Abilify tolerance

[lenora]

Thanks for the information @pattismith. You've certainly tried different drugs (thanks for the report on them) and I'm wondering if you've tried Brexpiprazole or plan to in the future?

It's true that drugs can affect each of us in a different manner....but what do your overall instincts tell you? Would you go back on any of the others? It helps people like me. Yours, Lenora

 

[pattismith]

Interesting! What dosage did you have to start with?

Duloxetine 30 mg twice a day (I also tried a few days with 90 mg/day )
Methylphenidate 5 mg x 2 to 4 times per day

 

[hmnr asg]

Duloxetine 30 mg twice a day (I also try some days with 90 mg/day )
Methylphenidate 5 mg x 2 to 4 times per day

this is pretty much my regiment.
Duloxetine and Ritalin. I was taking abilify along also until it stopped working.
The problem with ritalin is that i only take one in the morning, and then when it wears off i take a long nap. I cant imagine taking it twice a day, it would be like putting jet fuel in a broken car and running it at max speed.

 

[mitoMAN]

this is pretty much my regiment.
Duloxetine and Ritalin. I was taking abilify along also until it stopped working.
The problem with ritalin is that i only take one in the morning, and then when it wears off i take a long nap. I cant imagine taking it twice a day, it would be like putting jet fuel in a broken car and running it at max speed.

Same for me with ritalin, I cna only take it once and then have energy for 1.5 hours and then need to rest.
I need 15mg tho. (Have ADD)

 

[pattismith]

this is pretty much my regiment.
Duloxetine and Ritalin. I was taking abilify along also until it stopped working.
The problem with ritalin is that i only take one in the morning, and then when it wears off i take a long nap. I cant imagine taking it twice a day, it would be like putting jet fuel in a broken car and running it at max speed.

I too need a nap between two ritalin doses. It gives me energy for 2 to 3 hours max;

I had to stop Duloxetine, because it improves my energy/muscle tone and strength/exercice tolerance but it takes away all my motivation.

Same for me with ritalin, I cna only take it once and then have energy for 1.5 hours and then need to rest.
I need 15mg tho. (Have ADD)

I too think I have ADD from my young age, but I'm not diagnosed formally. I also have chronic low iron stores.

 

[lenora]

Is there now a true "test" for ADD? Our 51 year old daughter has it (of course it didn't exist at the time) and school was a bit of a nightmare. I taught her again when she came home and we changed school. She must have pushed some buttons b/c I used to hear from crying teachers about once/wk. However, the payoff was great. She's now doing very well in her profession, has a good marriage and two children. She also sees a therapist and makes any accommodations that she needs...that's now her job, too.
Ritalin came out in the early days when it was suspected that she had it. Unfortunately in her case it led to suicidal thinking and was quickly stopped. As is a common theme with us, the doses were too high but since she was going into the teen years it was a concern we decided against.


I'm at least glad that ritalin is giving you even an hour of two of relief but, yes, I'm sure you pay for it overall. Good luck as you try different meds. You're pioneers. Yours, Lenora.

 

[pattismith]

Abilify is very likely an antagonist at adrenergic receptors, like all antipsychotics are if they have any affinity for those receptors. See Exhibit II here https://s1.q4cdn.com/460208960/files/News/2021/Zacks_SCR_Research_01132021_RVPH_Vandermosten.pdf

So if Abilify is stimulating you it’s likely the higher intrinsic activity at dopamine receptors or it’s varied functions at serotonin receptors, which amisulpride has very little of.

But even if Abilify stimulated you more than you wanted, did it work? If it stimulated me too much I would try only taking 0.1 mg.

What do the +++ symbols represent in that Exhibit II table, the receptor binding affinity? That will not tell you whether Abilify acts as an agonist or antagonist.

Generally the feeling of stimulation can come from adrenergic receptor agonism, from adenosine receptor antagonism, and I suspect the similar feeling of being "wired" may come from too much glutamate. So there is more than one mechanism which can cause overstimulation.

I got this overstimulation effect even from a single 0.1 mg dose of Abilify.

@leokitten is right

Aripiprazole is an alpha1 and alpha2 adrenergic antagonist, and an antihistamine H1.

