Talk:Aripiprazole

From Wikipedia, the free encyclopedia
Jump to: navigation, search
          This article is of interest to the following WikiProjects:
WikiProject Physiology (Rated Mid-importance)
WikiProject icon This article is within the scope of WikiProject Physiology, a collaborative effort to improve the coverage of Physiology on Wikipedia. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.
 ???  This article has not yet received a rating on the quality scale.
 Mid  This article has been rated as Mid-importance on the importance scale.
Taskforce icon
This article has been classified as relating to the physiology of the brain, nerves and nervous system.
 
WikiProject Pharmacology (Rated B-class, High-importance)
WikiProject icon This article is within the scope of WikiProject Pharmacology, a collaborative effort to improve the coverage of Pharmacology on Wikipedia. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.
B-Class article B  This article has been rated as B-Class on the project's quality scale.
 High  This article has been rated as High-importance on the project's importance scale.
 
WikiProject Medicine (Rated B-class, Mid-importance)
WikiProject icon This article is within the scope of WikiProject Medicine, which recommends that this article follow the Manual of Style for medicine-related articles and use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine.
B-Class article B  This article has been rated as B-Class on the project's quality scale.
 Mid  This article has been rated as Mid-importance on the project's importance scale.
 
WikiProject Autism (Rated Low-importance)
WikiProject icon Aripiprazole is within the scope of WikiProject Autism, a collaborative effort to improve the coverage of all aspects of autism and Autistic culture on Wikipedia. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.
 ???  This article has not yet received a rating on the project's quality scale.
 Low  This article has been rated as Low-importance on the project's importance scale.
 

EPS[edit]

Why isn't there any mention of it's potential for extrapyramidal side effects

The reason there's no mention is because there's not any. The studies haven't found significant evidence of them. It's a dopamine receptor AGONIST. Technically, if it did what they think, it could be used to treat parkinsons. 69.205.97.220 (talk) 03:23, 1 May 2009 (UTC)

hogwash. —Preceding unsigned comment added by 76.108.242.37 (talk) 15:14, 15 May 2011 (UTC)

this is a misunderstanding of partial agonism. Partial agonists usually function as a competitive antagonist at the receptor site. A full agonist will exhibit 100% effect, while a partial agonist has <100% effect leading to a relative reduction in function despite being an agonist. Therefore, the partial effect exhibited by aripiprazole at the dopamine receptor sites(2-4 primarily) decrease the effect of dopamine and can cause parkinsonian types of side effects.

sure it can cause EPS. it's dose-related from 5%-16%

                            Pharm D at psych hospital

Effects[edit]

Surely weight gain is a side effect as with other atyp anti psy.??? 220.237.158.214 10:22, 26 September 2007 (UTC)


Can anyone find specific information about what this medication does?

ADHD instead of due to the calming effect it has although it is not licensed for ADHD treatment What specific kind of information are you looking for?


Search Google for aripiprazole and you will find more information than you may wish to digest.


This is just medical justifiation of many cases of mind control

Yes, I need this class of drug. Thanks for the info - I am going on a drug trial of this.

The statement that there are case reports of abilify inducing mania needs citations. Medline does not show any such case reports in my search, and I have never heard this. Abilify is used to treat mania. It can cause akathesia and states of agitation, which are not the same as mania, although may be confused with mania. It does not cause weight gain, unlike most of the other atypical agents. —Preceding unsigned comment added by Lizdoc (talkcontribs) 17:31, 14 February 2008 (UTC)

Anecdotal evidence[edit]

I know Wikipedia prohibits original research, but I know that I experienced tardive dyskinesia and insomnia after only about a week on this drug (prescribed for manic break). I was also taking an antibiotic that is metabolized by the liver, so I think that was blocking the pathway and may have strengthened the effect some. Is there any data to be had as to how common such reactions are among users of the drug, or is still too early? I was rather upset, to say the least, once I had recovered to find that I had been put on such an untried medication. Now I'm on Depakote, which seems to stabilize me without any significant side effects Evan Donovan 03:10, 25 March 2006 (UTC)

Anti-biotics commonly interact with many drugs.J. M. 02:25, 22 May 2006 (UTC)
What you was experiencig after a week of aripiprazole medication almost certainly was not tardive dyskinesia, unless you've been taking other antipsychotics before at least for some weeks (rather months or years); what it well could have been would be early extrapyramidal syndrome; in this cases, dystonia, dyskinesia, akathisia and the like are not uncommon. Insomnia could have been a side-effect of aripiprazole medication; and some antibiotics are certainly inhibiting microsomal metabolism of other drugs, aripiprazole included. Wish you all best with current therapy.--Spiperon 09:21, 4 May 2007 (UTC)

I would not consider this "original research" anymore maybe it is time some doc wrote an article on this so we can make it a fact. Oh i know this is not a "request page" but can someone clarify that MAJOR WARNING!!! message at the bottom of this page? its making me nervous.

