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Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits Choosing to write about a specific antipsychotic drug may seem a tad bizarre for a science paper. There are plenty more interesting things to write about than a single drug, a drop of water in a sea of similar medications. But my reasons for choosing to write about aripiprazole (also known by its brand name, Abilify) were personal ones. Both my aunt, and myself suffer from Bipolar I disorder, also known as Manic Depressive disorder. Treating such a disease with medication is not a precise art. There are countless varieties of antipsychotics, anti-depressants, and mood stabilizers used to treat Bipolar, and no one person uses the same amount or combination of medications. Finding the correct balance is a lengthy process that stretches from weeks to months and often years. Numerous medical trials have been conducted in the recent past to test for the safety and effectiveness of aripiprazole. These tests have yielded numerous beneficial results. Despite this, the side effects caused by the drug have often outweighed the benefits for some patients. Aripiprazole has also been tested for use outside of its primary functions as an atypical antipsychotic. Though aripiprazole was at one time considered a risky and volatile drug, extensive studies from many different medical groups have provided evidence that aripiprazole is a highly beneficial medication. Aripiprazole is known as an atypical antipsychotic (AAP), also known as a second generation antipsychotic. It primarily works by restricting (or antagonizing) dopamine flow between the neurotransmitters in the brain, as an imbalance of dopamine “may produce the psychotic symptoms (e.g., hallucinations, delusions, bizarre behavior) characteristic of schizophrenia and more severe cases of bipolar disorder ("Understanding Addiction." Carl Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits Erikson The University of Texas at Austin.).” This is different than that of a typical antipsychotic (TAP). A typical psychotic attaches to a dopamine receptor in the brain and “imitates” dopamine. Typical antipsychotics are used for patients with too little dopamine flowing throughout the brain. Both TAPs and AAPs target the ‘positive’ symptoms of
psychosis (e.g., hallucinations, delusions, bizarre behavior, disorganized speech).These medicines have proven to be highly effective for treating ‘negative symptoms’ of
schizophrenia, which are characterized by emotional and social withdrawal, flat affect, lack of spontaneity, inability to feel pleasure, Attention impairment, and other restrictions in thought, speech, and behavior.” ("Second Generation Antipsychotics." Academic Search Premier). This gives aripiprazole a wide variety of uses when treating psychosis, allowing it to fill the functions of multiple drugs at once. Aripiprazole is an antipsychotic, but the drug is often combined with antidepressants. The FDA has approved that aripiprazole can help improve the potency of antidepressants in patients who suffer from severe depression, studies involving aripiprazole and anti-depressants yield results that are across the board. Results from studies have varied from “70% of subjects achieving remission at the end of the study” (source N). However, a concerning side effect in rare cases have shown that aripiprazole that was used to treat depression caused patients to experience new or increased suicidal thoughts or actions (a symptom that aripiprazole is trying to treat, not exacerbate). “It is a known fact that antipsychotics and antidepressants can cause suicidal ideations. However, cases where the patient has suicidal actions or thoughts are fairly rare, and side effects are often overhyped by the media. The most important thing to do when prescribing a Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits patient new medication is to monitor them closely for side effects.” (Dr. Cynthia O’Brien). If a patient plans to start taking a new antipsychotic medication, consultation with their doctor is key, especially in the first few months of taking the drug. Strong communication about feelings and side effects while on the drug must be used so that problems can be identified and the patient be quickly taken off the drug to prevent harm to themselves or Aripiprazole is an antipsychotic, but the drug is often combined with antidepressants. The FDA recently approved that aripiprazole can help improve the functionality of antidepressants in adult patients who suffer from severe depression. This recent approval has been granted in light of a large number of medical studies involving aripiprazole, a vast majority of them yielding positive