Update on the Mechanism of Action of Aripiprazole: Translational Insights into Antipsychotic Strategies Beyond Dopamine Receptor Antagonism (nih.gov)


We can compare it with mirtazapine for exemple, which is a potent alpha2 adrenergic antagonist and a potent antihistamine H1

-alpha2 adrenergic antagonism has a noradrenergic stimulant effect
-Antihistamine H1 effect is sedative

So in the case of Mirtazapine, it has both a stimulant and a sedative effect.

Interestingly in Mirtazapine, the H1- sedative effect is sensitive to tachyphylaxis, which means it fade after one or several weeks.
the antiH1 Mirtazapine effect is also bigger at lower dose, so I wonder of the antiH1 effect of low dose Aripiprazole may be involved in both activity and tolerance to this drug.


Tachyphylaxis to the Sedative Action of Mirtazapine (nih.gov)

The selective Alpha2 adrenergic agonist Medetomidine is a sedative veterinary drug, and it's effect can be reversed with Atipamezole, a selective alpha2 adrenergic antagonist.

Interestingly atipamezole have positive effects on vigilance and sex drive that may be useful for some of us!

(I'm currently doing a trial with it, after I failed with Mirtazapine)

Pharmacological Properties, Central Nervous System Effects, and Potential Therapeutic Applications of Atipamezole, a Selective α2-Adrenoceptor Antagonist (nih.gov)

@Hip, how did you react to Mirtazapine?

 

[Hip]

@Hip, how did you react to Mirtazapine?

Mirtazapine is one drug which I have not tried.

 

[Martin aka paused||M.E.]

I had to stop Duloxetine, because it improves my energy/muscle tone and strength/exercice tolerance

I wonder how an SNRI can give you energy. Are you low in Serotonin?

 

[pattismith]

I wonder how an SNRI can give you energy. Are you low in Serotonin?

Hello Martin, this drug taught me that postural Muscle Tone depends on norepinephrine

Postural Muscle Tone depends on Norepinephrine | Phoenix Rising ME/CFS Forums

...

 

[Paraprosdokian]

Apologies for not reading through all 15 pages, but on a skim read I did not see any anecdotes of people successfully pausing Abilify dor a month or two and restarting. Is that correct?

 

[mitoMAN]

Apologies for not reading through all 15 pages, but on a skim read I did not see any anecdotes of people successfully pausing Abilify dor a month or two and restarting. Is that correct?

correct
even a year break didnt help

 

[nsdn]

What improvements did you get from the Abilify? Did you mention somewhere how you were before and after (functional scale or something similar)? Thanks

I have been taking Abilify 0,5 mg. since May 2021. I improved a lot in all aspects. I went from severe to moderate.


I no longer take Amisulpride because of weight gain, but now I could use some help with my mood.

What antidepressant that doesn't cause weight gain can I try? Fluoxetine?



SCALE

● Those with mild ME/CFS may be working full or part time, but struggle to do so. Of necessity they may have stopped or curtailed all leisure and social pursuits.

● Those with moderate ME/CFS are generally not able to work, probably don't leave the house much, have to perform domestic chores slowly with breaks and rests, and may need 1 or 2 hour's nap in the middle of day.

● Those with severe ME/CFS are more-or-less fully housebound, and likely bedbound (or lying horizontal on a sofa) for much of the day. They are unable to leave the house except on rare occasions, and usually dependent on a wheelchair for mobility, except for very short walks within the home or garden. They find domestic chores like cooking or any form of housework very difficult or impossible.

● Those with very severe ME/CFS will bedbound nearly 24 hours day, except for a few minutes each day to go to the bathroom. Dependent on help for all daily care. Often unable to tolerate any noise, and are generally extremely sensitive to light.

 

[leokitten]

I have been taking Abilify 0,5 mg. since May 2021. I improved a lot in all aspects. I went from severe to moderate.


I no longer take Amisulpride because of weight gain, but now I could use some help with my mood.

What antidepressant that doesn't cause weight gain can I try? Fluoxetine?



SCALE

● Those with mild ME/CFS may be working full or part time, but struggle to do so. Of necessity they may have stopped or curtailed all leisure and social pursuits.