I would just like to add that within one month of my starting Abilify, I started having severe restless leg syndrome. Just another side effect to look out for with this drug. —Preceding unsigned comment added by 66.140.82.161 (talk) 16:31, 28 March 2008 (UTC)

I thought I would add that I had been on Abilify for a short while, but started having linguistic hallucinations (basically, auditory hallucinations, however as a polyglot I couldn't attach a specific language to any of the hallucinations, just random spontaneous hallucinations of meaning). I tried to offer my pen to a wall one time. It's probably important to note that this drug shouldn't be used for anyone without mood-stabilization issues in their depression. --Puellanivis (talk) 08:06, 16 December 2008 (UTC)

Abilify is a dopamine receptor AGONIST. What you guys are describing is basically impossible if you were normal. The person who says RLS, it's probably tremors - abilify increases motor activity (though dopamine), you're probably only noticing because when you go to sleep, dopamine levels RISE until you fall asleep. And the other person who says hallucinations - you're probably right. Hallucinations get worse on Abilify, but usually only after pre-treatment with a typical antipsychotic - a typical antipsychotic can upregulate dopamine up to 98% - check haloperidol, but I don't doubt someone will develop hallucinations after taking it normally. Anecdotally, I'm having some language difficulty on Abilify (I say the wrong words e.g. if they sound alike) and my attention is reduced to nothing - like from playing video games for an hour now I quit after five mins, but here's the catch - I have treatment resistant depression, and the medicine isn't working for that anyway.

Here's one link for agonism proof: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1J-4CCP0FS-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=6f2e8a522bc80b0d62b05df0fa11ba81

Risperidone to Abilify relieves Tardive Dyskinesia: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TBR-4VFC82H-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4b829dcb22e31474b8a55b57cd0e11a1 69.205.97.220 (talk) 03:42, 1 May 2009 (UTC)

It is a partial and selective dopamine agonist, your sir are a tard. Anti-psychotics, typical or atypical, should be used with caution in anyone. Also raising dopamine lowers serotonin and raising serotonin lowers dopamine, so perhaps there is something to do with that if it actually was a true dopamine agonist (like cocaine or amphetamine) 71.162.227.170 (talk) 19:36, 4 June 2009 (UTC)

This is a misunderstanding of pharmacology. Abilify is a partial agonist, meaning that is exhibits less effect on the receptors than does a full agonist, in this case dopamine. It is a competitive antagonist since they are both capable of exerting effect at the receptor site, which REDUCES the effects of dopamine. In parkinson's disease, there is a relative lack of dopamine receptors, using abilify would exacerbate the disease state by inhibiting dopamine activity. Hope that helps.

PharmD at a psychiatric hospital — Preceding unsigned comment added by 159.238.36.19 (talk) 20:23, 16 August 2013 (UTC)

Spelling[edit]

Please correct "miscle", etc under "Side Effects"

Tardive dysphrenia[edit]

I've included a link to the new wiki Tardive dysphrenia (under See Also), which I hope, must be of interest to this one. Cheers, LFrota.

Major Warning![edit]

Waring: This drug (even at low dosages) may cause liver failure/disease, high chlosterol, diabetes, and weight gain, etc.

This guy better be screwing around! ill rather die than to go trough this kinda fucked up stuff... oh and cholesterol is misspelled... can someone clarify this ASAP? (please?)

There's no evidence of those effects. 69.205.97.220 (talk) 05:11, 1 May 2009 (UTC)
69.205.97.220, I swear to fucking god you work for a pharma company, weight gain is common with dopamine changes because less dopamine = more eating (that is why amphetamine for example stops you eating since it is such a potent dopamine agonist), stop spewing shit out of your mouth. 71.162.227.170 (talk) 19:38, 4 June 2009 (UTC)
This is a dopamine agonist too, dork. — Preceding unsigned comment added by 67.169.180.34 (talk) 19:29, 5 November 2011 (UTC)

Not an azole[edit]

Who names these drugs? It's not an azole! Bloody pharmacologists.

New Indication for Major Depressive Disorder[edit]

On 11/16/2007, US FDA approved aripiprazole for use as adjunctive therapy for Major Depressive Disorder (unipolar depression).

For this purpose, it is usually prescribed at a much lower dose than for bipolar or schizophrenia (schiz= 10-15 mg/day, bipolar=15-30 mg/day, major depress=5-10 mg/day with starting dose of only 2 mg/day).