results. However, studies have only focused on adults with depression, not children, so the FDA has not approved aripiprazole for the treatment of youth depression. The FDA has approved the use of aripiprazole for youth patients for other purposes, just not as an amplifier for antidepressants. Whenever planning to start taking a new medication, it is vital for a potential patient to consult their doctor, because taking aripiprazole with an antidepressant may strengthen side effects or introduce new ones. The most common side effects seen were insomnia, fatigue, restlessness, and fidgeting. As stated previously, communication is key when dealing with Aripiprazole has been used for three primary purposes: treating psychotic disorders like schizophrenia and bipolar, amplifying the effects of antidepressants, and helping to stabilize mood swings and irritability of young autism patients. Numerous trials have Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits contributed into the FDA approving it for public use. Recent studies have also suggested that aripiprazole can be taken to help control substance abuse problems. This is because atypical antipsychotics control the flow of dopamine through the brain, and dopamine is the primary neurotransmitter involved with pleasure or “personal rewards.” Though once considered controversial, examining a few of the numerous medical trials involving aripiprazole has shed light unto its usefulness. A study involving aripiprazole and patients with bipolar disorder was conducted over May of 2003. The trial lasted for three weeks, and was one of the largest studies involving aripiprazole at the current date. All patients were age 18 or above and suffered from bipolar I disorder, and was hospitalized for the first two weeks of the three week trial. The two week hospitalization was implemented in order to thoroughly study and monitor side effects for both keeping the patients in good care (in case there were complications with side effects) and for accurate scientific results. 262 patients taking no other medications were given either a 30mg dose of aripiprazole (taken daily) or a placebo. On average, participants taking the aripiprazole began seeing improvements in their symptoms within four days. After two weeks of the three week study, all patients were evaluated to see if the symptoms of their bipolar I disorder had been alleviated or reduced. Patients were also tested for symptoms of involuntary movement disorders, a common side effect of atypical antipsychotics like aripiprazole. Those patients who did not pass the tests were deemed too unstable to be released, and were no longer instructed to take aripiprazole (or the placebo) and remained hospitalized. Subjects deemed stable were discharged from the hospital and continued to take aripiprazole (or the placebo) for another week before being Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits evaluated again for symptom improvement. The final results showed that of the total 262 participants, 42% of those taking aripiprazole achieved significant progress in reducing symptoms of their bipolar I disorder, compared to only 21% of participants taking the placebo. Of the 262 participants, only 27 discontinued due to side effects alone (14 aripiprazole patients and 13 in the placebo group). The results of this trial reinforce that aripiprazole is an effective drug for treating bipolar I, and also provides fast symptom improvement to those taking it. (Medical Trial: Fountoilakis, Konstantinos N., Eduard Vieta. Frank Schmidt. “Aripiprazole Monotherapy in the Treatment of Bipolar Disorder: A Meta- One of aripiprazole other uses is to improve the effectiveness of antidepressants of non-psychotic major depression disorder (NPMDD). In a study conducted in 2009, 50 patients from ages 18 to 65 participated in a 12 week trial. Participants took two medications: venlafaxine-XR (at a 37.5mg dose) and aripiprazole (starting at 5mg). Doses increased at regular increments over the 12 week trial, reaching 300mg of venlafaxine-XR and 30 mg of aripiprazole. 