Sansone, 2013 Aripiprazole withdrawal: a case report.

[Altostrata]

Another researcher who referred to anecdotes on the Internet in researching aripiprazole withdrawal syndrome.

 

Innov Clin Neurosci. 2013 May;10(5-6):10-2.
Aripiprazole withdrawal: a case report.
Sansone RA¹, Sawyer RJ.

Free full text at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719459/

 

Atypical antipsychotics, including aripiprazole, are effective medications for the treatment of psychotic disorders as well as the augmentation of antidepressants in the treatment of major depression.¹ In support of mood augmentation, aripiprazole has this indication through the United States Food and Drug Administration (FDA). Despite the broad use of atypical antipsychotics for various clinical syndromes, discontinuation syndromes related to these second-generation drugs are not well characterized.²

 

It appears that discontinuation symptoms from atypical antipsychotics may be grouped into three general categories: 1) withdrawal supersensitivity psychosis (i.e., abrupt psychotic relapses associated with the acute decrease or cessation of an atypical antipsychotic³), 2) abnormal movement disorders, and 3) various mixed symptoms. Withdrawal supersensitivity psychosis has been reported with ziprasidone,⁴ olanzapine,⁵ and clozapine.⁶ Likewise, various abnormal movement disorders have been associated with the abrupt withdrawal of aripiprazole (e.g., abnormal jaw, tongue, and hand movements⁷), ziprasidone (e.g., akathisia⁸), risperidone (e.g., tics,⁹ akathisia,¹⁰ dyskinesias,¹¹ rabbit syndrome¹²), quetiapine (e.g., hyperkinesis,¹³ dyskinesias,¹⁴ chorea¹⁵), and clozapine (e.g., oculogyric crisis,¹⁶ catatonia,¹⁷ dystonias, and dyskinesias¹⁸).

As for the third group of discontinuation symptoms, according to infrequent reports, various mixed symptoms may emerge following the cessation of atypical antipsychotics.

....

However, we were not able to locate a single case report in the PubMed database regarding aripiprazole withdrawal and various mixed symptoms. In addition, the Gold Pharmacology reference source did not identify a discontinuation syndrome associated with aripiprazole.²² However, the package insert for aripiprazole indicated the presence of withdrawal symptoms in monkeys after abrupt cessation of the drug.²³ In addition, the internet revealed a number of individuals who reported withdrawal symptoms from aripiprazole, such as nausea, lightheadedness, tachycardia, diaphoresis, and anxiety,²⁴ as well as insomnia.²⁵ Likewise, consumers reported headaches, tremulousness, and flu-like symptoms.²⁶ In the following case report, we describe a 61-year-old man who abruptly discontinued aripiprazole and experienced a number of unpleasant symptoms highly suggestive of withdrawal.
....

In January of 2013, the patient abruptly discontinued aripiprazole 5mg per day as the prescription had expired and he was on vacation. Within two days of cessation, the patient began to experience sudden-onset lightheadedness, intermittent nausea, severe insomnia (i.e., difficulty falling and staying asleep), irritability, generalized muscular twitches, intense anxiety, worry, rumination, and dysphoria. The symptoms waxed and waned over the initial days, but gradually began to dissipate after two weeks. Before and during this time, all concomitant medications remained unchanged in prescription and dose.

 

Discussion. This patient’s experience mimics the reports by consumers, which are described on the internet. However, it is important to note that some of these symptoms may be attributable to depression relapse, such as dysphoria, rumination, insomnia, and irritability, whereas other symptoms are more suggestive of withdrawal (e.g., nausea, lightheadedness, muscle twitching).

 

Ariprazole and its active metabolite, dehydro-aripiprazole, have half-lives of 75 and 94 hours, respectively, and are seemingly unaffected by age or gender.²² Given these lengthy half-lives, it would seem less likely that aripiprazole would cause withdrawal symptoms. However, fluoxetine and its active metabolite, norfluoxetine, have half-lives of 96 hours and 384 hours, respectively (i.e., longer than aripiprazole), and may cause discontinuation symptoms in the week following abrupt cessation—a finding that was confirmed in a prospective study.²⁷
....

Conclusion. We report a case of probable aripiprazole withdrawal characterized by various mixed symptoms, which to our knowledge has not been previously reported in the empirical literature. In this case, these various symptoms gradually receded over time. Therefore, it appears that on rare occasion, aripiprazole can cause a discontinuation syndrome characterized by various mixed symptoms that are likely to dissolve over time—a reminder to clinicians to always taper psychotropic medications when administered long-term. This rare risk is of clinical importance due to the current broad role of aripiprazole in the augmentation of mood disorders.

 

Also see, by the same author, Sansone 2010 SSRI-Induced Indifference

[btdt]

For some people the internet is the only place they feel heard when the tell the truth about drugs.  

[westcoast]

This sounds like the horrible terrible terror time, but made clinical. If it is what we have or had, you can't get it across with out biblical words. Living hell, ungodly, etc. But it's a start. Wish they had omitted the relapse conjecture. Patient knew the difference.

Here's Britain's Dr. Wessely who heads the Royal College of Psychopaths:

"...how many patients don’t receive enough support to assist them staying on vital medication, without which relapse is all-too common and all-too ghastly."  That's the propaganda. I'll post the article in In the Media.