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”
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10 Comments to
“Hiding Akathisia in Abilify”
You don’t think Bristol Myers is marketing this drug directly to PCPs/internists/Family Practitioners? Think again, and ask how many of MDs in this grouping knows about akathesia. If 50% know or are close in answering correctly, I’d be surprised!
You are absolutely right about the end of this post, in Dr Carlat’s words:
[this] kind of deceptive editorial practice that we as a society can no longer tolerate.
I’d go one step further and put my colleagues front and center: Prescribing without fully appreciating the real risks of drugs is nearing, if not crossing the line of carelessness, if not malfeasance if it is mostly driven by drug reps and perks!!! And, ignorance is not excuseable in this day and age of access to information when reliably and responsibly offered.
First Lilly with Zyprexa, now Astra Zeneca with Seroquel, and soon to be BM with Abilify. Does anyone learn from the mistakes of others?!
therapyfirst
I’m on Abilify now. I have the shakes a little and I’m more fidgety. All and all, though, it beats psychosis.
Thank goodness my doctor does give me freebee samples from the drug reps. I couldn’t buy them on my own without insurance.
What works for some may not work for every one I guess.
abilify has been hell for me. it has caused akathesia and it has been going on 3 weeks that i have suffered from this. it is the worst thing i have EVER gone through and i am furious with my doctor for not telling me about this side effect. i can only hope the longer i go without taking this drug the better i will get.
I have been consuming a low dose since it was released in the US. gave me a better reality base but must take other drugs to counteract anxiety (akathesia).
Are there some better alternitives out there?
I had akathisia with abilify and was able to get rid of it by reducing the dose to where it was just enough to prevent paranoia. I never had to go off the abilify.
Try getting in touch with people who’ve got the dose right and who use psychological interventions alongside this medication before you right off this drug.
I can tolerate people who take a short-sighted view of Abilify because they’re ignorant and don’t know that it can take a prolonged period of fine-tuning to get things right. Things will get worse before they get better, but you’ve got to have the courage and the determination to get through the dark days and work hard at it.
Persist. It can be worth it in the long run.
Abilify has caused the worst side effects I have ever experienced, and I have been on drugs for 10 years now for depression and bipolar type 2. This akathisia, the term I just disovered yesterday, is a terrible, frightening, and uncontrollable feeling. I have panic attacks on a regular basis but nothing compares to this. I stopped taking it after a few weeks and I will never walk down this dark road again. In fact I’m foregoing new drugs for awhile. Lithium is the only drug that has had very little side effects for me and has been incredibly effective. Thank you for letting me know I am not alone.
Thank you all, I see my p-doc in a couple days and will discuss lowering the abilify to a tolerable level w/out paranoia. Also I cut my caffine consumption to a min., and that seems to help.
I have been on Abilify 5 mg for about 3 weeks and I think I could run a marathon! I am so restless and my neck muscles won’t relax, not to mention the blurred vision and insomnia…I am calling my doctor today to see if lowering the dose would help or if I just need to come off of it. I enjoyed the energy boost the first week, but from that point it and all the other side effects became a problem.
I experienced horrific episodes of akathasia while take antipsychotics including Abilify and Geodon. I am still shocked that the psychiatrists who prescribed these medications to me never told me that what I experienced is called akathisia. I discovered this on my own and had to ask my psychiatrist to put me on an antipsychotic that does not cause this side effect. My understanding is that all antipsychotics can trigger akathisia but that the incidence of the side effect is much lower among certain antipsychotics such as Seroquel. I have now taken Seroquel for about 1 1/2 year and have thankfully not experienced any akathisia. However, I have gained a lot of wait due in part I’m certain to waking in the middle of almost every night to eat (sugary foods in particular), something I NEVER did before taking Seroquel. Psychiatrists should warn patients and their families about the potential (and very harmful) side effects of these drugs and be more vigilant in detecting when these side effects occur. True story– I was hospitalized 2 years ago and experienced a terrible bout of akathisia several days after starting Geodon. The attending psychiatrist described the episode as a panic attack to my family and informed them that this was a good sign as it indicated my psychosis was going into remission.
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Last reviewed: By John M. Grohol, Psy.D. on 11 May 2009
