wiresoma: What's going on here with Abilify withdrawal?

[wiresoma]

I was on a 2mg dose of Abilify for about five months when I decided to stop it. Since 2mg was low dose, I just stopped without a taper. Terrible stomach pain/anxiety. Went back on and tried a taper several months later. Tapered 2/1.5/1.0/0.5mg and felt 0.5mg was a small enough dose to complete the taper. Terrible stomach/pain anxiety came back. Stayed off the med for 35 days and symptoms did not subside so went back on med and currently at 2mg. Is this a hypersensitivity to Abilify or is something else going on here? Has anyone else had that severe stomach pain/anxiety? Do I need to further taper down from 0.5mg slowly? Thank you for listening.

[Altostrata]

Welcome, wiresoma. I moved your introductory topic here to our Introductions forum.

 

See http://www.drugs.com/ppa/aripiprazole.html

Major Depressive Disorder

Adults

 

PO Recommended starting dosage for patients already receiving an antidepressant is 2 to 5 mg/day. Gradually make dose adjustments of up to 5 mg/day at intervals of no less than 1 wk. Efficacy of adjunctive therapy was established within the range of 2 to 15 mg/day.

Relative to some drugs, 2mg might be a small dose, but for Abilify, it's a full dose. And your nervous system might be sensitive to it, drugs interact differently with different nervous systems.

 

Yes, Abilify has withdrawal symptoms. Clearly, the way you tapered before was too much for your nervous system. We recommend a very conservative 10% taper per month to give your nervous system an opportunity to adjust.

 

When you did the 2/1.5/1.0/0.5mg taper, how fast did you make the reductions?

[wiresoma]

I made the reductions every 45 days.

[Altostrata]

That's pretty good. Did you have any withdrawal symptoms before you got to .5mg?

[wiresoma]

Absolutely no withdrawal symptoms down to 0.5mg. And then the withdrawal symptoms hit with a vengeance and I was shocked, because I figured I'd done a good taper. Has anyone else had a sensitivity to such a small dose?

[Altostrata]

Sure, people are sensitive to low doses. But .5mg is 25% of your Abilify dosage. If you were taking 20mg Prozac, it would be 5mg.

 

Suggest this time around, you could try 2/1.5/1.0/0.5mg at one-month intervals, then taper at 10% reductions from .5mg. But if you get withdrawal symptoms in the first month, you'll have to go slower.

 

Abilify comes in a liquid, which will help tapering off that last .5mg. See Tips for tapering off Abilify (aripiprazole)

[wiresoma]

10% reductions from .5mg would take over two years if I did the math right. That seems like an extremely long time.

[Altostrata]

Since you're having trouble getting down from .5mg, try doing it in very small steps. Try 10% for 3-4 weeks first. If you have no withdrawal symptoms, you can do 10% decreases faster.

 

The point is to edge your nervous system very gradually off the drug. It's the only nervous system you have, is there any reason to subject it to withdrawal symptoms?

[wiresoma]

Thanks so much for your help. I will take your advice. But anyway, have you heard of anyone else having such a hard time with a .5 dose?

[Altostrata]

We don't have a lot of Abilify withdrawers (yet). But plenty of people have had trouble going off of very small doses of other psychiatric medications.

 

Abilify is not special in this regard.

[Rhiannon]

We don't have a lot of Abilify withdrawers (yet). But plenty of people have had trouble going off of very small doses of other psychiatric medications.

 

Abilify is not special in this regard.

 

This is one of the least known facts about psych drug withdrawal. And really common. Rather than being the easiest, the last little bit is usually the hardest to get off.

 

It doesn't have to take two years--the idea is to make smaller cuts and find your own body's pace and tolerance. 10% a month is just a guideline.

 

But even if it did, isn't two years tapering and the rest of your life off the drug better than the rest of your life on the drug because two years sounded like too much?

[wiresoma]

Thanks Rhi for acknowledging the smallest dose dilema. You've both been of great help in reassuring me.

[Rhiannon]

Thanks Rhi for acknowledging the smallest dose dilema. You've both been of great help in reassuring me.

 

:-)

 

I'm trying to get off the last 5 mg of Neurontin (down from 300 and, originally, 1200!). Most doctors would tell you I was crazy or hypochondriac or Goddess knows what else, having trouble with such a small dose. But it really doesn't want to let go of me, and I know it's Neurontin because the withdrawal from Neurontin causes very specific symptoms (hot flashes and dizziness).