This is listed on FDA website:

http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#apphist

and new FDA labeling info is here:

http://www.fda.gov/cder/foi/label/2007/021436s018,021713s013,21729s005,021866s005lbl.pdf

Crazymiddle (talk) 03:57, 22 November 2007 (UTC)

I've just been perscribed this drug at 5mg to replace the Seroquel I've been taking for the last 7 months after having gained 30 pounds in 7 months. But this doesn't seem to be any better when I read the side effects. Has anyone actually taken this drug and did you gain weight or not? What about the diabetes issue? —Preceding unsigned comment added by 71.127.131.100 (talk) 20:19, 20 June 2008 (UTC)

I just recently started taking it and my appetite is way up, so I guess it can make you overweight. Not sure about the Diabetes, though. It seems likely that diabetes would be a product of increased appetite, thus making Apiprazole only the indirect cause.

3D structure[edit]

It would be nice to get a 3D representation of the aripiprazole molecule. Is their anyone out there that could add one?--Metalhead94 (talk) 18:02, 19 November 2008 (UTC)

Someone added one, but an animated one, which I find next to unusable, and removed the stick-and-balls one. I'm pretty sure I've seen click-for-animation images somewhere on Wikipedia. Is there a better way to have those than a static GIF linked to a spinning one? Pending that, I'll remove the animated GIF and restore the ball-and-stick one. The Crab Who Played With The Sea (talk) 08:32, 22 July 2013 (UTC)

Using Abilify for ADHD?[edit]

I know a woman who has gotten Abilify for her ADHD. Does anybody know if this is a known usage of Abilify? --Algotr (talk) 22:41, 29 April 2009 (UTC)

Abilify has been researched for ADHD, and while there's nothing really definitive, at least one pilot study in children with no comorbidities and two studies in children and adolescents with comorbid bipolar disorder have been done, with mixed results (two favorable, one unfavorable wrt reduction in ADHD symptoms). --Aurochs (Talk | Block)
I think that information should be in the article as well! --Algotr (talk) 18:32, 14 May 2009 (UTC)
So do I. I just need to get up off my lazy ass and finish writing the therapeutic uses section. --Aurochs (Talk | Block)

"Aripiprazole is at least as effective as haloperidol at reducing manic symptoms"[edit]

I find this statement pretty dubious. I can understand how it would be better tolerated, but, I highly doubt it is AT LEAST as effective as haloperidol. This isn't just my original research or POV either, I think most psychiatrists would agree, I don't see aripiprazole being very effective in cases that would require Haloperidol. Any feedback is welcome.--Metalhead94 (talk) 13:57, 10 July 2009 (UTC)

I was only following the abstract of the article I cited. I don't have access to the article itself, nor the training to determine whether or not it's reliable. If you're able to review the study and debunk it, be my guest. However, my understanding is that anecdata is not a reliable source as far as Wikipedia is concerned. --Aurochs (Talk | Block)
Okay, I just reviewed what I could of the article, and it appears that most of the authors were employed by either Brisol-Myers Squibb or Otsuka. That alone makes the abstract suspect, but it doesn't necessarily disprove the findings. If anybody can get me a copy of the article, I would be pleased to review the data to the best of my ability. In the meantime, I'm tagging it as a possibly unreliable source. --Aurochs (Talk | Block)
I agree. I generally am careful around studies funded by pharmacuetical companies themselves, as they often seem slightly biased, especially when it is the very company[ies] that market the drug. Thanks for the feedback.--Metalhead94 (talk) 19:29, 11 July 2009 (UTC)

Side effects: citation needed for sudden death claim under side effects section[edit]

I've marked that tidbit of info with a citation needed tag. If anyone can find a source that says Aripiprazole causes sudden death, go ahead and add it in because I can't seem to find one. --69.109.159.232 (talk) 15:13, 11 February 2010 (UTC)

Location[edit]

Where do they make and produce abilify? —Preceding unsigned comment added by Eupeyd (talkcontribs) 21:05, 24 March 2010 (UTC)

Chemistry[edit]

Why does the posted synthesis use a chemical weapon (mustard gas, in this case)? I mean it's great to find new applications for chemical weapons but I am somewhat skeptical that this is the correct synthetic pathway. That and it doesn't come up in any patent/research article related to synthesis of this drug. —Preceding unsigned comment added by 18.60.11.132 (talk) 19:51, 19 May 2010 (UTC)

Use of Ki values[edit]

Is it really necessary to have a long list of numbers that are completely meaningless to the average reader, and easily found by anyone who does know what they mean? What's especially problematic is that there's only one source given for these numbers, even though different labs can come up with completely different values. There's no real assurance given in the text that these numbers closely approximate other published data. I just feel like aripiprazole's affinity for various receptors can be easily explained without getting so technical, and that anyone who wants more precise information (i.e. numbers) can follow the citations. --Aurochs (Talk | Block)

