Children who do not respond to stimulants for ADHD are sometimes given “off-label” prescriptions for other drugs to help them cope with the symptoms. “Off-label” use is when a drug is prescribed for a disorder other than what is approved by the Food and Drug Administration (FDA). This is a fairly common practice in Western psychiatry; for instance, until the ADHD drug Intuniv was approved by the FDA, some children were prescribed anti-hypertensive medications when stimulants failed them. Today we are going to talk about Abilify, an anti-psychotic drug approved to treat schizophrenia, bipolar disorder, depression, and irritability associated with autism. Abilify is sometimes used off-label for ADHD.
What is Abilify?
Abilify (generic name aripiprazole) was approved by the FDA in 2002 to treat symptoms of psychosis, including social withdrawal, blunted affect, inability to experience pleasure, and hallucinations in people with schizophrenia. It is thought that these effects are due to Abilify’s complex effects on dopamine and serotonin receptors. Essentially, Abilify is a “partial agonist” of dopamine receptors – it reduces excess dopamine activity, which is thought to cause delusions, hallucinations, and other symptoms of psychosis and schizophrenia. It can also increase dopamine activities in areas where it is deficit, and balance out levels of serotonin on the brain.
How can Abilify treat ADHD?
The drug is thought to benefit children and adults with ADHD because of its positive effects on symptoms of bipolar disorder. These symptoms include impulsivity, irritability, and racing thoughts, which are also the hallmark symptoms of ADHD. However, researchers are still investigating Abilify as an ADHD treatment. One study, which was completed in May 2009, concluded that “No significant treatment effect in ADHD symptoms was observed.”
What are the side effects of Abilify?
Like medications for ADHD, Abilify has side effects that may actually aggravate the symptoms of the disorder. The pharmaceutical website states that Abilify may cause akathisia (restlessness or the need to move), fatigue, constipation, or insomnia. Although Abilify is said to have a low rate of significant weight gain in adults, parents of children who took the drug reported excessive weight gain due to overeating. Although their ADHD symptoms did improve, parents eventually discontinued the use of medication for fear that the excessive eating caused by the drug will lead to serious health complications in the long run.
Severe side effects include an increased risk for neuroleptic malignant syndrome (NMS), a potentially fatal condition that is sometimes associated with the use of antipsychotic drugs like aripiprazole. Symptoms of NMS include irregular blood pressure, myoglobinuria (presence of myoglobin in the urine due to muscle destruction), excessive sweating, acute renal failure, and irregular heartbeat.
Another syndrome related to aripiprazole use is tardive dyskinesia. “Dyskinesia” is a condition characterized by involuntary, repetitive, and purposeless body movements, where as “tardive” means a “slow or belated onset.” Movements associated with tardive dyskinesia include lip smacking, tongue protrusion, rapid eye blinking, and grimacing. Anyone who develops tardive dyskinesia has a hard time staying still and not moving. As if this is not bad enough, tardive dyskinesia is thought to be irreversible. The likelihood of developing this syndrome increases throughout the duration of the treatment and the total cumulative dose of the drug.
Since there are virtually no studies on the long-term effects of Abilify, the use of this drug as an off-label treatment might be too risky for children. Although Abilify is said to have fewer side effects than the average anti-psychotic medication, it may too dangerous to take this gamble, especially since children are more vulnerable to the neurological effects of medication.