SHinojosa: Taper my 14 year old son off of Abilify after 9.5 years

[SHinojosa]

I want to get my son off of abilify. I've been reading a lot in this website and have begun to taper 10% of 10 mg of abilify yesterday. 

 

He was on 5 mg until June 2018 when the Dr upped him to 7.5 mg. Then in July 18, the hospital dr upped it to 10 mg. Can I taper at a faster rate since he has been on 10 mg from 7.5 mg for only 2 weeks?

 

Thank you

 

Stephanie 

[mammaP]

Hi Stephanie,  from the signature (thank you for that, it is very helpful) he was put on intuniv and abilify at 4 years old?  Why do they keep changing the doses and drugs?   I am wondering if he is having side effects. Doctors often see side effects as the 'illness' and increase the dose or change the drug when what is really needed is a reduction in dose.  

9 hours ago, SHinojosa said:

He was on 5 mg until June 2018 when the Dr upped him to 7.5 mg. 

What happened for the doctor to increase the dose to 7.5? 

9 hours ago, SHinojosa said:

Then in July 18, the hospital dr upped it to 10 mg

Did his symptoms change after going up to 7.5 that meant he was admitted to hospital? 

Have the adderall and intunive been discontinued now? 

How has the 10mg affected him?

 

I am sorry for all the questions, we need to get the full picture to give the best advice, we don't want to advise something that might see him back in the hospital, we want to help you to help him. I can imagine how hard it is not kowing which way to turn. 

 

When you start to taper, will you be looking to get him off the drugs completely?  It will need to be very very slow because his brain has developed along with the drugs and it will need to be able to take over functioning very gradually to avoid any withdrawal that might be interpreted as relapse and have him back in the hospital. This is especialy important when the drugs were started very young.

This post by Rhi explains it well.  

https://www.survivingantidepressants.org/topic/6447-best-of-sa/?do=findComment&comment=91582

 

Edited August 1, 2018 by mammaP

[SHinojosa]

He was being aggressive and threatening self harm and running away so the Dr upped his,abilify to 7.5 mg in mid June this year. Then for the same symptoms he,was put in a psychiatric hospital in mid July and July 16 his abilify was upper to 10 mg. 

 

I'm asking if it's possible to go down to the 7.5 mg faster since he's only been at 10 mg fo2 2 weeks. 

 

What started the uping doses was me trying to taper him off from 5 mg to 3.75 mg taper. After 1 week he became aggressive and we thought it was old symptoms but now I know it was withdrawal.  

 

Thank you.

[SHinojosa]

I hope to one day get him all the way off but I think he was,fine at 5 mg. I just tapered too fast so I'd like,to get him back to 5 mg. Where he,was,at 6 weeks ago

[SHinojosa]

So I'm asking if I can go back down to 5 mg faster since he's only been at 10 mg for 2.5 weeks and 7.5 mg for a month before,that. 

 

The problems came when I tried to taper too fast from the 5 mg in june. 

 

He is off intuniv and adderall completely. He came off the intuniv in 1 week in the hospital and then the hospital dr put him on adderall.  I gave him the adderall for a week after he came home and then discontinued the adderall cold turkey and he had no withdrawal.  

 

He is doing well on 10 mg but I know that abilify is causing him to have learning disabilities and short term memory problems and I'd like to get him off it by the time he is 18 so he can join the armed forces. He wants to go into the USCG but can't be on any meds in order to join. 

 

I don't think he needs it anymore but I do plan on taking it way slower next time. For 2 days now I've tapered down to 9 mg from 10 mg. I've dissolved his tablets in water and giving it to him in a suspension using an oral syringe.  So far he is doing ok. 

 

But do you think I can take him back down to 5 mg faster since he was,at the level for years and only upred to 10 mg in the last 2.5 weeks. 

Thanks so much

 

Stephanie 

 

 

 

[mammaP]

I would keep him at 9 for a while to let his nervous system catch up and stabilise after stopping the intuniv and adderall.  Withdrawal can happen after several changes, they seem to be fine then suddenly are in withdrawal and back at the hospital with more drugs, usually more than one and higher doses. After a few months he could be ready to start the taper. I would not try to go any faster when he has taken the drugs for so many years.  When you do start to taper he could start to feel better as the dose lowers and you should see a difference as long as it is done very slowly.   Trust me, it is well worth the patience and time to have a young man who is stable and doing well in life. It is heartbreaking when they can't achieve their potential because of the drugs they have been taking most of their liives. I am going to ask the team to take a look, and see if they think it might be ok to go back to 7.5. I haven't personally taken antipsychotics for a long time, only briefly, but I know some of the others have taken them for long periods.  I am so glad that you found us and posted here,  we can help you to get your son free of the drugs and making his way in the world.

