Someone near and dear to me was just prescribed Abilify. She 26, and has a lot of anxiety and is a little “bipolar” - but not necessarily clinically bipolar, just incredibly moody, with anger management issues. PMS is also a problem. She thinks she’s a little OCD, but I haven’t ever seen it. The prescriber is a new medical resident, and may not necessarily be all that familiar with possible meds and their side effects. We’re wondering if Abilify would be overkill, with too many risks.
That new medical resident had to get an attending physician to approve that Abilify prescription so it’s not that she’s getting inexpert advice. Also, medical residents are constantly being graded on their clinical work, which is pretty motivating to do good work. They study medications more in depth than many graduate docs do, they have to. They also have a huge Step lll exam coming.
She should keep notes. Dosages, side effect, how she is feeling, if the drug seems to help. You might keep an informal journal too, how she seems to you, benefits and drawbacks, for when it comes time to evaluate next steps.
I had a scary experience with it. One side of my face was paralyzed. It was short-lived but scared the crap out of me so I wasn’t on it for very long.
I should mention that I’ve always been really sensitive to medications. That “1 in 1000 patients experienced…” That’s me. Wellbutrin gave me grand mal seizures. It’s always something.
Due to its cost and side effect profile, Abilify is not a first-line medication; in other words, it is usually not prescribed unless other drugs have failed.
The only previous Rx was for sertaline, which wasn’t doing much at the initial low dose. After a checkup last week, they upped the dosage (which she hadn’t yet filled), but called her today saying they’d decided Abilify would be a better fit.
As a pharmacist, did you get any off-the-cuff feedback from patients?
It’s been almost 20 years since I worked at the grocery store, and after that, I did work at a hospital that had a psychiatric unit, and did see a lot of use of Abilify, although some of that was because it was introduced during that time.
Her psychiatrist would be the one who would make the ultimate decision about this.
There is no psychiatrist. As I tried to state in the OP, it was prescribed by a new medical resident who had just given her a checkup. This is a small neighborhood branch clinic of a teaching hospital, staffed almost entirely by newbies with a doc overseeing everybody. The first and last time I went, for a broken bone in my foot, the resident googled the answer to my question, admitting she hadn’t ever treated a broken foot yet.
The first time the current patient went and described her anxiety, the head doc told her that her only problem was she was smoking too much pot (after she told them that pot was the only thing that helped with her anxiety) and refused to prescribe anything. We were happily surprised when they believed her enough to prescribe sertaline last year.
We don’t have a lot of faith in their judgment of prescribing Abilify after only trying 1 SSRI at the lowest dose. It seems like a big jump from a drug with low potential for problems to a drug with more (albeit probably rare) potential for harmful side effects. But maybe they’re overblown, because you really only hear about the people who’ve had problems.
I personally don’t see how someone that is not specifically trained as a psychiatrist would feel comfortable at all diagnosing and prescribing medication for medical illness. I assumed from the start that this resident was a resident psychiatrist. I didn’t feel comfortable taking any of the Xanax prescribed to me by my family doctor after my panic attack, simply because I was already seeing a psychiatrist as well and would rather wait and see what they (I don’t remember what gender psychiatrist I saw at the time, sorry) said.
If you don’t have faith in them and you don’t think the newbies are doctors (medical residents are real doctors, graduates of medical school), why keep going there?
Go to a board certified psychiatrist, lay all the cards out on the table, then follow their recommendations. If there isn’t a psychiatrist available, find a board certified Family Practice physician, they have the next most training and experience in mental illness and psychiatric medications.
I don’t go there anymore after my one visit. The patient in question has gone back because the location is most convenient for her, and they can do checkups without problem. And she had unpleasant experiences in the distant past with psychiatrists and is distrustful. I think she’s coming around now.
After the first-line depression med doesn’t work, then a psychiatrist is the next stop, not another med. GPs do not have the necessary experience, and IMHO should not be prescribing antipsychotics.
I also think that only psychiatrists should decide if someone is clinically bipolar. The average age of onset for bipolar is 25 and your friend is 26. Finding a good psychiatrist that she trusts is important.
No idea why Discourse is not displaying this correctly, but here’s the link anyway:
I asked my GP for it and he prescribed the generic. I take it in combo with an antianxiety med and it works great. Unfortunately one of the side effects (for me) is chronic constipation which I cannot abide so I’m going to stop taking it for now.
Hey, if one needs it, he needs it, but just for the record:
The side effects:
" Common Abilify (aripiprazole) side effects include nausea , vomiting , headache, insomnia and weight gain. Serious Abilify side effects include tardive dyskinesia and neuroleptic malignant syndrome. Stopping Abilify may cause withdrawal. Abilify withdrawal symptoms include anxiety , panic attacks and sweating."