It's been over a month since I posted this, and nobody has responded. I'm going to go ahead and remove the list of values from the page. --Aurochs (Talk | Block) 00:31, 26 September 2011 (UTC)
It's an encyclopedia. Please put the table back. — Preceding unsigned comment added by 67.169.180.34 (talk) 19:31, 5 November 2011 (UTC)
Exactly. It's an encyclopedia, not a technical reference. I do not expect to see long lists of data in any encyclopedia article. --Aurochs (Talk | Block)

Litigation[edit]

It would be helpful to have a section entitled "Litigation" on this drug and many others. The best way to gauge the seriousness and pervasiveness of the side-effects for drugs like Abilify is to look at the lawsuits. Who is suing? Why? Have class actions been initiated? What are the characteristics of the Plaintiffs? What are the claims? Wrongful death? Loss of consortium? Serious bodily harm? Have doctors been sued as well as the drug companies? Have settlements been reached? If so, how much? Has a verdict been rendered? If so, where and for how much? Has the research that lead to the approval of this drug been subjected to scrutiny through the deposition process? If so, what were the results? Were admissions made? Etc. — Preceding unsigned comment added by 70.173.238.127 (talk) 04:46, 29 May 2012 (UTC)

Binding Profile[edit]

There is an error there: aripiprazole is 5HT2A partial agonist, not parcial antagonist. Correcting it. Thank you. — Preceding unsigned comment added by 163.247.80.14 (talk) 13:36, 13 May 2013 (UTC)

Ongoing Phase 3 trial[edit]

Is the currently ongoing phase 3 trial (efficacy and tolerability of aripiprazole depot IM injection for treatment of bipolar disorder I) worth mentioning in the wiki? Here's the link: http://clinicaltrials.gov/ct2/show/NCT01567527 I'd make that nicer... but I don't know how to do a link in wiki markup! Sorry... Havensfire (talk) 18:20, 22 June 2013 (UTC)

We do not typically mention ongoing trials unless they have been discussed in a secondary source (thus putting them into context). Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:30, 22 June 2013 (UTC)

Chemical structure diagrams with no description[edit]

If I draft a description, can someone check for me that it's accurate? The Crab Who Played With The Sea (talk) 08:39, 22 July 2013 (UTC)

Autism[edit]

Some portions of the article say irritability associated with autism, and some just say autism. The drug is approved by the FDA for the former. It's misleading to only say autism, and I believe this should be changed. Thoughts? Archdiamond (talk) 17:09, 3 October 2013 (UTC)

Is this the same as saying that it treats symptoms? MaynardClark (talk) 14:46, 26 April 2014 (UTC)

...Society and Culture...?[edit]

Society and Culture seems like a weird heading for the information it contains, but I'm having trouble coming up with a better one.Archdiamond (talk) 17:17, 3 October 2013 (UTC)

I agree, I was expecting more about how commercials advertising the drug have become the target of jokes. Seriously the list of side effects is comical. — Preceding unsigned comment added by 74.97.30.242 (talk) 19:36, 4 July 2014 (UTC)

Diabetes etc.[edit]

The article mentions diabetic ketoacidosis as a side effect, but it doesn't say anywhere that Abilify can cause blood sugar problems that lead to diabetes. To me, saying diabetic ketoacidosis does not imply that. Thoughts? Archdiamond (talk) 17:19, 3 October 2013 (UTC)

Removed large tract of uncited text added by good faith edit by IP, I've placed it below if anyone wants to restore it with citations[edit]

Misuse of Aripiprazole (Abilify)


Receptors are activated by agonists and blocked by antagonists. Upon binding to its receptors, an agonist will trigger a cascade of biochemical and/or physiological reactions. Each agonist has two characteristics: affinity and efficacy. Affinity is the reciprocal of dissociation constant. It indicates how tightly an agonist binds to its receptors. Efficacy was measured by the effectiveness of the response elicited by an agonist. A full agonist produces 100% response while an antagonist produces no response and blocks the activation of receptors by its agonists. A partial agonist, also called a partial antagonist, produces less than 100% but more than 0% response. It blocks a full agonist but can still produce partial response. It also can replace an antagonist and unblock the blockage by the antagonist. As a result, it will produce a partial response. Using a simple analogy, we may say a full agonist opens a door fully; a full antagonist keeps the door closed. A partial agonist will keep the door ajar.