Edited August 1, 2018 by mammaP

[SHinojosa]

Thank you. I appreciate your help tremendously.  Luckily the intuniv was a med for high blood pressure that they found helped kids with adhd to settle down so it did not effect his brain at all. I think that's why he came off it in 3 days so easily with no withdrawal at all. 

 

The adderall he was on for 2 weeks at a very low dose so he came off of that in 1 day with no problems at all. 

 

It's this abilify that caused him to go in the hospital a couple of weeks ago because I went down from 5 mg at 25% taper (to 3.75 mg ) for 2 weeks thinking I was going slow. The Dr told me to go 50% taper for 1 week then off completely. But I went slower at 25% knowing it was,too fast because  I tried that once before with him the summer of 2015 and it was a near disaster but as soon as he showed problems i put him back at 5 mg. 

 

Thanks again so much. My goal is to have him drug free by the time he graduates high school which is 4 years from now. If I don't then he will try and do it himself when he leaves home and will be impatient and mess up his life. I know him and I know that will happen. 

 

Stephanie 

[mammaP]

Doctors always tell people to go fast, then tell people they need it for life and blame relapse when it is in fact withdrawal.  Lots of us here have left psychiatry behind after finding out that we were in and out of withdrawal at the hands of doctors for years. It is great that you can see this now and taper him off while he is still in your care. 

[mammaP]

Thank you for claifying the intuniv, it is not one i am familiar with. 

Edited August 1, 2018 by mammaP

[SHinojosa]

I look forward to the teams input on tapering down faster to 7.5 mg. I'll be honest though. I don't want to mess him up again. I wish we were at 5 mg again and I had figured all this out about slow taper in june before we doubled it. 

[SHinojosa]

I just want to add that my son was never sleepy from the 5 mg. He would take it in the morning. Now at 10 mg it knocks him out and he has to take it at bedtime and he is tired all day from it. For 2 days he has been at 9 mg. 

[Altostrata]

Welcome, SHinojosa.

 

6 hours ago, SHinojosa said:

He is doing well on 10 mg but I know that abilify is causing him to have learning disabilities and short term memory problems and I'd like to get him off it by the time he is 18 so he can join the armed forces. He wants to go into the USCG but can't be on any meds in order to join. 

 

How old is your son now? Have you discussed this with him? He should understand that changes in his drug dosage might make him feel funny, and he needs to stay calm and discuss this with you if it happens. When did he decide to go into the military? What are all these drugs supposed to treat?

 

What do you mean when you say he's doing well on 10mg? What do you mean by learning disabilities and short-term memory problems?

 

When he went off Intuniv in June, did his symptoms change? Did he go off Intuniv and increase Abilify to 10mg at the same time?

[SHinojosa]

I was answering all of mommap questions. 

I can go through it again if you need me to. 

Basically my son is 14. He has been on abilify since he,was 5. I tried tapering him 25% (3.75 mg) from 5 mg in june. He did badly and so the Dr upped it to 7.5 mg thinking it was old symptoms returning. By mid July he had a total meltdown and went into a psychiatric hospital where they took him off 4 mg of intuniv and upped his abilify to 10 mg. They added 10 mg adderall.  

 

I took him off the adderall last Monday after he was on it for 2 weeks. He is fine without it just tired but I think the tired is from the 10 mg of abilify not wd from adderall.  

 

I originally started tapering in june because I believe his learning disabilities and memory problems are from the abilify. I tapered him too fast because I didn't know better and thats why he's on twice as much now. 

I said he was,doing fine on 10 mg of abilify meaning that he is stable and ok. 

 

I was asking if I could bring him down from 10 mg back to 7.5 mg since he has only been on 10 mg for 2 weeks. 

 

My plan is to have him off abilify completely by the time he is 18 because he wants to join the armed forces and recruits can't be on any meds. I don't think he needs them anymore.

 

The intuniv was for high blood pressure and they found it to help the hyper part of adhd kids. So he came off intuniv no problem as it's not a psychiatric med. 