● Those with moderate ME/CFS are generally not able to work, probably don't leave the house much, have to perform domestic chores slowly with breaks and rests, and may need 1 or 2 hour's nap in the middle of day.

● Those with severe ME/CFS are more-or-less fully housebound, and likely bedbound (or lying horizontal on a sofa) for much of the day. They are unable to leave the house except on rare occasions, and usually dependent on a wheelchair for mobility, except for very short walks within the home or garden. They find domestic chores like cooking or any form of housework very difficult or impossible.

● Those with very severe ME/CFS will bedbound nearly 24 hours day, except for a few minutes each day to go to the bathroom. Dependent on help for all daily care. Often unable to tolerate any noise, and are generally extremely sensitive to light.

Moclobemide - has very few if any side effects compared to SSRIs and SNRIs.

 

[leokitten]

Apologies for not reading through all 15 pages, but on a skim read I did not see any anecdotes of people successfully pausing Abilify dor a month or two and restarting. Is that correct?

Not here on this thread but on much older threads on PR and on other forums there have been reports of people being able to cycle with 4-5 month breaks

 

[Hipsman]

A Method to Reverse Abilify Tolerance​

Has anyone actually tried amisulpride to reverse tolerance? It's been almost a year since @Hip post!
@hmnr asg I think you wanted to try it

 

[leokitten]

I’m going to start low dose abilify again next week, it’s been 6 months or a bit more since I stopped. Hope it works again… really f—ing tired of constantly either being in a crash or recovering from a crash for this entire hiatus

 

[GlassCannonLife]

I’m going to start low dose abilify again next week, it’s been 6 months or a bit more since I stopped. Hope it works again… really f—ing tired of constantly either being in a crash or recovering from a crash for this entire hiatus

That's exciting! Hope it works for you!

Sorry not sure if I asked this already (I may have..) but I remember you set out on the journey being very careful etc, planning to extend its useful window by not doing too much too soon etc. Do you believe that you achieved that? Or that you felt too good so kept doing more and more?

In essence, do you believe your activity when on Abilify (taking "full advantage" of any benefit or being more careful) has any impact on when you reach tolerance?

Thanks a lot

 

[leokitten]

That's exciting! Hope it works for you!

Sorry not sure if I asked this already (I may have..) but I remember you set out on the journey being very careful etc, planning to extend its useful window by not doing too much too soon etc. Do you believe that you achieved that? Or that you felt too good so kept doing more and more?

In essence, do you believe your activity when on Abilify (taking "full advantage" of any benefit or being more careful) has any impact on when you reach tolerance?

Thanks a lot

I started taking 0.25 mg/day which didn’t have any effect until a couple weeks in I raised it to 0.50 mg and then very soon after that most of my ME symptoms disappeared. For me I was in the group of people where I didn’t suddenly reach tolerance, instead it slowly reduced in its effect on ME symptoms over a period of months until 6 months or so in it wasn't working nearly as well as in the beginning and I eventually stopped. I didn’t have any withdrawal symptoms and only over the next couple months my ME symptoms came back to to pre-Abilify.

Will try the same approach this time. I also started moclobemide three months before trying low dose Abilify so I don’t know if it played a role in my experience, but it had zero effect on my ME symptoms during those three months I was taking it by itself and didn’t prevent reverting back after. I still take it every day.

 

[borko2100]

As far as I understand it Abilify helps promote dopamine release. I wondered if promoting dopamine release trough other natural means would have the same beneficial effects.

I know that playing video games releases dopamine. I usually cannot play games due to symptoms and lack of energy and focus. However, one day I forced myself to get into a certain game and surprisingly after a few hours of playing I noticed increased energy and reduction of symptoms. The biggest sign that the game helped was that I didn't get the typical afternoon crash I get almost every single day.

So maybe dopamine does something that fixes us, until we run out of it? Maybe people get tolerance from Abilify because the dopamine release blunts over time from it? Similar to how novel activities (new foods, video games, etc.) start getting less novel over time (due to less dopamine being released).

Then again there's the caveat that maybe those benefits people get from dopamine release is maybe just masking of symptoms and not a temporary cure.