Properties Of Abilify In Treatment

Properties of Abilify Running head: ABILIFY

Properties of Abilify in Treatment Carolyn Frances Argosy University, SFBA

PC6250 Arinn Testa August 2009

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Properties of Abilify Properties of Abilify in Treatment Mental suffering has plagued the human race since ancient times. Over the centuries many methods have been used to aid those who were afflicted.

Today more than 22% of Americans

suffer from some form of mental disorder (Orange County Psychiatric Society).

In modern times, medications have been

developed and discovered with varying levels of success to help those in need.

As time progresses, these drugs have become more

targeted in their action.

This paper will focus on an atypical

antipsychotic, Abilify, which was discovered within the last decade, its properties, and alternatives. Antipsychotics were first used in 1952 as a sedative and were discovered to have antipsychotic properties when used in this manner for psychiatric patients (Preston, O’Neal, & Talaga, 2008).

Because they blocked dopamine receptors globally,

initially their side-effects were neurological with a great many extrapyramidal symptoms such as restlessness, muscle spasms, and slowed movements (Preston et al., 2008).

Atypical

antipsychotics received the label atypical because they significantly reduced the extrapyramidal side-effects (Farah, 2005) by targeting specific dopamine receptors (Preston et al., 2008). Abilify (aripiprazole) is one of the newer atypical antipsychotics.

It was discovered by Otsuka Pharmaceutical Co,

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Properties of Abilify Ltd. (Hitti, 2007; Medical News Today, 2007).

The FDA

originally approved the medication for treatment of adults with schizophrenia in 2002 (National Alliance on Mental Health, 2004).

In 2004, it was approved for use with Bipolar I with

psychotic features and in 2005 without psychotic features, both approvals being for treating adults (Medical News Today, 2008). In 2007, it became the “first medication approved by the FDA as an add-on treatment for MDD” in adults (Medical News Today, 2007) as well as being accepted for review of use with patients aged 13-17 with schizophrenia (Medical News Today, 2007).

More

recently, Abilify was approved for patients aged 10-17 with a Bipolar I diagnosis in 2008 (Medical News Today, 2008). Like other antipsychotics, Abilify blocks dopamine, although it is a partial agonist, which puts it in the atypical group.

Unlike other antipsychotics, it also acts to block some

serotonin receptors and is an antagonist for others (Pae, Serretti, Patkar, & Masand, 2008).

As a result, there is a

change in “serotonin and dopamine neurotransmitter systems in the prefrontal cortex” (Pae et al., 2008, p. 371). Specifically, Abilify is a partial agonist at the following sites: 5-HT2A, 5HT2C, and D2.

As a partial agonist at these sites, it decreases

serotonergic neuron firing, decreases the number of binding sites for 5-HT2, and increases the release of dopamine (Pae et al., 2008).

Dopamine increase is also accomplished by the

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Properties of Abilify antagonistic action of Abilify at the 5-HT2A, 5-HT2B, and 5-HT6 serotonin receptor sites (Pae et al., 2008).

It also decreases

binding sites for 5-HT2. Abilify has a bioavailablity of 87%, with peak plasma concentrations being reached within three to five hours and stable concentrations being obtained within 14 days (Mosby’s Drug Consult, n.d.).

This medication is metabolized by the

CYP3A4 and CYP2D6 enzymes through dehydrogenation, hydroxylation, and N-delkylation (Mosby’s Drug Consult, n.d.). Because these enzymes can be inhibited by other prescription drugs, such as fluoxetine, dosages may need to be adjusted (Pae et al., 2008).

When these enzymes are inhibited, blood

concentrations of Abilify increase (Mosby’s Drug Consult, n.d.; Pae et al., 2008).

The blood concentration of Abilify can also

be affected by whether the patient is a poor metabolizer or extensive metabolizer (Mosby’s Drug Consult, n.d.).

Poor

metabolizers will obtain a higher concentration of the medication than extensive metabolizers (Mosby’s Drug Consult, n.d.). Because Abilify effects the neurotransmitter Dopamine, which “strongly influences both motor and thinking areas of the brain” (Carver, 2002), side effects are primarily extrapyramidal in nature.

Although akathisia and tardive dyskinesia may occur,

Abilify may be a preferred choice because it is generally well

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Properties of Abilify tolerated, safe, and is associated with a higher level of patient compliance than earlier medications (Pae et al. 2008). Another possible, but infrequent, serious side effect is Neuroleptic Malignant Syndrom (Mosby’s Drug Consult, n.d.). Abilify is not recommended for those patients, such as the elderly, who are susceptible to seizures or aspiration pneumonia (Mosby’s Drug Consult, n.d.).

Caution should be used when there

is a cardiovascular disease, cerebrocascular disease, or hypotention (Mosby’s Drug Consult, n.d.).

It is unknown how

this medication affects the human fetus during pregnancy, although Abilify is excreted in breast milk (Mosby’s Drug Consult, n.d.) therefore caution should be used if a patient is pregnant or considering becoming pregnant. Although Abilify has been approved for BiPolar disorder, Major Depressive Disorder, and Schizophrenia, there are alternative and adjunctive therapies available for these conditions.

Various forms of movement have been used for these

conditions.

“There is a relationship between motion and emotion

that supports integration and growth” (Leahy, 2004, p. 115).

A

patient can engage in dance, yoga, or exercise to involve the body in movement.

Physical exercise has been shown to have an

inverse relationship to depressive symptom scores and any level of physical activity will alleviate depressive symptoms (het Rot, Collins, & Fitterling, 2009).

In addition, exercise does

Properties of Abilify have an impact on both serotonin and dopamine levels in the body naturally (het Rot et al., 2009).

