Do you remember the TV commercials for Abilify? At the time, it was being marketed in such a way that a lot of people thought it was an antidepressant. It’s not, though. Abilify is most definitely an antipsychotic, primarily indicated for schizophrenia and bipolar disorder, and it comes with the full list of potential side effects that another antipsychotic might come with. When Abilify was first released, its manufacturer pushed a lot of half-truths (or null-truths) like “Abilify is weight neutral” (26% of patients experience clinically significant weight gain, albeit not as much as Zyprexa) and “Abilify doesn’t cause movement disorders” (it can cause tardive dyskinesia (TD), and 9% of patients experience akathisia — a profound inner restlessness that patients often describe as wanting to “crawl out of [their] skin”). Overall, 15% of patients experience a serious adverse drug reaction.

All of that said… Abilify isn’t a bad drug.

I took Abilify for four years before developing a TD-like movement disorder that ultimately led me to discontinue it. (The same movement disorder worsened on Vraylar, which is a very close relative of Abilify.)

It might be fair to say that Abilify is misunderstood. I don’t think it should have been marketed the way it was. But when we’re talking about schizophrenia and bipolar disorder, well, it’s not the worst of the options. Clozapine and Zyprexa are worse for weight gain. Haldol is worse for movement disorders, like TD and akathisia. But is it effective?

Actually, Abilify was pretty effective for me. When I first started taking it, I would sleep all day. I’d fall asleep in my classes, like, head-on-desk, passed out. (This was particularly troublesome in my class on child abuse.) Then I started taking a stimulant for my ADHD, and everything seemed to be in harmony. Until a new psychiatrist took me off of Abilify to try a newer drug (Latuda — which did nothing for me). When I eventually went back on, I had all kinds of weird side effects. I couldn’t sit, or even stand still — a condition that my psychiatrist would later describe as akathisia. And my head started to shake involuntarily.

So how effective is it, really? The maximum dose of Abilify is 30mg, but benefit at doses higher than 15mg has not been established. A concept that is sometimes floated around in psychiatry is that of equivalent doses, usually CPZ (chlorpromazine) or OLA (olanzapine) equivalents. In this case, we’ll use haloperidol equivalents. 15mg Abilify is equivalent to 7.5 mg of Haldol which is also equivalent to a whopping 750mg quetiapine (Seroquel) — very close to the maximum dose of 800mg. We can see here that Haldol is stronger than Abilify, and Seroquel is weaker. We can tell based on the maximum dose of each and where the others stand in comparison.

Think of it like this: the maximum daily dose of Haldol is 30mg. The equivalent dose of Abilify is 35 mg — above the maximum. So it’s a bit weaker than Haldol. Meanwhile, Seroquel is much weaker. (In fact, Seroquel is the lowest potency antipsychotic, and usually isn’t used to treat psychosis.)

The moral of the story is not to trust the commercials put out by drug companies. I won’t be taking Abilify again, and unfortunately my movement disorder has never completely gone away. For some people, though, it’s a great medication.