Aripiprazole (Abilify) Withdrawal Symptoms and Management

Can aripiprazole (Abilify) cause withdrawal symptoms?

Cessation of aripiprazole (Abilify) can cause withdrawal symptoms, particularly if the medication is stopped abruptly.

Aripiprazole (Abilify) is an antipsychotic medication, most commonly used to treat schizophrenia, and also sometimes used in the treatment of bipolar disorder mania, major depressive disorder, autism spectrum disorder (ASD), and Tourette’s syndrome. ^[1]

Sometimes, people requiring aripiprazole to manage mental health symptoms will need to remain on medication long-term. For example, schizophrenia is a chronic condition that typically requires long-term maintenance treatment. However, aripiprazole can also be used short-term to manage acute symptoms, such as in ASD or bipolar disorder. ^[1]

Aripiprazole treatment will sometimes need to be stopped when treatment is no longer required. It might also be stopped if there are unmanageable side effects or contraindications, or when switching medications. When aripiprazole treatment is stopped, withdrawal symptoms can emerge. This is more likely if treatment has been ongoing for several months or years and if it is stopped suddenly. ^[2][3]

Because aripiprazole is used in the treatment of severe mental health conditions, it can be difficult to differentiate between withdrawal symptoms and a re-emergence of mental health symptoms during medication cessation. Research into the withdrawal symptoms of antipsychotic medications has expanded in recent years, although scientific literature about aripiprazole withdrawal symptoms specifically is still limited. ^[2]

Common Abilify withdrawal symptoms

Aripiprazole withdrawal symptoms can include psychological, physical, and movement-related symptoms.

Distinguishing withdrawal, relapse, and rebound

It can be difficult to differentiate between withdrawal, relapse, and rebound symptoms when discontinuing a medication. These terms refer to: ^[6]

• Withdrawal: New symptoms that occur quickly after discontinuation or a dose decrease.
• Relapse: Symptoms of the original condition that return after the medication is stopped.
• Rebound: Symptoms of the original condition that return after discontinuation but are more severe than they were prior to treatment.

Withdrawal symptoms can be similar to rebound symptoms in that they tend to last a short time and alleviate on their own. However, the difference is that withdrawal symptoms often involve a new set of symptoms, while rebound symptoms are similar to those that occurred before treatment, albeit in greater severity. ^[6][7]

Relapse can be differentiated from withdrawal by the time of onset. Withdrawal occurs within the first couple of days of cessation and abates within a matter of weeks. Relapse, however, may involve a gradual return of symptoms, distributed over time. ^[6]

People may be at risk of relapse after aripiprazole discontinuation for 1-3 years, and the onset of severe withdrawal symptoms might increase their vulnerability. ^[7]

Timeline: How long do Abilify withdrawal symptoms last?

When Abilify is stopped, withdrawal symptoms are likely to emerge within 2-3 days. They can be at their most severe within the first two weeks, after which, they typically will reduce gradually on their own. ^[2][3]

In some cases, withdrawal symptoms can be more severe and may last longer, which might require professional intervention to manage. Research suggests that antipsychotic withdrawals can be long-lasting, sometimes lasting months or even years after the medication is stopped. The timeline and severity of withdrawals vary depending on a number of factors, including the dose and length of time the medication was used. ^[3]

Risks of stopping Abilify suddenly

Stopping aripiprazole abruptly can significantly increase the risk and severity of withdrawal symptoms. It can also be dangerous, as mental health symptoms can re-emerge if they are not being managed effectively. It is recommended to reduce the dose of Abilify gradually and to utilize professional guidance throughout the cessation process. ^[4]

Tapering schedules and medical management

When coming off aripiprazole, it is advised to make gradual dose reductions under the close supervision of a doctor or prescribing professional. A tapering schedule might depend on the individual, the duration and amount of their treatment, and their response to dose reductions. 

Generally, it is recommended to commence aripiprazole tapering slowly, to give time for the body to make the necessary neurological and biological adaptations and to recognize and manage any severe withdrawal symptoms that occur. Slow dose reductions can help prevent the onset of withdrawal symptoms and reduce the risk of rebound symptoms. ^[7][8]

An example of an aripiprazole tapering schedule might involve making a 10% dose reduction every 2-4 weeks. ^[7]

If withdrawal symptoms occur, they can be managed with professional support, such as medications like benzodiazepines and anticholinergics. They might also be manageable with lifestyle changes and improvements in diet and exercise. If withdrawal symptoms are severe or problematic, the dose can be increased slightly, followed by a slower and more gradual taper. ^[7][8]

Tapering can be paused or slowed as required. It can be beneficial to prolong this process to last for several months, particularly among those who have used high doses for many years, to help prevent withdrawal symptoms. 

When to seek medical help

Always seek professional advice before changing the dosage of aripiprazole. Never skip or reduce doses unless instructed by a medical professional. With professional guidance, aripiprazole can be reduced, and the individual will receive regular reviews and symptom monitoring to ensure their safety.

During this process, if concerning or severe withdrawal symptoms emerge, contact the prescribing physician immediately. It may be necessary to pause or reverse dose reductions, or additional medications and support might be required to help manage withdrawal symptoms.