Movement itself can assist

clients with schizophrenia in developing “a sense of internal stability and external separateness” (Leahy, 2004, p. 116). One specific form of exercise is dance.

In one study on

dance movement therapy (DMT), depressive symptoms decreased significantly in comparison to the control group. “The literature suggests that DMT produces both subjective and objective improvements including redefining and strengthening body image; clarifying ego boundaries; providing an outlet for relief of physical tension, anxiety, and aggression; reducing cognitive and kinesthetic disorientation; increasing the capacity for communication, pleasure, fun, and spontaneity; and support for therapeutic medical goals.” (Jeong, Hong, Lee, & Park, 2005, p. 1713) In this study, there were also “significant changes in the levels of serotonin and dopamine” (Jeong et al., 2005, p. 1717), the two neurotransmitters effected by Abilify. Movement, in the form of Yoga, has also been studied for Schizophrenia.

In Duraiswamy, Thirthalli, Nagendar, &

Gangadhar’s 2007 study, after four months, yoga participants had “significantly less psychopathology” and “greater social and occupational functioning and quality of life” (p. 226).

There

were no serious adverse events for participants in either the

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Properties of Abilify yoga or physical exercise groups during this study.

However,

the changes in symptoms were significant in comparison to just physical exercise, in particular a reduction in negative symptoms.

Yoga tames the anxiety response and “decreases

physiological arousal” ("Yoga for anxiety and depression," 2009, p. 4).

In another study, for “patients with bipolar disorder,

major depression, and schizophrenia … average levels of tension, anxiety, depression, anger, hostility, and fatigue dropped significantly” ("Yoga for anxiety and depression," 2009, p. 4). Research suggests that “mental and physical health are not just closely allied, but are essentially equivalent” ("Yoga for anxiety and depression," 2009, p. 5).

As a client begins to

change their lifestyle to improve their overall health, it is conceivable that the need for medication may decrease. Abilify seems to be a promising medication with multiple applications.

When “there is evidence to suggest that [a]

person’s problems are due to some form of biologic disturbance” (Preston et al., 2008, p. 15) it may be a good choice to target the symptoms expressed.

It should be remembered, however, that

other non-chemical methods exist which could possibly alleviate symptoms in less serious cases without medication or if used in conjunction with medication could speed recovery.

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Properties of Abilify References Carver, J. (2002, January 1). The “chemical imbalance” in mental health problems. Retrieved 1 July 2009, from http://www.drjoecarver.com/clients/49355/File/Chemical%20Im balance.html. Duraiswamy, G., Thirthalli, J., Nagendar, H. R., & Gangadhar, B. N. (2007). Yoga therapy as an add-on treatment in the management of patients with schizophrenia – a randomized controlled trial. Acta Psychiatrica Scandinavica, 116(3), 226-232. Farah, A. (2005, July 1). Atypicality of atypical antipsychotics. Prim Care Companion J Clin Psychiatry, 7, 268-274. het Rot, M. a., Collins, K. A., & Fitterling, H. L. (2009, April 1). Physical exercise and depression. Mount Sinai Journal of Medicine, 76(2), 204-214. Hitti, M. (2007, November 20). FDA oks abilify for depression. Retrieved 11 June 2009, from WebMD: http://www.webmd.com/depression/news/20071120/fda-oksabilify-for-depression. Jeong, Y. J., Hong, S. C., Lee, M. S., & Park, M. C. (2005, December 1). Dance movement therapy improves emotional responses and modulates neurohormones in adolescents with mild depression. International Journal of Neuroscience,

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Properties of Abilify 115(12), 1711-1720. Leahy, D. (2004). How and why movement works: A movement workshop for adults with schizophrenic disorders. Social Work with Groups, 27(2/3), 113-127. Medical News Today. (2007, June 9). Abilify sNDA for pediatric patients with schizophrenia accepted for priority FDA review. Retrieved 03 July 2009, from http://www.medicalnewstoday.com/articles/73330.php. Medical News Today. (2007, November 21). U.S. food and drug administration approves ABILIFY(R) (aripiprazole) as the first medication for add-on treatment of major depressive disorder (MDD). Retrieved 08 July 2009, from http://www.medicalnewstoday.com/printerfriendlynews.php?new sid=89414. Medical News Today. (2008, March 3). ABILIFY approved for acute treatment of bipolar I disorder in patients 10 to 17 years old. Retrieved 03 July 2009, from http://www.medicalnewstoday.com/articles/99195.php. Mosby’s Drug Consult. (n.d.). EHS: Mosby's drug consult - drug updates - aripiprazole 003577. Retrieved 11 June 2009, from Mosby: http://www.mosbysdrugconsult.com/DrugConsult/003577.html. National Alliance on Mental Illness. (2004, August 1). Abilify (aripiprazole). Retrieved 3 July 2009, from

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Properties of Abilify 10 http://www.nami.org/Template.cfm?Section=About_Medications& template=/ContentManagement/ContentDisplay.cfm&ContentID=81 33. Orange County Psychiatric Society. Let's talk facts about mental illness. Retrieved 3 August 2009, from http://www.ocps.org/ocps_resources_letstalk_mentalillness.h tm. Pae, C.U., Serretti, A., Patkar, A. A., & Masand, P. S. (2008). Aripiprazole in the treatment of depressive and anxiety disorders: A review of current evidence. CNS Drugs, 22(5), 367-388. Preston, J. D., O'Neal, J. H., & Talaga, M. C. (2008). Handbook of clinical psychopharmacology for therapists. Oakland, CA: New Harbinger Publications, Inc. Yoga for anxiety and depression. (2009, April 1). Harvard Mental Health Letter, 25(10), 4-5.