Q. A good friend got tardive dyskinesia (TD) from taking the combination of Prozac and Abilify. This led to abnormal facial expressions and uncontrollable tongue movements. This person was always tired and showed no emotion. Even after stopping the Abilify and reducing the dose of Prozac the symptoms persisted.
The makers of Abilify continue to advertise this drug on television. Why is there no outrage? I have read that older people are especially vulnerable to side effects and may never recover. Please investigate and report on Abilify!
A. Abilify (aripiprazole) is a powerful antipsychotic medication first approved for the treatment of schizophrenia a decade ago. Since then it has received the green light to treat bipolar disorder, major depression (in combination with antidepressants) and irritability associated with autism.
Initially it was believed that newer generation antipsychotic drugs like Abilify (called atypical antipsychotics) were unlikely to cause tardive dyskinesia (TD) compared to older drugs like chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol) or thioridazine (Mellaril). While this terrible (and potentially irreversible side effect) is seemingly less common with the newer drugs, it is not unheard of.

TARDIVE DYSKINESIA [TD]

We think of this neurological side effect of antipsychotic drugs as brain damage. That is, the medications can cause the following symptoms. Stopping the medicine does not always eliminate this devastating condition. It can become permanent. You are right that older people may be especially vulnerable to TD:
• Involuntary and repetitive movements of the tongue, lips and mouth
• Grimmacing
• Lip smacking, lip pursing
• Sticking out of the tongue repeatedly and uncontrollably
• Blinking of eyes over and over
• Uncontrollable movements of the neck, arms or legs
• Inability to sit still
We share your outrage that Abilify and other antipsychotic drugs are advertised on television. These are extremely powerful drugs with a very long list of serious adverse reactions.

SEROQUEL SIDE EFFECTS:

• Headache
• Weight gain, increased appetite
• Sleepiness, fatigue, drowsiness
, insomnia
• Impaired judgment or thinking
• Dry mouth
, cough
• Dizziness, unsteadiness
, walking difficulties, lightheadedness
• Rapid heart rate
• Constipation, digestive upset, heartburn, stomachache, nausea
• Tremor, shaky hands
• Difficulty swallowing
, excess salivation
• Uncontrollable muscle movements
, tardive dyskinesia, restlessness, agitation, anxiety
• Visual disturbances
, blurred vision
• Anemia, blood disturbances
• High cholesterol, elevated triglycerides
 (this is a drug class effect)
• Back pain
, muscle pain, muscle spasms
• Liver enzyme elevation
• Rash, serious skin reactions (requires immediate medical oversight!)
• Difficulty sleeping
• Fever (requires immediate medical attention!)
• Diabetes
• Worsened depression, suicidal thoughts
• Seizures, stroke
With a list of such serious side effects we find it incredible that this drug can be advertised on television. The idea that a patient should ask his doctor if Abilify “is right for you” is indeed outrageous to us. We also find the “free trial offer” equally disturbing.
And here’s one other concern. Abilify can interact with a number of other drugs. For example, fluoxetine (Prozac) and paroxetine (Paxil) may increase the blood levels of Abilify in the body and therefore increase the risk of side effects, especially something called serotonin syndrome. We wonder whether your friend, who was taking Prozac and Abilify simultaneously, got into trouble for this very reason. Such combinations may require careful dosing adjustments.
Before taking Abilify please check with your pharmacist to make sure you aren’t taking any other medicine that might be incompatible with this antipsychotic drug.
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  1. L.A.L.
    Reply