 

Down to 4 mg today. It's not going to win!

[wiresoma]

Okay. I wrote earlier that I had a hard time going off a low dose of Abilify. I have been down to 0.5mg dose for a while now. I have some liquid Abilify on hand and this is the point at which I will start using it when I decide to decrease further. I'm telling you all this because I can use the support. I'm actually very scared of the dreadful withdrawal symptoms I experienced the last time. I will keep you posted of my progress. I am also on 40mg Celexa and have decided to leave that be for now. I've read somewhere about it being adviseable to withdraw the antidepressant first but I don't know if that pertains here.

[Altostrata]

wiresoma, get the tiny 1mL or .5mL oral syringe, you can decrease by .01mg or .02mg if you feel you need to go very carefully.

[wiresoma]

Thanks, already got the 1mL!

[wiresoma]

Well, I've tapered down to .3mg with the liquid Abilify and a 1mL syringe. I'm down to about two doses left and saw my ARNP today. It's a state run facility and when I got there I was seen by another ARNP. She determined that there was no medical reason for me continuing with Abilify, that I should just quit at the .3 level. She would not write a prescription for more and said she would have to talk with my therapist. Why I wasn't seen by my therapist I never asked, and she was there. Finally I was told directly by my therapist that there was no reason to continue a taper at such a low dose. She even said the literature supports her and said only with delusions and hallucinations would one want to taper at all. She told me I could have just stopped even at 10mg cold turkey. I said, "You've got a patient here trying to do the right thing and you're not going to help me?" That's all the time she allowed me and I left with no prescription.

 

So, what I figured I'd do is go back to the pills. The smallest pill is 2mg and I'd quarter that down to .5mg, then I'll half that to taper down to .25mg and half again to .125mg and finish there. I hope this is sufficient for my nervous system.

[Altostrata]

That's very disappointing, wiresoma. Did you tell them you had withdrawal symptoms before? So many doctors really don't have a clue about tapering.

 

How did you get from .5mg to .3mg? How did you feel after every decrease?

 

Do you have another doctor who can write a prescription for liquid Abilify? Any doctor can do it.

 

As near as I can tell, the ordinary Abilify tablet is insoluble in water. Crushing the tablet and weighing it would be the only way to taper by very small decrements, but it does come in 5mg and 2mg tablets.

[wiresoma]

I had liquid Abilify for the .5 to .3 taper that she prescribed. I felt real good after each decrement. I don't really have another doctor but I did see one about a year ago that I might call up and see if I can arrange something there. I have 2mg tablets. That means I'd have to quarter it to get to .5, then half that for .25, then half that for .125 and then taper complete. Can I do this visually and just cut the pills since it's basically halfing the whole way? I don't know. Oh, and yes, I told them I had withdrawal symptoms at .5.

[Altostrata]

Since you're tapering by tenths, I don't think you'll be able to visually shave those tablets to the dosage you need. You're going to find it difficult to cut anything smaller than a fourth.

 

Try to get a prescription for the liquid. It comes in a 150-mL bottle, NDC 59148-013-15 (that's the pharmacy ordering code). At .3mg or less a day, one bottle will last you until it expires, usually several months. You don't have any left of the last bottle??

[wiresoma]

Have about one days' dose left. 150mL? I spent $80 for 15mL. Besides I only need about 10mL to complete the taper.

[Altostrata]

I'm confused. Did you get brand-name Abilify solution? It comes in 1 mg/mL 150-mL bottle.

[wiresoma]

Yes, it was brand name Abilify. But the prescription was for just 15mL 1mg/1mL solution. So they gave me 15mL in a small generic bottle. They might have had the 150mL bottle on the shelf in the pharmacy, I really don't know.

[Altostrata]

Oh, they poured out 15mL for a dose of .5mg per day for 30 days.

 

Is there any way you can get a doctor to write a prescription for the liquid for you? Any doctor can write it. Or, you may have to phone the clinic and insist on it. You might need to speak to a supervisor.

 

See Tips for tapering off Abilify (aripiprazole) It looks like aripiprazole is insoluble in water, so I'm leery of suggesting you make your own liquid.

 

Otherwise, the best way to do it would be to crush the tablets and weigh the powder out for your dose.