Abilify is a partial agonist on the Dopamine D2 receptor site. It has been misused with full D2 antagonists, such as Risperdal, Zyprexa, Geodon, Haldol. It will attenuate the effects of a full D2 antagonist. It has been observed that Abilify worsened TD, similar to withdrawal TD, and exacerbation of psychosis in patients who were on a full antagonist and then started Abilify.


Partial agonists have used for various reasons. Subutex, a partial agonist on opioid mu receptors, is used for opioid withdrawal and addiction. If a patient has been on a full opioid agonist, the patient has to wait until moderate withdrawal symptoms occur before starting Subutex. If it is used too early, it can precipitate opioid withdrawal symptoms. Suboxone, a combination of Subutex and Naloxone, a full opioid antagonist, is used to prevent perenteral use of Subutex. When administered sublingually, due to its low bioavailability, Naloxone has minimal effects on Subutex activity, whereas when administered intramuscularly, Naloxone is able to block the partial agonist activity of Subutex. Chantix, a nicotinic acetylcholine receptor partial agonist, has been used for nicotine cessation. It produces partial activation of the nicotinic acetylcholine receptors so that a smoker will not have severe nicotine withdrawal symptoms and at the same time, the smoker will not be able to feel the full effects of nicotine as Chantix occupies the receptor and prevent nicotine from binding to the receptor. Acebutolol, a partial agonist on beta adrenergic receptor site, produces a lesser reduction in heart rate and cardiac output than does a full antagonist (propranolol or atenolol). It has been used on hypertensive patients with slow heart rate.


Abilify is also a 5-HT-2A receptor antagonist and can alleviate depressive symptoms. But it should not used when a patient is on a D2 antagonist or a D2 agonist.


In summary, Abilify interferes with full D2 antagonists or agonists. It should not be used with those medications. Economically, it is a waste of money. Pharmacologically, it does not make sense. Clinically, it is not a good practice.Wzrd1 (talk) 16:13, 16 October 2013 (UTC)

Off-Label Uses[edit]

Can the edit (inserted sentence) "Abilify is sometimes used to treat ADHD instead of due to the calming effect it has although it is not licensed for ADHD treatment" be rewritten as "Abilify is sometimes used of-label for ADHD because of its calming effect."? MaynardClark (talk) 14:46, 26 April 2014 (UTC)

That would be an off-label use. It'd require a citation, but we should first get some consensus here on including it. Anyone, is it a common off-label use for ADHD that would make it notable enough to include in the article?Wzrd1 (talk) 14:57, 26 April 2014 (UTC)

Edits of August 2014[edit]

@Jmh649: what can we do here to make this better? I am convinced that despite the limitations of these drugs and the excessive marketing that gave the whole industry yet another black eye, the statement that "there is tentative evidence that aripiprazole may be useful in schizophrenia" does not represent mainstream medical thought.

Cochrane in particular has seemed pretty inconsistent in their conclusions:

  • Comparing aripiprazole to placebo:
  • In 2006, based on 15 trials/7110 people comparing aripiprazole to placebo or a first gen antipsychotic, "Compared with placebo, aripiprazole significantly decreased relapse in both the short and medium term"
  • In 2011, based on 9 RCTs with 2585 people (comparisons to placebo only), this conclusion is softened by the same author to "Aripiprazole may be effective for the treatment of schizophrenia."
  • Comparing aripiprazole to other antipsychotics:
  • In 2006, based on 15 trials/7110 people comparing aripiprazole to placebo or a first gen antipsychotic, "Aripiprazole is not much different from typical antipsychotic drugs with respect to efficacy. However it presents significant advantages in terms of tolerability due to its favourable adverse effects profile."
  • In 2009, aripiprazole is compared to other atypicals (4 trials with 1404 participants). The article states "Aripiprazole may be somewhat less effective than olanzapine, but more tolerable in terms of metabolic effects and sedation. There is no evidence for a difference in efficacy compared to risperidone, but far better tolerability..."
  • In 2013, a non-Cochrane analysis by Leucht, concludes confidently that the efficacy of all of the 15 atypical and typical antipsychotics examined in their meta analysis is similar, and all are "substantially better" than placebo.
  • In 2014 and 2013 the Cochrane group publishes meta analyses comparing aripiprazole to other atypicals. Compared to the 2009 Cochrane meta analysis, the number of patients and trials has exploded to 17,244 and 174, but now every comparison is followed by the phrase "low level of evidence" or "very low level of evidence" complaining about the trial designs and endpoints, emphatically making clear that no comparison can be made with confidence. NOtably, one of the co-authors is Leucht, who reached very different conclusions in his separately published meta analysis in 2013 (above)

As the amount of data increased, the tentativeness of the conclusions only grew. Perhaps one aspect of this was the revelation of selective publication and increasing understanding of its impact, but even the earliest study states "We contacted relevant pharmaceutical companies, the FDA and authors of trials for additional information." Furthermore, dramatically different conclusions were reached in two studies co-authored by Leucht in the same year. That co-written with Cochrane collaborators was by far the more critical/skeptical.

