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Abilify vs Seroquel
Introduction
For patients with bipolar disorder or schizophrenia, there are certain drugs that can help stabilize mood fluctuations and manage symptoms by altering the balance of specific chemicals in the brain called neurotransmitters. Abilify (aripiprazole) and Seroquel (quetiapine) are two such medications commonly prescribed for these conditions. Abilify and Seroquel impact different neurotransmitters in the brain, but both have mood-stabilizing effects on patients with mental health conditions such as schizophrenia and bipolar disorder. Abilify is classified as an atypical antipsychotic, and works as a partial dopamine agonist and serotonin antagonist, affecting levels of both dopamine and serotonin in the brain. Seroquel is also classified as an atypical antipsychotic, but acts primarily as a selective antagonist of specific subtypes of serotonin receptors (5-HT2) and dopamine receptors (D2).
Abilify vs Seroquel Side By Side
| Attribute | Abilify | Seroquel |
|---|---|---|
| Brand Name | Abilify | Seroquel |
| Contraindications | Cannot be taken with MAOIs or SSRIs without a proper washout period. May worsen symptoms of depression or suicidal ideation. | Cannot be taken with MAOIs or SSRIs without a proper washout period. May worsen symptoms of depression or suicidal ideation. |
| Cost | Around $900 for 30 tablets (10 mg) of brand-name Abilify. For generic aripiprazole, costs range from about $18.00 to $90.00 for 30 tablets. | Brand-name Seroquel costs approximately $420 for 100 tablets (25 mg). Generic quetiapine can cost from $18.00 to $120.00 for 100 tablets (25 mg strength) . |
| Generic Name | Aripiprazole | Quetiapine |
| Most Serious Side Effects | Neuroleptic malignant syndrome, increase in suicidal thoughts or tendencies, severe allergic reactions. | Neuroleptic malignant syndrome, enhanced suicidal thoughts or tendencies, severe allergic reactions. |
| Severe Drug Interactions | MAOIs, SSRIs | MAOIs, SSRIs |
| Typical Dose | Oral dosages range from 2–30 mg/day, with a starting dose usually beginning at 10 or 15 mg/day. | Typically initiated at 25 mg/day, increasing to 300-400 mg/day by the fourth day, with a maximum dosage of 800 mg/day. |
What is Abilify?
Aripiprazole (the generic name for Abilify) belongs to a class of medications called second-generation antipsychotics, which are also known as atypical antipsychotics. Aripiprazole was first approved by the FDA in 2002. It works by stabilizing dopamine and serotonin levels in the brain to alleviate symptoms related to mental health conditions such as bipolar disorder and schizophrenia. Unlike other antipsychotics, aripiprazole partially stimulates dopamine receptors rather than fully blocking them, resulting in relatively fewer side effects.
Quetiapine (the generic name for Seroquel) is another second-generation antipsychotic drug, which was approved by the FDA in 1997. It blocks both serotonin and dopamine receptors, but also influences adrenergic and histaminergic systems, which gives it a distinct side effect profile that can include things such as sedation or weight gain. Both drugs are used for similar psychiatric indications, but each can has its own benefits and drawbacks and the choice between these medications will be made in consideration of individual patient factors.
What conditions is Abilify approved to treat?
Abilify (aripiprazole) is approved for the treatment of several mental health disorders, including:
- Schizophrenia, in adults and adolescents aged 13 to 17 years
- Manic or mixed episodes associated with bipolar disorder in adults and pediatric patients aged 10 to 17 years
- Major depressive disorder (MDD) in adults, as an adjunctive therapy to antidepressants
- Irritability associated with autism spectrum disorder in pediatric patients aged 6 to 17 years
How does Abilify help with these illnesses?
Abilify aids in the management of conditions such as schizophrenia and bipolar disorder by regulating the levels of dopamine–and to a lesser extent serotonin–in the brain. It does this through its differential action as both a partial agonist and partial antagonist at dopamine D2 receptors, which means that it binds to these receptors and stimulates or blocks them, but not to the same extent as dopamine itself would. Dopamine is a neurotransmitter that plays a critical role in how we feel pleasure, think, plan, and motivate ourselves. In disorders like schizophrenia and bipolar disorder, there's typically an imbalance of dopamine which can lead to symptoms like hallucinations or mood swings. By stabilizing levels and activity of dopamine, Abilify helps mitigate these symptoms, allowing patients to achieve better control over their condition. Abilify also has effects on serotonin receptors, being a partial agonist at 5-HT1A receptors and an antagonist at 5-HT2A receptors. Serotonin is another neurotransmitter that's involved in regulation of mood, sleep, and body temperature, among other functions.
