Hiding Akathisia in Abilify
What if your new drug has an unwanted side effect that’s going to impact sales if it becomes widely known? Well, in the case of Abilify (aripiprazole) apparently, you make that side effect’s data difficult to find (or just fail to report it when it’s ugly).
CL Psych has the scoop:
The authors go through a long list of second-generation antipsychotic medications. The drug that receives the least attention is aripiprazole (Abilify).
The authors conclude that “in studies comparing aripiprazole with placebo, akathisia rates in the aripiprazole arm were similar in some studies, and higher in others. As with other SGAs, akathisia rates with aripiprazole were lower than those of FGAs.”
So Abilify causes less akathisia than older medications and it’s unclear if it causes more akathisia than placebo. But, wait, wasn’t akathisia related to much higher rates of akathisia than placebo in treating depression?
Fortunately, the authors had a little trick to erase that inconvenient piece of evidence; they only examined trials trials involving people diagnosed with schizophrenia or bipolar disorder. So the depression studies — POOF — vanished, along with their damning data.
Akathisia, if you’re wondering, is really just an odd sensation of restlessness, shakiness, and fidgeting. Almost like your whole body is anxious, but in a way that’s hard to put your finger on. Psychiatric medications seem, as a class, to have more odd symptoms like this than their non-psychiatric brethren, but akathisia — while not life-threatening — is usually bad enough to want to stop taking the medication.
Dr. Carlat follows up with a real-life example of his switching a patient to Abilify, and her reaction to the switch. It’s an interesting read, and one that he’ll provide updates to his readers as she continues on with it. I couldn’t have said it any better than Dr. Carlat, so I’ll give him the last word:
But it is crucially important for BMS, Otsuka [the makers of Abilify], and their various minions to be accurate about the dangers of the drug, so that doctors can use it appropriately and prevent the kinds of side effects my patient suffered. Publishing an article that was carefully crafted to draw attention away from Abilify’s main liability was shameful, and is exactly the kind of deceptive editorial practice that we as a society can no longer tolerate.
Read Clinical Psychology and Psychiatry’s entry: Phase V, Abilify, and Vanishing Akathisia
Read The Carlat Psychiatry Blog’s entry: Abilify, the Journal of Clinical Psychiatry, and “Akathisia-gate”
Grohol, J. (2009). Hiding Akathisia in Abilify. Psych Central. Retrieved on July 2, 2015, from http://psychcentral.com/blog/archives/2009/05/11/hiding-akathisia-in-abilify/