 

I appreciate all of your input. I wish I had figured this out in june and tapered at 10% of last dose. The abilify is making him extremely tired. At 5 mg he could take it in the morning and it didn't make him sleepy. At 10 he has to take it at bedtime and it's making him tired during the day. 

 

Thanks again,

 

Stephanie 

[SHinojosa]

The drugs were supposed to treat bipolar and adhd. 

 

I have discussed this with him and told him to tell me if he feels out of control or even a little funny and that I can up it a little to help and that he must tell me everything he is feeling. He wants to go into the USCG. 

 

Also, he didn't have learning disabilities before. He had memorized the alphabet and the sounds of letters and was teaching himself to read around 3 yrs old. The learning disabilities are specifically memory related. So I think it's the meds that are hampering his reaction time and learning abilities. He would do better in football too I think. 

[SHinojosa]

He has been on 9 mg of abilify for 2 days. I made his abilify into a liquid. He is so tired on the 10 mg of abilify. 

[mammaP]

Hi Stephanie, thank you for all the information.  When the dose was cut by 25% he went into withdrawal, then it was increased to 7.5 and he worsened.  Withdrawal destabilises the nervous system, and increasing the dose so much has intensified that instead of helping. Then they did what doctors tend to do all the time, they increased it until he was sedated and calm. That is why he seems 'stable', he is sedated.  What we are concerned about now is that if the dose is reduced back to 5 too fast, he will lose the sedation but could easily be back where he was and in distress. It is very important that he is kept stable.  Reducing the dose will not take him back to how he was when he was at 5mg.  His nervous system has changed, it is unstable and needs to be calm.   If he is fine with the 9mg, I would keep him on that for at least 3 months. I know that seems like a very long time but reducing fast would be a gamble that could go horribly wrong.  I understand why you are  tempted to reduce quickly but after being here for 5 years and seeing people suffer badly after dose reductions that have caused awful withdrawal I see the wisdom in holding after changes that have made someone sick.  As the dose lowers he will be less sedated, he could improve so gradually that you barely even notice until one day you will realise that he is brighter, more alert, more active etc. 

 

When you are ready to taper,  Brassmonkey's sliding scale would be best for your son. It means tapering 2.5% per week for  4 weeks, making 10%,  then holding for 2 weeks. It is more gentle  and has a good success rate.   You can read about it here. 

https://www.survivingantidepressants.org/topic/17671-the-brassmonkey-slide-method-of-micro-tapering/

 

You seem to have mastered making a liquid and using a syringe which is brilliant, that can be daunting for people but you already have that skill so it will not be as stressful.  Let us know how your son is and if there are any changes.  If he gets any symptoms at all, however mild, hold the dose for longer, don't make any more suts until the symptoms have abated and he has been stable for a few weeks. He needs extra caution because of his age and the time he has been on the drug. It is such a shame that they increased the dose so much, and you now have to start from there, but he will get off them and be able to live a normal life. My heart truly goes out to you, and I hope he goes on to do acieve his goals. 

 

Edited August 2, 2018 by mammaP

[SHinojosa]

Thank you and I will heed your warnings and take your advice. 

 

I'll check back in 3 months then. 

 

Thank you all for all your help

 

Stephanie 

[SHinojosa]

He has been on 9 mg from 10 mg for 4 days. This is his 4th day. If he is to show intolerance going down to 9 from 10 mg, when do you think I'll begin to see that. And if I do should I go back up to 10 mg for 3 months? 

 

Thanks 

 

Stephanie Hinojosa 

[SHinojosa]

If he shows signs of wd on 9 mg of abilify should I put him back at 10 mg for 3 months? 

Please respond because he's acting really restless. 

 

Thank you, 

 

Stephanie 

[mammaP]

  Try not to panic. What do you mean by restless? Is he needing to move around a lot, or is it like he is bored? Is he still sleeping?  Can you tell us what happened when they increased to 7.5  that made them go up to 10?

It takes 14 days to get to a steady level in the blood, so it may be best to go back to 10. 

We are all volunteers and from different countries and may not see your replies right away. It is early morning here and i am just up but checked in before my day starts. 

Edited August 3, 2018 by mammaP

[SHinojosa]

He was,wanting to walk to his friends house at 11:45. I just panicked because I'm so afraid he's going to get messed up again from wd.  I went a head and gave him 1 mg so a total of 10 mg of abilify last night. I'm too afraid he will go into wd from all the med changes and since he was on 10 mg for 2 weeks and it's been 4 days on 9 mg. I want him to stabilize before I try and taper again in 3 months. Do you think I did the right thing by giving him 10 mg instead of 9 last night?