What is Seroquel?
Seroquel is a brand name for quetiapine, an atypical antipsychotic medication that acts primarily on serotonin and dopamine receptors in the brain. It was first approved by the FDA in 1997. Seroquel works as an antagonist at dopamine, serotonin, and adrenergic receptors, partially blocking the activity of these neurotransmitters. It also has antihistamine and anticholingeric properties, which increases the likelihood of drowsiness and sedation. Because of this, Seroquel has a somewhat different side-effect profile than other antipsychotic medications, that can include sedation, weight gain, and metabolic changes. Seroquel has been shown to be beneficial for managing symptoms of schizophrenia and bipolar disorder, especially in patients who do not respond well to other atypical antipsychotics.
What conditions is Seroquel approved to treat?
Seroquel has been approved by the FDA for the treatment of a number of serious mental health conditions, including:
- Schizophrenia, in adults and children who are at least 13 years old
- Bipolar disorder (manic depression) in adults and children who are at least 10 years old
- Major depressive disorder (MDD) in adults, when used together with antidepressant medications
How does Seroquel help with these illnesses?
Seroquel, also known as quetiapine, belongs to a class of drugs known as atypical antipsychotics, which work by influencing the actions of certain chemicals in the brain known as neurotransmitters. Seroquel has a strong impact on both dopamine and serotonin, which are heavily involved in mood regulation and the body's response to stress. It also impacts levels of norepinephrine, and has antihistamine and anticholinergic properties as well. Through modifying the activity of these different chemical messengers and their receptors, Seroquel helps alleviate symptoms of psychiatric disorders such as schizophrenia or bipolar disorder. Like Abilify, Seroquel can either be used alone or in combination with other medications for treatment-resistant cases. Compared to other drugs of the same class, it may have more pronounced sedative effects due to its antagonism of histamine receptors. However, this property also makes it potentially useful for patients who also struggle with insomnia related to their mental health condition.
How effective are Abilify and Seroquel?
Both Abilify (aripiprazole) and Seroquel (quetiapine) have established histories of success in managing symptoms of psychiatric disorders such as schizophrenia, bipolar disorder, and major depressive disorder. While often prescribed for similar conditions, they work on neurotransmitter pathways through distinct mechanisms of action and therefore one or the other may be preferred depending on individual patient factors. The effectiveness of Abilify and Seroquel has been directly compared in several double-blind clinical trials. The two drugs demonstrated comparable efficacy in managing symptoms related to psychotic disorders, although their safety profiles varied somewhat.
A 2006 review highlighted that aripiprazole has consistent anti-psychotic activity starting from the first week of treatment. The study also revealed that its side effect profile is more favorable than those of many other antipsychotics due to its unique mechanism of action, acting to stabilize the dopamine system. As Abilify (aripiprazole) does not block dopamine receptors completely but rather modulates their activity, weight gain and metabolic issues associated with many antipsychotic medications are less likely to occur with Abilify.
Studies done on Seroquel suggest that it is also effective in treating symptoms associated with psychosis and depression. However, it's typically considered when initial treatment with another drug does not yield sufficient results, or when other antipsychotic agents cannot be prescribed due to contraindications. Quetiapine's main advantage over related drugs lies in its sedative properties, which makes it particularly useful for patients suffering from insomnia or anxiety-related conditions alongside their primary psychiatric condition. However, this can sometimes lead to excessive daytime sleepiness, which should be monitored by both the physician and the patient.
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At what dose is Abilify typically prescribed?
Oral dosages of Abilify range from 2–30 mg/day, but studies have shown that a starting dose of 10 or 15 mg/day is usually effective in treating schizophrenia or bipolar disorder in most adults. Adolescents aged 13-17 may be started on 2 mg/day. For both populations, dosage can be adjusted after a couple of weeks if there is no improvement. The maximum dosage that should not be exceeded in any case is 30 mg/day.
At what dose is Seroquel typically prescribed?