7 patients discontinued due to side effects, and it was during week 6 of the trial that the occurrence of moderate or higher intensity side effects peaked. Side effects then began to decline by the start of week 7. “Powerful side effects can discourage a patient from taking a medication. The key is to keep a record of where and when the side effects occur, and then have the patient consult their doctor. As a patient continues to regularly take a medication, they will build up a tolerance to the side effects, and they will experience them less and less often.” (Dr. Cynthia O’Brien) The most frequent side effects included “weakness or fatigue, loss of sexual interest, feeling drowsy Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits or sleepy, and irritable.” Other common side effects included fidgeting and “feeling hyper.” The results of the test were successful: 73% of participants were in a state of remission (no sign of negative symptoms) and 80% of participants not in remission were showing positive reactions to the drug and reduced symptoms. This is one of the many examples of the benefits of aripiprazole when combined with an antidepressant, widening the drug’s application for treating a multitude of ailments. (Medical Trial: John Rush, et al. “effectiveness Study of Venlafaxine-XR with Aripiprazole for Chronic or Recurrent Major A more recent study of aripiprazole’s uses comes from a study in conducted in December 2009. Aripiprazole is often used as a mood stabilizer, and has been approved by the FDA to treat youths with autism. One of the symptoms of autism is intense (and sometimes aggressive) mood swings, often increased during the period of adolescence. During a double blind study, 98 participants (51 taking aripiprazole, the other 47 on a placebo) took a daily dose of medication (or placebo), amount varying from 5mg -* 15mg, depending on the case. The ages of the participants ranged from six years old to 17 years old. As the 8 week trial continued, the children / adolescents took weekly surveys that measured their aggression levels. Those taking aripiprazole were significantly less aggressive compared to their peers taking the placebo. However, 10.6% of participants on aripiprazole discontinued due to side effects, as did 8.0% of participants on the placebo did the same. Beyond those who discontinued, the drug was well received by those who stuck with the medication, supporting that aripiprazole is an effective mood stabilizer for Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits youths with autism. (Medical Trial: Robert L Findling, et al. “Aripiprazole in the Treatment of Irritability in Children and Adolescents With Autistic Disorder.”) As an atypical antipsychotic, aripiprazole controls dopamine flow throughout the brain. Dopamine is known to be connected to problems with substance abuse, so interest involving aripiprazole and the treatment of substance abuse has risen. An 8 day study conducted in 2008 investigated if aripiprazole could be used to control alcohol cravings. 30 participants (ages 21 -65) who were seeking no other form of alcohol treatment participated in this 8 day study. Participants were issued packets of medication, either a placebo or a sample of aripiprazole. Participants were to take 5mg of the pill on day one, 10mg on days 2-3, and 15mg for days 4-8. Before the study, participants turned in a survey about how often they drank, and also kept a “drinking diary” over the following 8 days while on the medication (or placebo). All participants chosen had similar drinking patterns (a mean of 9.8 drinks over the past 72% of the last 90 drinking days. Over the eight days of the trial, all subjects on aripiprazole reported drinking less, and also had an increased number of days without drinking at all. While those on aripiprazole suffered from mild to moderate nervousness and insomnia, no subjects dropped the trial due to side effects. This study is yet another example of the uses of aripiprazole, and if more studies continue, patients needing help to control their substance abuse issues will have another option for assistance.(Medical Trial: Voronin, MD, PHD, Konstantin, Patrick Randall, PHD, Hugh Myrick, MD, and Raymond Anton, MD. "Aripiprazole Effects on Alcohol Consumption and Subjective Reports in a Clinical Laboratory Paradigm: Possible Influence of Self- Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits While aripiprazole has a wide number of uses, it is not for everyone. “Some people react badly to a drug. Often a bad reaction will happen because they are already taking medications, and adding a new one causes a bad reaction. Other times it’s a person’s ‘personal chemistry,’ and they have an adverse reaction, whether it be an allergic reaction or a bad response in their brains.” (Dr. Cynthia O’Brien). However, there are a number of other drugs that can perform other functions that aripiprazole does. Quetiapine (brand
name: Seroquel) is an atypical antipsychotic for treating disorders like bipolar or
schizophrenia. Users should know that it has a very powerful side effect that makes the user drowsy, as well as uncontrollable movements, like facial tics. Risperidone is another
atypical antipsychotic with the same functions as quetiapine. Its most common side effects are weight gain and movement disorders, which is typical of atypical antipsychotics. Paliperidone (sold as Invega) is also an atypical antipsychotic, which shares functions
