reported on 3 cases of pathological gambling in people with no history of gambling. The pathological behavior disappeared as soon as the drug was stopped.
if there are so many problems with Abilify, why do doctors prescribe it and why do people take it? Please come back on Nov. 11 for Part 2 of our fascinating interview with Dr. Fink on Abilify, Is Abilify Worth the Risks.