[SHinojosa]

When they increased to 7.5 it was,because he was,becoming violent and aggressive. Then he just became more violent and aggressive being on 7.5 for 2 weeks until I had to call the police to come get him because he is not a small person. He is 6 foot tall and,weighs 170 lbs. He is very strong and when he gets like,that he's even stronger. After being on 7.5 for 2 weeks he finally had a huge melt down and destroyed my house and a lot of my furniture and TV. He busted doors and walls.  He got a kitchen knife and put it to his throat and then threatened me. So me and my daughter ran outside and I called 911. He calmed down when the police came and they took him to the ER in an ambulance. We stayed at the ER for 18 hours until they found a bed for him at a psychiatric hospital. He,was there for 8 days. While he was there he was remorseful and it scared him. While in the hospital they upped his,dose to 10 mg. Put him on adderall and took him off guanfacine. The guanfacine was a high blood pressure medicine but now I'm thinking there have been too many changes and I want to go back to 10 mg from 9 mg since he,was only on 9 for 3 days. I'm so afraid the aggression will happen. If it does its no small occurrence and he will need to be institutionalized since he is so big. Much bigger and stronger than me. 

[SHinojosa]

He had drank a monster drink which is high in caffeine so he was acting restless and had lots of energy. I didn't know he had had one because his friend bought him one. So I got scared and gave him 1 more mg of abilify after giving him the 9 mg about an hour earlier. This happening just made me realize that I want him stable totally before we taper. He's really a sweet boy. I'm so afraid of messing him up again. 

[mammaP]

I am so sorry, it must have been really frightening for you and also terrifying for him too.  It is very very important that he is on the same dose, same time every day to stabilise. The blood pressure drug may not have been a psychiatric drug but because he was taking it for so many years would still have needed tapering. I wish doctors realised this. It might not have caused outburst but his body was functioning with it and when it was taken away he would have felt something as his body had to adjust. It must have affected his brain in some way because it calmed down the ADHD.   Don't worry though he doesn't need to reinstate it. He was taking adderall for 2 weeks before that was stopped so there would be some effect from that change too but try to get him to keep calm if he gets any symptoms while his body is adjusting.  He sounds like an intelligent and thoughtful young man, can you show him this topic so that he is aware and can try some of the suggestions?    I found it very helpful when I was stabilising.  

 

 

[SHinojosa]

Do you think I am doing the right thing to go back to 10 mg for 3 months instead of staying on the 9mg? 

[mammaP]

His body had reached a steady level after 2 weeks at 10mg and he was doing ok but sedated.  He took 9 for 3 days, and would take another 10 days to reach a steady level of 9mg.  If it was the decrease to 9 that had caused the latest symptoms it would indicate that he was not good at that dose.  You know your son best, and all we can do is advise based on what you have told us.  If you think 9 would be best it is your decision but whatever dose you choose now he needs to stick with it, same time, same dose every day. It will be good if you can keep a diary or journal every day and log how he is and when he takes his dose.  I use an appointments diary for this. it has a page for every day and times for appointments. I fill in symptoms through the day when I am struggling and it helps to work out if I am ready for a drop in dose or if I need to hold for longer.  I know this must be terribly hard for you, but he really needs stable dosing for now.  In 8 weeks he has had so many changes, drugs stopped and started, doses up and down, it will take time to stabilise and regular dosing is so very important. It is absolutely not your fault, you did what the doctor advised and then they changed the doses of everything.   I think you were right to stop the adderall before he became dependent on that too, and now he just needs time to stabilise, then you can start the slow taper.  I really feel for you both and wish I could make it right for you. 

[SHinojosa]

Thank you. I really appreciate your help. I'm going to keep him at 10 until November then slow taper like yall said. 

 

Thanks again

 

Stephanie 

[mammaP]

Let us know how he is Stephanie. You will probably find that he has windows and waves, you can read about those here. It can be hard but stabisation will happen. You need to reassure him when he is in a wave that it will pass. Hopefully they will not be too bad, they are generally worse when someone has been off a drug for a while before reinstating.  

https://www.survivingantidepressants.org/topic/82-the-windows-and-waves-pattern-of-stabilization/

 

[SHinojosa]

Hello,

My son is having a hard time going to sleep. I used to give him small amounts of Melatonin to help him sleep. 1 mg to 2 mg. 