    I have TD. I became aware of it in 2013. I didn’t know I had it, but often times had people ask me why I made a face when they said something to me. I was treated for several years with both Paxil CR and Abilify to control depression and mood swings, supposedly brought on by menopause. I had heard and seen the ads on TV for Abilify and heard them give their disclaimer about the uncontrolled muscle movements.
    I did some research on the internet and discovered that the combination of Paxil and Abilify just made it worse. I asked my doctor to take me off the Abilify for several reasons, significant weight gain, pre-diabetes Dx, but mostly the movements, and facial contortions. I was weaned off the Abilify and stopped having the brief spells of disorientation when I moved, pretty immediately. I had no problems with the mood swings returning. My doctor had never had anyone with TD brought on by Abilify before and thought that the diskinesia I was displaying was just part of who I was.
    I also lacked emotions unless under very extreme circumstances. I couldn’t cry, I didn’t feel sadness when I should. I made an appointment with a neurologist that specialized in the motor problems, and had to wait several months to be seen. In the meantime, I asked my doctor to be taken off of the Paxil as well, that was a much slower process. Even so, when it was finally discontinued, I experienced the brain zaps and horrific migraines!
    I was unemployed at the time, but couldn’t interview because of the TD making my face weird all the time. I finally got to be seen by the neurologist, and was put on 0.25 mg klonopin at bedtime. That stopped the migraines stemming from the SSRI withdrawal. That seemed to help the TD some, but made getting up in the morning very difficul; I was sleeping about 12 hours a night. I am now down to 1/2 tab of the 0.125 mg dissolving tab of klonopin so I can get up in the morning.
    I am working now, and I still have the mouth movements, lip licking, tongue movements, but they are not so noticable now. I also can’t sit still, I feel this all day long and wonder what it would look like if I had a camera recording my movements all day. I sit in an area of the office that is pretty isolated and I don’t see a lot of people all day long, so I get by. I see my neurologist again in October. He told me that there is a window when TD sometimes abates, at 6 months and 18 months. We’ll see, October will be 18 months.
    I’m not happy about this, and feel that my doctor could have been better informed, but I don’t know how much they are to blame. The drug companies send their reps around and tell the docs how safe the meds are. We only find out after the fact. Oh, I haven’t suffered any relapse of depression since getting off the Paxil and Abilify. It’s been over a year since I stopped the Abilify, and getting close to a year from stopping the Paxil.
    I just wanted to say what it’s like first hand, I have TD and probably always will. Encourage those you know treating for psychiatric issues to do their research on the meds they take before they take them. Talk to their doctor, be your own advocate.

  2. nurse dell
    Reply

    Drug ads are not primarily to sell drugs. They exert strong influence on the various media to modify how or if, they cover stories that might offend the advertiser.
    Good example: I saw a two page story on phage therapy in the Seattle Times a few years back. Phages are harmless microbes which create competition for pathogens; they have been in use in Europe since World-War Two. Here, it’s being studied… apparently indefinitely. Currently in the US, MRSA (touted as incurable) is being treated with prolonged, intermittent use of very expensive but minimally effective IV antibiotics.
    I had a 9 year old client who had hospital-acquired MRSA and was failing, from years of cycling in and out of sepsis, as well as organ damage from the meds. This child’s parents overcame objections of the MD’s here, got a Rx under “compassionate care”, contacted a well-known clinic in Georgia (in Europe) and obtained and used the Phages at home, completely eliminating the MRSA, as well as another dangerous infection called Pseudomonas in her IV central line. The total cost was a few hundred dollars.
    But here’s the thing. Shortly after that newspaper article ran, Merck ran four, full-page color ads in one single Tuesday issue of the Seattle Times. Two of the “ads” did not promote any specific drug, “The people at Merck love you…etc”. That’s a lot of money for a struggling independent newspaper, but chump-change to Big Pharma, which has similar ongoing relationships with TV networks and popular magazines. But not with the Graedons. They really are Heroes.

  3. Judy P.
    Reply

    I was on a low dose of abilify for a year and a half. The drug was discontinued but I still developed a tardive dyskinesia of the mouth that has persisted for over a year. It is debilitating.
    My psychiatrist who prescribed it was so surprised that I developed this. He said he never had anyone else with it. How can he be so clueless? I can only guess that with time, he will find more people who develop serious side effects as well.
    The TV ad lists the side effects casually, as if they are minor, or will go away if the drug is stopped.
    Please warn others!
    PEOPLE’S PHARMACY RESPONSE:
    Tardive dyskinesia (TD) can be incredibly debilitating. It results from drug-induced damage to the brain and can cause uncontrollable muscle movements such as lip smacking, tongue protrusion and grimacing. Some people develop rapid eye blinking or other involuntary movements.
    Many of the antipsychotic medications can cause this and we are surprised that your psychiatrist was unaware of this potentially irreversible complication.

  4. Marilyn
    Reply

    One day, shortly after starting Abilify at it’s lowest dosage, I had an overwhelming urge to get on top of my desk at work and jump up and down. Fortunately I did not do so! My doctor felt it was due to the Abilify and stopped it right away.

  5. Chica39
    Reply

    I was put on Abilify – just .5mg yet had severe weight gain, and diabetes. I wasn’t on this drug for more than 3 months…. Very disappointed, didn’t have my depression resolved either.

