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Sansone, 2013 Aripiprazole withdrawal: a case report.


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Another researcher who referred to anecdotes on the Internet in researching aripiprazole withdrawal syndrome.

 

Innov Clin Neurosci. 2013 May;10(5-6):10-2.
Aripiprazole withdrawal: a case report.
Sansone RA1, Sawyer RJ.

Free full text at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719459/

 

Atypical antipsychotics, including aripiprazole, are effective medications for the treatment of psychotic disorders as well as the augmentation of antidepressants in the treatment of major depression.1 In support of mood augmentation, aripiprazole has this indication through the United States Food and Drug Administration (FDA). Despite the broad use of atypical antipsychotics for various clinical syndromes, discontinuation syndromes related to these second-generation drugs are not well characterized.2

 

It appears that discontinuation symptoms from atypical antipsychotics may be grouped into three general categories: 1) withdrawal supersensitivity psychosis (i.e., abrupt psychotic relapses associated with the acute decrease or cessation of an atypical antipsychotic3), 2) abnormal movement disorders, and 3) various mixed symptoms. Withdrawal supersensitivity psychosis has been reported with ziprasidone,4 olanzapine,5 and clozapine.6 Likewise, various abnormal movement disorders have been associated with the abrupt withdrawal of aripiprazole (e.g., abnormal jaw, tongue, and hand movements7), ziprasidone (e.g., akathisia8), risperidone (e.g., tics,9 akathisia,10 dyskinesias,11 rabbit syndrome12), quetiapine (e.g., hyperkinesis,13 dyskinesias,14 chorea15), and clozapine (e.g., oculogyric crisis,16 catatonia,17 dystonias, and dyskinesias18).

As for the third group of discontinuation symptoms, according to infrequent reports, various mixed symptoms may emerge following the cessation of atypical antipsychotics.

....

However, we were not able to locate a single case report in the PubMed database regarding aripiprazole withdrawal and various mixed symptoms. In addition, the Gold Pharmacology reference source did not identify a discontinuation syndrome associated with aripiprazole.22 However, the package insert for aripiprazole indicated the presence of withdrawal symptoms in monkeys after abrupt cessation of the drug.23 In addition, the internet revealed a number of individuals who reported withdrawal symptoms from aripiprazole, such as nausea, lightheadedness, tachycardia, diaphoresis, and anxiety,24 as well as insomnia.25 Likewise, consumers reported headaches, tremulousness, and flu-like symptoms.26 In the following case report, we describe a 61-year-old man who abruptly discontinued aripiprazole and experienced a number of unpleasant symptoms highly suggestive of withdrawal.
....

In January of 2013, the patient abruptly discontinued aripiprazole 5mg per day as the prescription had expired and he was on vacation. Within two days of cessation, the patient began to experience sudden-onset lightheadedness, intermittent nausea, severe insomnia (i.e., difficulty falling and staying asleep), irritability, generalized muscular twitches, intense anxiety, worry, rumination, and dysphoria. The symptoms waxed and waned over the initial days, but gradually began to dissipate after two weeks. Before and during this time, all concomitant medications remained unchanged in prescription and dose.

 

Discussion. This patient’s experience mimics the reports by consumers, which are described on the internet. However, it is important to note that some of these symptoms may be attributable to depression relapse, such as dysphoria, rumination, insomnia, and irritability, whereas other symptoms are more suggestive of withdrawal (e.g., nausea, lightheadedness, muscle twitching).

 

Ariprazole and its active metabolite, dehydro-aripiprazole, have half-lives of 75 and 94 hours, respectively, and are seemingly unaffected by age or gender.22 Given these lengthy half-lives, it would seem less likely that aripiprazole would cause withdrawal symptoms. However, fluoxetine and its active metabolite, norfluoxetine, have half-lives of 96 hours and 384 hours, respectively (i.e., longer than aripiprazole), and may cause discontinuation symptoms in the week following abrupt cessation—a finding that was confirmed in a prospective study.27
....

Conclusion. We report a case of probable aripiprazole withdrawal characterized by various mixed symptoms, which to our knowledge has not been previously reported in the empirical literature. In this case, these various symptoms gradually receded over time. Therefore, it appears that on rare occasion, aripiprazole can cause a discontinuation syndrome characterized by various mixed symptoms that are likely to dissolve over time—a reminder to clinicians to always taper psychotropic medications when administered long-term. This rare risk is of clinical importance due to the current broad role of aripiprazole in the augmentation of mood disorders.

 

Also see, by the same author, Sansone 2010 SSRI-Induced Indifference

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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For some people the internet is the only place they feel heard when the tell the truth about drugs.  

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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This sounds like the horrible terrible terror time, but made clinical. If it is what we have or had, you can't get it across with out biblical words. Living hell, ungodly, etc. But it's a start. Wish they had omitted the relapse conjecture. Patient knew the difference.

Here's Britain's Dr. Wessely who heads the Royal College of Psychopaths:

"...how many patients don’t receive enough support to assist them staying on vital medication, without which relapse is all-too common and all-too ghastly."  That's the propaganda. I'll post the article in In the Media.

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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