[wiresoma]

Been trying to get another doctor but no one's got an appt. soon enough. Tried my family doctor but she's part of a clinic and they won't prescribe a new medication unless the patient is seen. Anyway, with the liquid, I was going to do .3, .2, .1 to complete the taper. But I might be able to complete the taper with the pills anyway. Take a 2mg pill and quarter it to .5. That's easy, been doing that. Then it's halving from there which might be possible visually. I just completed the .3 taper today so I'm ready to move on. Taking that .5 piece and cutting it in half would give me .25. In half again would be .125 to complete the taper. So I'd be doing a .3, .25, .125 taper with the pills versus .3, .2, .1 with the liquid. Not that big of a difference. Only thing is the pills won't be as precise as the liquid.

[Altostrata]

You might cut up the tablet to get through the weekend but do try to see your family doctor on Monday to get the liquid.

 

I'm worried that you might be sensitive to variations in dosage, since you had such a bad time before.

 

You may need to say you've run out of medication and you need a prescription.

[wiresoma]

Good advice, thank you!

[wiresoma]

All my avenues of getting the liquid Abilify failed. All I needed was 10mL which is 10mg to complete the taper. I had to finally see a private psychiatrist at $250 (no insurance)to get the prescription. But she was an exceptional therapist and I can say I don't regret spending the money because our conversation was great! So now I continue with the taper down from 0.25mg to 0.2mg, 0.1mg, and then 0.05mg unless others here have a better recommendation.

[Altostrata]

So you did finally get the liquid?

 

So now I continue with the taper down from 0.25mg to 0.2mg, 0.1mg, and then 0.05mg unless others here have a better recommendation.

If you have the liquid, I suggest you taper by .05mg at a time, or less, depending on symptoms. At 0.05mg, you may wish to taper by .01mg.

 

Don't rush it, you're almost done!

[wiresoma]

Yes, I did get the liquid and I think I will follow your decrement recommendation. Thanks, again.

[wiresoma]

Well, I made it off the Abilify! I had previously tried to go off by tapering down to 0.5mg but that wasn't far down enough. Here was my tapering schedule; .5, .4, .3, .2, .1, .05, .025. I stayed at each level for ten days. I have had none of that terrible stomach pain/anxiety I had when I dropped off at .5. So, I had a severe withdrawal experience when I tried to stop at a relatively low dose of .5. I don't know if I'm unique in this experience or if this is a much needed warning for others.

[Altostrata]

Good to hear, wiresoma. When was your last dose?

 

Many people find they can only go off psychiatric drugs by tiny amounts.

 

Please check in ever so often and let us know how you're doing, and add to our Success Stories here http://survivingantidepressants.org/index.php?/forum/28-recovery-success-stories/

[wiresoma]

My last dose was 12 days ago. From my own experience, symptoms would show up 9-10 days after quitting the meds so I waited until I was certain I'd made it through that. Thank you!

[wiresoma]

It's been a long time since I last posted but I wanted to finish this conversation for those in the future who decide to taper off Abilify. It was very difficult for me and what I learned is that I had to go real slow and use real small doses to finally get off of it. I used the liquid form and had to taper down to as low as .3mg and then .1mg. It was almost humorous the aomunt of liquid I was using near the end. But I was able to finally finish it!

[Altostrata]

Excellent news, wiresoma. Thank you for letting us know!

 

Did you get any symptoms after your last dose? How are you feeling now?

 

Please open a topic in Success Stories http://survivingantidepressants.org/index.php?/forum/28-recovery-success-stories/ with a summary of how you got off Abilify and a link back to your Intro topic (this topic).

[wiresoma]

I did not experience any major symptoms after my last dose.

It was only a couple months later in which I decided to taper off my Celexa as well. Went slow and steady with that as well but did not have to be as overly cautious as with the Abilify. It's been about two months now since I've been off the Celexa, so currently I am psychotropic free!

One thing that has persisted has been the restless leg syndrome which I think is still from the Abilify but I'm not sure of that. It crops up about twice a week and I find moving my legs back and forth for a few minutes helpful. It feels as if some energy gets trapped down there and a bit of shaking is necessary to dispel it.

Also, the weight gain, about 35lbs, has not diminished at all since stopping the meds. I assumed my body would naturally find it's natural rhythym and help me to drop some weight. I believe that that weight gain was due to primarily the Abilify. I had an insatiable appetite on Abilify which made me feel hungry only a couple of hours after eating a meal.