I don't know the best way to approach this, but I am increasingly skeptical that meta analysis is much more than the writing of detailed editorials. The process of analysis is opaque and not readily evaluated by the reader. Different (and sometimes the same!) authors look at the same data and reach different conclusions by means that one cannot readily examine and critique for oneself.

And somehow, whatever mistakes are sometimes made by these agencies, the opinions of the FDA and the EMA needs to come into play. Ultimately, if the analysis is subject to the prejudices and pre-judgments of those doing the analysis, the more people involved in the analysis the better. And the regulatory opinions involve scores of people not two to eight.

I'm not trying to be difficult here, but if you have any thoughts on navigating this issue I would appreciate it. Somehow in following Cochrane, we've ended up with "may be useful" in the lede of an article about a drug that has been approved by regulatory agents on every continent, which is recommended by NICE, and which is prescribed millions of times each year by psychiatrists who are quite competent to judge whether or not a patient is psychotic and who are familiar with competing drugs. We set aside all of this and rely on a paper written by 6 analysts, one of whom expressed very different opinions in a separately published paper the same year written by 2 analysts, each of whom has fewer than 20 publications under their belt. It seems to me that this is not the best way, and if you have any thoughts on alternative approaches that would be acceptable to you, I'd be eager to hear them. Formerly 98 (talk) 19:44, 10 August 2014 (UTC)

Will take me a little time to review all this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:18, 12 August 2014 (UTC)
Would changing to "Aripiprazole may be useful in schizophrenia" be good? Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:49, 12 August 2014 (UTC)
Yes, I'm guilty of throwing a very long-winded, open-ended question about the nature of medical evidence at you. If you are interested in thinking about this and getting back to me at your leisure, that would be great. If not, I understand entirely. For now I'll leave it as is, and perhaps circle back in a week or two and see if I can do something better (and mutually acceptable) with it.
One thing that I found interesting in this case is that as time rolled by, the nature of the data did not change so much as did the Cochrane Group's interpretation of its significance and meaning. The p values favoring efficacy remain the same in the later studies, but the analysts now question the validity of the endpoints, the impact of the high dropout rates, and other trial features. Since this interpretation aspect is not derived mathematically, does the meta analysis in this case differ in evidence quality from any other review and its associated expression of opinion? The facts did not change much, but the interpretation changed dramatically.
Anyway, that's what I've been thinking about. If its interesting to you, I'd be interested in your thoughts. If I'm just being a data geek, kindly disregard this entire note. Formerly 98 (talk) 06:28, 12 August 2014 (UTC)Formerly 98 (talk) 06:18, 12 August 2014 (UTC)
Agree we need to add the positions of major guidelines. Am not home for a week yet. 65.42.208.133 (talk) 15:54, 12 August 2014 (UTC)
@Jmh649: can you email me reference 9? I'm a little concerned that the prominence of the statement "there is tentative evidence of efficacy" is a little like a see-saw, with half a dozen Cochrane authors on one side sitting on the ground, and all of current treatment guidelines and clinical practice on the other side, up in the air. Formerly 98 (talk) 01:49, 24 August 2014 (UTC)
Okay let me try to get you a copy. IMO there is room for both the position of guidelines (which is often simply expert opinion) and the best available evidence. We have the same situation with electronic cigarettes. All the guidelines raise the concern of addiction in children yet their is tentative evidence of no concern. We do and should mention both. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:38, 24 August 2014 (UTC)

Which ref do you want? Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:44, 24 August 2014 (UTC)

This is a bland statement that is not really needed "The efficacy of aripiprazole for the treatment of acute exacerbations of schizophrenia and for the prevention of relapses has been examined by several groups."
This "Overall, there is strong support for the efficacy of aripiprazole in the treatment of acute psychotic episodes. The Cochrane collaboration evaluated aripiprazole and 14 other anti-psychotics in 2013, concluding that aripiprazole on average produced a 43% reduction in symptoms. It was found to be more effective than asenapine, lurasidone, ziprasidone, and chlorpromazine, but less effective than amisulpride, olanzapine, and clozapine" has issues for a number of reasons. First of all the ref is not a Cochrane review but a lancet paper. Second most of the confidence intervals overlap and thus one cannot make the statement about one be better than the other that that was made.Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:14, 24 August 2014 (UTC)
Agree that I made several errors here. Formerly 98 (talk) 10:22, 25 August 2014 (UTC)