  6. Bryan C.
    Reply

    I was diagnosed with bipolar disorder and was placed on a mood stabilizer and anti-depressant. The psychiatrist indicated that Abilify would be helpful to add to my regimen to assist towards reaching the desired therapeutic effect. I began to pace and was unable to sit still. I literally walked the halls for three days straight. I was desperate for relief and felt in order to keep myself safe I chose to be hospitalized during that time. The symptoms persisted days beyond the time the medication was taken away.
    I also had uncontrollable movements with my tongue and slurred speech. None of these side effects were discussed with me. May I strongly encourage that you develop a strong alliance with your psychiatrist. If you feel they are not proactive and forthright on the effects of your meds, I suggest you find one that is. Your quality of life could be adversely and permanently affected.
    PEOPLE’S PHARMACY RESPONSE: It sounds as if you began to experience a side effect called “tardive dyskinesia.” Your advice that patients need to work closely in an alliance or partnership with their psychiatrists is right on target.

  7. DM
    Reply

    A major part of the problem is the FDA, so easily succumbing to drug company influence without demanding adequate testing. These companies only have to submit a few positive studies for approval. They can omit the negative ones. Another part of the equation is the Congress who are easily pressured (or bribed) by drug companies to allow TV advertising, and in the case of vaccines, shielding them from being sued when a person is injured or dies.

  8. dp
    Reply

    In response to C. I know what you mean. Getting a transfer off the psych. unit was the best move I ever made. I could no longer stand to pass out meds that made patients unable to interact or take part in their therapy sessions due to side effects and lethargy. Most of the doses were “one size fits all” no matter the age, weight or gender of the patient. Get them in, get them all drugged up and discharge them.
    Years ago psych. pts. stayed until they had actually made progress and were over the episode that destablized them. Psychiatric care is no longer therapeutic. So glad I’m retired from nursing and no longer have to feel guilty about handing out meds that “may cause death”. Medications are disabling, and worse, killing our people and not just psychiatric medications.DP

  9. EH
    Reply

    Seroquel helped me tremendously. I was hospitalized after a couple weeks of no sleep. I was prescribed 25 mg of Seroquel to take before bed. This helped reset my sleep schedule and eventually I got back to normal.
    I knew of the side effects before-hand so I was very cautious and wanted to get off of it as soon possible. Even on the low dose for one week, I started having restless leg syndrome and “brain zaps.”
    Amazing short-term drug for me.

  10. Cindy B.
    Reply

    I’ve worked for many years in the mental health system, where patients are put on these drugs all the time. What’s even worse than the terrible side effects and permanent damage suffered by so many of them…. is the fact that they are RARELY given any credibility when they report these side effects. I’ve heard patients say, “It feels like my head is in a vice….” “I feel electric-ky all over…” “I can’t read or watch TV, my vision is blurry….” “I can’t think or remember anything….” “I can’t relax…” The list goes on. And what is the response of those in authority– the “caregivers?” Precious little. A pat on the head with empty reassurances, such as “Oh, it’ll get better.” “Try not to think about it.” “You’re probably just making it worse by worrying…” Or worse, that’s the cue to Rx one more medication!
    Just makes you want to cry. But of course you can’t say anything if you want to keep your job. The right interpersonal support, education and counseling would provide much more improvement than most of those meds — but of course there’s always a lack of money and always a shortage of competent staffers. So there you are.

  11. crandreww
    Reply

    Dear O.G.
    It is absolutely appalling that we allow these commercials to swarm our media, 24/7. And most of the “clinical data” is manipulated numbers which mean absolutely nothing in reality.
    I was permanently disabled by another “wonder drug” Lipitor…and as a former Critical Care RN, I am so disgusted in what we allow as “medicine” in this country. It saddens me to think that I once so blindly took part in this over medication of this country. I am so very ashamed of the lack of health care in this country. It isnt health care, it is sick care…because there is no money in health care, but mega dollars in sick care. And a medicine to cure? You will never see it…but only medicine to “treat” symptoms.
    I am with you in this outrage…if you get a chance, read a book called “Confessions of an ex rx pusher” by Gwen OLsen…former Drug rep, who woke up after her niece committed suicide while being “treated” with one of the antidepressant drugs she sold…very sad story.
    God bless!
    C.

  12. O.G.
    Reply

    I have no personal experience with these drugs, but I am fast coming to the conclusion that the advertising of drugs, especially on television, ought to be against the law. There seem to be no controls in place to protect patients.
    PEOPLE’S PHARMACY RESPONSE:
    Dear O.G.,
    The U.S. and New Zealand are the only two countries that permit this kind of advertising. We think it is outrageous. Most of the physicians we have talked to as well as most people we have surveyed find the ads objectionable. Yet they continue unabated…and for powerful drugs that have some incredibly serious side effects. We share your indignation.

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