Sunday, January 11, 2015

Is Abilify Effective for Depression?

Abilify is the top-selling prescription drug in the U.S., a ranking it has held for a couple of years now. What's astonishing is that this drug was originally approved as (and only used as) an antipsychotic. My wife, who has schizoaffective disorder, is an experienced user of Abilify, Haldol, Latuda, Zyprexa, and Saprhis. She will attest to the antipsychotic properties of Abilify (and I'll show a graph for efficacy further below). But treatment of psychosis is not what made Abilify the top-selling drug in the U.S. Abilify is now widely prescribed as an adjunctive drug for depression; plus other uses, both on-label and off-label.

The manufacturer says Abilify is indicated for:
  • Use as an add-on treatment to an antidepressant for adults with Major Depressive Disorder who have had an inadequate response to antidepressant therapy
  • Treatment of manic or mixed episodes associated with Bipolar I Disorder in adults and in pediatric patients 10 to 17 years of age
  • Treatment of schizophrenia in adults and in adolescents 13 to 17 years of age
  • Treatment of irritability associated with Autistic Disorder in pediatric patients 6 to 17 years of age
Physicians and consumers alike have bought into the "Abilify as an adjunct" idea in a big way. Why has this "adjunct" modality become so popular? The main reason is that regular antidepressants simply aren't very effective, and people in a desperate mental state naturally want to know what else can be done other than switching from one ineffective drug to another.

But how good is Abilify, really, as an adjunct to antidepressants? Here is the graph touted on the Abilify website:

Abilify's efficacy (as an adjunct to antidepressants), versus placebo. (Click to enlarge.) The vertical scale plots average change (decrease) in patient scores on the Montgomery–├ůsberg Depression Rating Scale.

This graph pools data from three studies. It shows that the average drop in MADRS score for patients on placebo-plus-antidepressant is a drop of 6.2 points after 6 weeks (from a starting average score of 26). When Abilify is added to the mix, the average score drop is 9.4 points. So if you add Abilify, you can expect a 3.2-point drop in your MADRS score that you wouldn't otherwise have had.

But if you look at the MADRS test, a change in just one answer (e.g., better sleep) could easily produce a 3-point change in your score. What you need to ask yourself is whether this magnitude of change is clinically significant. If you found a dollar bill on the sidewalk, your MADRS score would probably change by 3 points (briefly, of course). If your tax refund was $100 larger than you expected, it would probably mean a 3-point change on MADRS. The point is, the magnitude of change we're talking about here is small. It may be statistically significant, but is it clinically significant?

Abilify's primary use is in treatment of schizophrenia symptoms. Here's the efficacy graph for improvement on the PANSS scale, a common rating system for assessing schizophrenia symptoms:

Abilify efficacy with respect to schizophrenia symptoms (placebo in grey).
This is a much different graph. It shows what anyone would call good separation from placebo: five to eight times bigger change, with Abilify, than with placebo alone.

Abilify costs over a thousand dollars a month (10 mg, 30 pills) if you were to have to pay for it out of pocket. For most patients, this cost is hidden by insurance (or Medicare, in my wife's case). If you were taking Abilify for depression (as an adjunct) and had to pay for it out of pocket, you'd probably find the cost depressing (to the tune of much more than a 3-point drop in MADRS). Still, desperate people will do desperate things. Adding Abilify is "one more thing to try." So by all means try it. But don't expect miracles. If you see any effect at all, it's likely to be a rather small one.

Buy my books (or click to find out more, at least):
Have you added your name to our mailing list? Thank you. Be well.

9 comments:

  1. Excellent point regarding clinical trials and the scales used to evaluate efficacy.
    BTW Lundeck / Otsuka announced results of their second generation Abilify drug Brexpiprazole for adjunct after failure MDD using the MADRS scale, link below.

    http://investor.lundbeck.com/releasedetail.cfm?ReleaseID=886966

    Looking forward to reading your paper!

    ReplyDelete
  2. Very good info. It's worth pointing out that all drug companies have the stats to back up the meds, but that doesn't mean they all work as planned in the long run. I know of reports that more people become suicidal on Abilify, and I think you mentioned in a previous post that Robin Williams had started on it before his death. I lost a friend to suicide after she started Abilify. I still believe it works for many people, just that it requires very close monitoring. Thanks for the insights.

    ReplyDelete
  3. It works for my wife (for schizophrenia, not depression; she's still depressed). Robin Williams was taking Remeron (which I take) and Seroquel (which I have taken). He had just started on Seroquel (an antipsychotic that's often given adjunctively for bipolar) eight days before the hanging. Williams was likely taking these drugs for bipolar, not schizophrenia. But you make good points. Thanks for commenting.

    ReplyDelete
  4. an unique amusement tool. http://www.blogolink.com/ we examine in this overview are Android TV Box Reviews its brand name at the facility of everybody's Best Android TV Box of 2018 that traditional Android mobiles currently have. Android TV Box run a larger choice of applications and also material, official guide The versions we assessed.

    ReplyDelete

  5. We provide a wide range of computer chairs, ergonomic chairs, leather chairs and thus, we are leading manufacturer of office furniture chairs. We supply products not only to local clients but also to national and international clients. We are commonly known as office chairs Mumbai that provides a lot of office furniture all over the world and help their employees in working in a comfortable seating without getting tired or back pains.
    Chair Manufacturers in Mumbai
    Chair Supplier in Mumbai
    Office Chair Supplier in Mumbai
    Visitor Chair Supplier in Mumbai
    Chair Dealers in Mumbai

    ReplyDelete
  6. Indian Packers and Movers in Mumbai provide service right from picking up parcels from your desk to delivery at the destination door step, including taking care of all related matters. ( Packers and Movers in Mumbai providing 24X7 customer care service for its new and lifetime valuable clients. )
    Please Visit Our Website : https://indianpackersmovers.in/
    Packers and Movers in KhargharPackers and Movers in Jogeshwari
    Packers and Movers in Kharghar

    ReplyDelete
  7. Welcome to Indian Packers and Movers in Mumbai, We have a realistic team of professionals in Moving & Packing, Loading & Unloading and Transportation of your expensive goods with care. Packers and Movers in Mumbai goes behind the intercontinental principles which give surety that the goods are relocates carefully without any smash up. We at, Packers and Movers in Mumbai has experienced employees to take care of your goods in Packing and Moving Services in Mumbai.
    Movers and packers in Dhanu Road
    Movers and packers in Mumbai CST
    Movers and packers in Masjid
    Movers and packers in Sandhurst Road
    Movers and packers in Byculla

    ReplyDelete
  8. Professional movers and packers Hyderabad employ skilled individuals who have the experience to carry out your relocation with efficiency. They are expert in packing your goods, using the required equipment to move your household goods and ensuring their safety.
    Please Visit Our Website : Packers and Movers Hyderabad

    ReplyDelete

Add a comment. Registration required because trolls.