Cochrane reviews of antipsychotics[edit]

With much temptation to cherry pick, I did my best here to fairly pick some representative examples of how Cochrane findings translate to global summaries of antipsychotic effectiveness. My conclusion is that the latter correlate with the authorship much more so than with the findings, and thus should not be used. Formerly 98 (talk) 18:06, 24 August 2014 (UTC)

Ah... We should not use the global summaries of Cochrane reviews? Unclear why.Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:16, 24 August 2014 (UTC)
I've tried to make two points, Doc.
  • The added external validity of a meta analysis as I understand it comes from the fact that is is averaging across many studies. This is true for the data analysis, such as when they find that there is no statistically significant difference in relapse rate. But when they go on to opine about the adequacy of the trial design or the absence of secondary endpoints they feel should have been included, they are just opining like the author of any primary citation.
  • As seen below, they do not opine consistently. Therefore its not really high value information.
The first point is probably more relevant than the latter one.
I think it would be fair to respond to the information and comments that I posted and not simply do the "Ah, I don't see why" routine. Its a completely nonspecific response, and I think I've put in enough good faith effort here as an editor to deserve a real one, whatever our differences in opinion.
And with due respect for your expertise and role here (genuinely, that's not a wise ass remark), I think you missed the point on your edits. Every treatment guideline, as well as Cochrane, the FDA, and the EMA distinguishes between studies designed to show efficacy in acute psychotic episodes and as prophylactic maintenance therapy. That difference is as real as primary and secondary prevention with statins in heart disease. Its not really that complicated that our readers can't understand it, and you're eliminating as useful part of the description of treatment.
I certainly don't want to edit war with the head of the Wikipedia Medcine project. If you are not willing to compromise, would you do me a favor and post a RFc? (Specifically with regards to the material you changed in this article, not the broader philosphical question about sourcing). Thanks.
Formerly 98 (talk) 23:15, 24 August 2014 (UTC)
You have raised a few issues. Which would you like to have a RfC regarding? That we not summarize the global summaries of the Cochrane collaboration?
That we instead ask editors to look at the results ourselves and provide their own interpretations? I have added some concerns regarding your edits in the section above. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:36, 24 August 2014 (UTC)
I think I was a initially put off by the extent of the edits, and reacted without reading it as carefully as I should have. I apologize for this. Let me look some more and respond more thoughtfully. Formerly 98 (talk) 23:40, 24 August 2014 (UTC)
I am happy to debate improved wording / a compromise.
The "adequacy of the trial design or the absence of secondary endpoints" put the conclusions into perspective. The endpoints used separate clinically meaningful from non clinically meaningful statistically significant conclusions. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:36, 24 August 2014 (UTC)
Frankly I'm still a bit put off a bit by the phrase "may be useful" in the opening sentence. Cochrane says its equivalent to other antipsychotics, as do the major treatment guidelines, and ALL the treatment guidelines say to treat with an antipsychotic.
Nonetheless, I recognize that the current text probably already reflects some compromise on your part. Let me think about this overnight and see if I have anything new to say tomorrow. Thanks. Formerly 98 (talk) 23:49, 24 August 2014 (UTC)
I have used "may be" as there are concerns regarding what endpoints were looked at and the quality of the evidence. We now state that it decreases relapse in definitive terms and improves treatment compliance compared to placebo. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:52, 24 August 2014 (UTC)
Continuing this conversation with some concern that I may be viewed as quibbling, but this was exactly the subject of my broader comment above. The Cochrane authors had concerns about the adequacy of the endpoints and the quality of the evidence, but I did not see those concerns voiced elsewhere. Nor in most cases did other Cochrane authors express similar concerns (at least not to the extent of going to "may be useful") when encountering similar shortcomings in trials of other antipsychotics. So the concerns being expressed here have not been voiced by non-Cochrane authors regarding aripiprazole, nor have they been voiced by Cochrane authors in most cases when encountering similar data sets for non-aripiprazole antipsychotics.
So I'm inclined to think that this is undue weight given the opinion of 6 authors, and that the fact that the meta analysis itself is a secondary source does not give their opinion greater weight than those of the other 300 or so psychiatrists who have written on the subject of aripiprazole.
I'm not asking you to do anything right now except to consider this idea and the possibility that I'm not just being a shill or a general pain in the ass. I can certainly understand that I sometimes give that impression. :>) Formerly 98 (talk) 00:10, 25 August 2014 (UTC)
Interesting paper here. The authors were quite critical of the Cochrane methodology in schizophrenia trials, in particular their failure to follow pre-specified inclusion and exclusion criteria or to disclose that they had disregarded the protocol. For what its worth, they also concluded that the 2006 aripiprazole review probably overestimated aripiprazole's efficacy.
"We found Cochrane reviews varied in their stated approach to handling attrition. This means that some drugs could be judged conservatively, while others could be judged generously. Whether it is possible or desirable for the Cochrane Schizophrenia Group to prescribe how to deal with attrition is a matter for further debate. Reporting the specific proportion of data that are missing for each outcome could allow readers to have a greater understanding of the robustness of each finding."
Mostly these are older reviews, though the 2010 review on olanzapine might be used in the corresponding Wikipedia article. Formerly 98 (talk) 19:17, 25 August 2014 (UTC)