with all the medications above. It is associated with weight gain, increased blood sugar levels, and movement disorders. There are even more drugs out on the market than mentioned here. Like stated previously, patients should establish strong communications with their doctor in order to find the right balance of medications and dosages. Aripiprazole has the ability to help control a wide variety of ailments. From its original purpose as an antipsychotic to a promising new way to help control substance abuse, aripiprazole has become a powerful drug that has the potential to help millions of patients. Medications like aripiprazole are not miracle drugs, but they have the potential to help a struggling patient conquer their symptoms so they can resume a functional and Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits Work Cited
"Aripiprazole - PubMed Health." PubMed Health. AHFS Consumer Medication Information, 16 May 2011. Web. 22 Sept. 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000221/>. Dazzan, Paola, Kevin D. Morgan, Ken Orr, Gerard Hutchinson, Xavier Chitnis, John Suckling, Paul Fearon, Philip K. McGuire, Rosemarie M. Mallett, Peter M. Jones, Julian Leff, and Robin M. Murray. "Different Effects of Typical and Atypical Antipsychotics on Grey Matter in First Episode Psychosis: the ÆSOP Study." The Good Drug Guide : New Mood-brighteners and Antidepressants. Medical Research Council (United Kingdom), 2005. Web. 27 Sept. 2011. <http://biopsychiatry.com/abilify-sideeffect.htm>. Description of Aripiprazole. Publication. Tokyo, Japan: Otsuka America Pharmaceutical, 2005. Academic Search Premier. Web. 23 Sept. 2011. <http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/021713s004,021436s007lbl.pdf>. Fountoilakis, Konstantinos N., Eduard Vieta. Frank Schmidt. “Aripiprazole Monotherapy in the Treatment of Bipolar Disorder: A Meta-Analysis.” Journal of Affective Dissorders 133.3 (2011) Academic Search Premier, EBSCO. Web 24, Sept. 2011 John Rush, et al. “effectiveness Study of Venlafaxine-XR with Aripiprazole for Chronic or Recurrent Major Depressive Disorder,” Austrailian & New Zealand Journal of Psychiatry 43.10 (2009): 956-967. Health Source: Nursing/Academic Editor. EBSCO.Web 25 sept 2011 Keck Jr. M.D., Paul E,, Ronald Marcus, M.D., Stavros Tourkodimitris, Ph. D., Mirza Ali, Ph. D., Amy Liebeskind, M.D., Anutosh Saha Ph. D., and Gary Ingenito, M.D. "A Placebo-Controlled, Double-Blind Study of the Efficacy and Safety of Aripiprazole in Patients With Acute Bipolar Mania -- Keck Et Al. 160 (9): 1651 -- Am J Psychiatry." The American Journal of Psychiatry. Aripiprazole Study Group, Sept. 2003. Web. 24 Sept. 2011. <http://ajp.psychiatryonline.org/cgi/content/full/160/9/1651>. Keck, P. E., P. J. Orsulak, A. J. Cutler, R. Sanchez, A. Torbeyns, R. N. Marcus, R. D. McQuade, and W. H, Carson. "ScienceDirect - Journal of Affective Disorders : Aripiprazole Monotherapy in the Treatment of Acute Bipolar I Mania: A Randomized, Double-blind, Placebo- and Lithium-controlled Study." ScienceDirect - Home. CN138-135 Study Group, 20 May 2008. Web. 26 Sept. 2011. <http://www.sciencedirect.com/science/article/pii/S0165032708002309>. Karl Hildner Science Through Film and Fiction Aripiprazole and Its New Benefits Mazza, Marianna, Maria Rosaria Squillacioti, Riccardo Daniele Pecora, Luigi Janiri, and Pietro Bria. "ScienceDirect - Psychiatry Research : Effect of Aripiprazole on Self-reported Anhedonia in Bipolar Depressed Patients."ScienceDirect - Home. 30 Jan. 2009. Web. 26 Sept. 2011. <http://www.sciencedirect.com/science/article/pii/S0165178108001455>. “Advice for Patients Taking Aripiprazole or Other Atypical Antipsychotic Medications.” O'Brien, Cynthia, M.D. Telephone interview. 21 Sept. 2011. Robert L Findling, et al. “Aripiprazole in the Treatment of Irritability in Children and Adolescents With Autistic Disorder.” Pediatrics 124.6 (2009): 1533-1540. Health Source: Nursing/Academic Editor. EBSCO. Web. 25 sept 2011 "Second Generation Antipsychotics." Academic Search Premier. EBSCO. Web. 25 Sept. 2011. <http://www.psychatlanta.com/documents/secondgeneration.pdf>. "Understanding Addiction” The University of Texas at Austin. Ed. Carl Erikson. University of Texas. Web. 25 Sept. 2011. <http://www.utexas.edu/research/asrec/dopamine.html>. Voronin, MD, PHD, Konstantin, Patrick Randall, PHD, Hugh Myrick, MD, and Raymond Anton, MD. "ARIPIPRAZOLE EFFECTS ON ALCOHOL CONSUMPTION AND SUBJECTIVE REPORTS IN A CLINICAL LABORATORY PARADIGM: POSSIBLE INFLUENCE OF SELF-CONTROL." NIH Public Access. Nov. 2008. Web. 26 Sept. 2011. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588475/?tool=pmcentrez>.

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