Do you think that will be alright? 

 

He is doing well but is naturally high energy. His high energy isn't concerning me because he has,always been that way even when on meds to slow him down like the intuniv. But the Melatonin helped him sleep at a decent hour. 

 

Also, does abilify come in an oral solution that I can ask his psychiatrist to prescribe once I begin to taper in 3 months? 

 

Thank you,

 

Stephanie 

Edited August 7, 2018 by mammaP
Removed surname

[mammaP]

Melatonin can help but we recommend very very low doses to start because people can react when the nervous system is unstable.  See the topic on melatonin. 

MELATONIN  

Abilify is available in oral solution that could be diluted to get low doses. 

Tips for tapering abilify

 

I am glad that he is doing well, he sounds like my grandson, he is never still unless he is sleeping! 

Edited August 7, 2018 by mammaP
added link

[SHinojosa]

Thank you! 

 

He's doing better and better. He is in football practice now. The intense exercise has helped him a lot. I've also been giving him magnesium and vitamin e and omega 3. 1 mg of Melatonin when needed. 

 

I am going to ask his psychiatrist to change his prescription from a tablet to the oral solution in preperation to begin tapering in November.  He's going to want to know why and I know the Dr will roll his eyes when I tell him but hopefully he'll switch to the oral solution for us. 

 

Thank you for all your help. I'll be in touch....especially when we start tapering. 

 

 

[SHinojosa]

Hi, I started tapering my son October 1 of 2018. He was at 10 mg of abilify. Now he is down to 7.5 mg. I dissolve his 10 mg tablets in 10 ml of water and use the slide method. So far so good. I just wanted to let you know that he is,doing well so far. 

My goal is to have him medicine free by may of 2022. 

 

Stephanie Hinojosa 

[Glosmom]

Glad to hear he is doing well!  Best wishes to you for continued successful tapering in 2019! glosmom

[SHinojosa]

Thank you for your kind words!  I have a question though.  As of now I am dissolving his 10mg tablet in 10ml of water and giving him oral doses according the suggestions in this forum for dissolving tablets.  I may want to buy a digital scale and begin weighing the tablets after a while because sometimes I worry that my son isn't getting a consistent dose with all the bits floating around in the water.  I try to make sure it's even and I'm very consistent.  As we taper more and more, I know that I will have to go to very small doses eventually.  He was on 5 mg since he was 5 or 6 and only recently they upped him to 10 mg.  I figure I will have to go super slow once we get below 5 mg.  

 

To get to my question though. ... how to I weigh a tablet?

 

Thanks

 

Stephanie

[ChessieCat]

Measuring by weighing tablets/powder can be very fiddly. 

 

Have you considered: 

 

For a drug that is "insoluble" in water, a pharmaceutical liquid to make suspensions might be the best option, see:  http://survivingantidepressants.org/index.php?/topic/3068-pharmaceutical-liquids-to-make-suspensions/

 

OR this would be the easiest - getting prescription liquid:

 

On 3/12/2012 at 10:34 AM, Altostrata said:

 

Use the Abilify or generic aripiprazole liquid suspension

 

Since dosage tends to be low in milligrams, the best way to taper would be to use the oral solution. Titrating using a liquid is very good for very small measured decreases in dosage, allowing more precise measurements.

 

Use a tiny 1mL syringe to measure dosage changes that are less than 1 milligram, to hundredths of a milligram.

 

From http://www.drugs.com/ppa/aripiprazole.html:"Oral solution may be substituted for tablets on a mg-per-mg basis up to a 25 mg dose. Patients receiving 30 mg tablets should receive 25 mg of the solution."

 

The best way to switch from tablet to liquid forms is to take part of your dose in tablet form and part in liquid, gradually converting to all-liquid.
 
From http://www.drugs.com/abilify.html :

 

Quote

The liquid form (oral solution) of Abilify may contain up to 15 grams of sugar per dose. Before taking Abilify oral solution, tell your doctor if you have diabetes.

 

 

 

Edited January 6, 2019 by ChessieCat

[SHinojosa]

I wanted to do that but his psychiatrist won't prescribe it and the insurance won't pay for it. His psychiatrist is not behind me on this at all. He says to just take him off by 50 % every 2 weeks. My son has never been able to tolerate that and most psychiatrists don't have a clue about how to come off of these things. So I have to dissolve it in water or weigh the pill. 

 

Thank you for your reply,

 

Stephanie