We could have a RfC. What wording are you wanting? Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:30, 27 August 2014 (UTC)

Let me think about it. My primary goal was to influence your opinion about the overall question of the hierarchy of evidence if I could; this particular article was just the vehicle for that discussion. I'm trying to argue a fairly argue a fairly complicated position, and if I wasn't able to convince you, my chances of convincing people who on average spend much less time and energy thinking about the issues than yourself are likely to be poor.
I'm disappointed I wasn't able to change your mind, but thanks for engaging and taking the time to listen. I appreciate it. Formerly 98 (talk) 02:51, 27 August 2014 (UTC)
Drug Year Issues considered / Evidence quality Summary evaluation
Aripiprazole 2011 "Compared with placebo, aripiprazole significantly decreased relapse in both the short (n = 310, 1 RCT, RR 0.59 CI 0.45 to 0.77) and medium term (n = 310, 1 RCT, RR 0.66 CI 0.53 to 0.81). It also produced better compliance with study protocol (n = 2275, 8 RCTs, RR 0.74 CI 0.59 to 0.93)". "Unable to extract any usable data on death, service outcomes, general functioning, behaviour, engagement with services, satisfaction with treatment; economic outcomes or cognitive functioning". "There was high attrition" "May be effective"
Trifluperazine 2014 "Significant clinical improvement in clinical global state (Low quality evidence"), all other outcomes described as supported by low quality or very low quality evidence "An effective antipsychotic"
Chlorpromazine 2014 "Chlorpromazine provided a global improvement in a person's symptoms and functioning" but "The quality of evidence is very low". "No difference was found in relapse rates". "Chlorpromazine's global position as a 'benchmark' treatment for psychoses is not threatened by the findings of this review"
Pimozide 2013 "Only one study provided data for global state relapse, for which no difference between groups was noted ". No study provided data on imporvement in mental state or quality of life. "seven studies provided data for global state relapse at medium term, for which no difference was noted..another study demonstrated no difference in the presence of first-rank symptoms at medium term" "Although shortcomings in the data are evident, enough overall consistency over different outcomes and time scales is present to confirm that pimozide is a drug with efficacy similar to that of other, more commonly used antipsychotic drugs "
Fluphenazine 2013 "Results, based on this small selection of studies, suggested that there was no significant difference between oral fluphenazine and placebo for most outcomes, including global state and leaving the study early. Results did suggest a statistically significant effect favoring oral fluphenazine in the short term for levels of relapse (n = 38, 1 RCT, RR 0.25 CI 0.06-1.03) with levels of extrapyramidal adverse effects more frequent with oral fluphenazine" " It is indeed a potent antipsychotic"
Sulpride 2009 and 2012 "There were no data for many important outcomes such as general functioning, service use or adverse effects". Data quality "poor" "Sulpiride may be an effective antipsychotic drug"

Auditory hallucinations[edit]

I was prescribed Abilify for auditory hallucinations (music, both choral and instrumental, & unidentifiable shouting voices). It worked and I'm now off it, with no return of the hallucinations. (I am not nor have ever been diagnosed schizophrenic.) Since this use isn't mentioned in the article, I googled and found several "references" (admittedly not good ones) for this use:


On the other hand, there are claims that Abilify can cause auditory hallucinations.

If an acceptable reference can be found showing Abilify effective for getting rid of auditory hallucinations, this would be an important addition to this article. --Hordaland (talk) 15:30, 26 September 2014 (UTC)

Antipsychotic Medication[edit]

I'm pretty sure abilify is also a antipsychotic... might want to add that into the beginning section — Preceding unsigned comment added by Oddtruth (talkcontribs) 20:25, 30 October 2014 (UTC)

Most people don't know what atypical means... might want to claify what that is as mental health is a HUGE problem is the USA. I would say abilify is primarily a antipsychotic... not an partial dopamine agonist. Again most people don't understand what these large and complicated words mean. I'm not a doctor but wikipedia a huge FREE encylopedia. Even kids use it. I did when I was in high school. Adults too.