Seroquel treatment is typically initiated at a dose of 25 mg twice per day, taken orally. The dosage can subsequently be increased in increments of an additional 50 to 100 mg/day, up to 300–400 mg per day by day 4 or day 5. Depending whether Seroquel has been prescribed for a depressive disorder or schizophrenia, the dosage may differ. Daily dosages should be divided into two or three individual doses throughout the day. If there's no noticeable improvement or response to treatment after several weeks, your healthcare provider may consider adjusting your daily dose beyond 400 mg/day. The maximum dosage not to be exceeded is 800 mg/day (again split into multiple doses).
What are the most common side effects of Abilify?
Common side effects of Abilify include:
- Anxiety or nervousness
- Trouble sleeping (insomnia)
- Drowsiness/somnolence
- General weakness and fatigue
- Tremors or shaking movements, often in the hands
- Loss of appetite
- Nausea
- Indigestion, discomfort, or pain in the digestive tract (dyspepsia)
- Constipation or diarrhea
- Dry mouth
- Decreased sexual desire (libido) and other sexual dysfunctions
- Skin rash
- Sweating more than usual
- Disturbed dreams
- Flu-like symptoms: fever, sore throat, swollen glands, lack of energy (known as 'flu syndrome')
- Inflammation in the back of your throat, which can cause a sore throat (known as pharyngitis)
- Infection in the sinuses, which can cause inflammation in the sinuses (known as sinusitis).
When taking Abilify, it's important to be aware of these potential side effects and communicate openly with your healthcare provider if you experience any of the symptoms listed above or any other strange or suspicious changes to your health.
Are there any potential serious side effects for Abilify?
While taking Abilify, there are certain things to watch out for which can indicate serious reactions and may require urgent medical assistance:
- Increase in suicidal thoughts or tendencies
- Signs of a severe allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Visual disturbances, including blurred vision, tunnel vision, and seeing halos around lights
- Cardiac symptoms, such as a rapid heartbeat (tachycardia), a fluttering sensation in the chest (palpitations), shortness of breath, or sudden bouts of dizziness or feeling like you might faint
- Symptoms of hyponatremia (low sodium levels), which can include headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination or feeling unsteady
- Neuroleptic malignant syndrome: A rare but serious neurological disorder characterized by muscle rigidity; high fever; sweating confusion; fast uneven heartbeats tremors feeling like you might pass out.
- Symptoms of serotonin syndrome, which can include agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness or twitching, loss of coordination, nausea, vomiting, diarrhea
If you experience any of the above symptoms while taking Abilify, please contact your healthcare provider immediately for guidance. If you can't get in contact with your physician/psychiatrist/etc., it's better to play it safe and seek emergency medial assistance.
What are the most common side effects of Seroquel?
Seroquel (quetiapine) has side effects that include:
- Dry mouth and/or sore throat
- Constipation
- Blurred vision
- Occasional dizziness
- Nausea or stomach upset (usually minor in severity)
- Sleep disturbances, including insomnia
- A feeling of restlessness or nervousness
- Weight gain, although weight loss is also less-commonly reported
- A fast or irregular heartbeat
- Headaches are common, but should not be severe
- Rashes (potentially serious so seek immediate medical attention if you develop a rash)
- Muscle pain or weakness
Please be aware of these potential side effects of Seroquel, and consult with your healthcare provider if you experience any of the symptoms listed above.
Are there any potential serious side effects for Seroquel?
Seroquel also carries a risk of rare yet potentially serious side effects which would require immediate attention. These can include:
- Symptoms suggestive of a severe allergic reaction, such as hives, difficulty breathing or swallowing, swelling in your face or throat
- Increase in suicidal thoughts or tendencies, especially among adolescents and younger adults
- More frequent seizures
- Changes in mood or behavior that are unusual for you, such as increased agitation, restlessness, anxiety, feelings of panic, aggressive behavior, or hallucinations.
- Vision disturbances, like blurred vision or eye pain
- A fast or irregular heartbeat
- Symptoms that can indicate neuroleptic malignant syndrome, such as fever, muscle rigidity/stiffness/twitching, rapid heartbeat/pulse/breathing rate, fluctuations in blood pressure, and/or abnormal changes to your mental state such as delirium or agitation
If you experience any of the symptoms listed above while taking Seroquel, please consult with your healthcare provider immediately or seek emergency medical assistance. Some serioues reactions, although rare, can be life-threatening if not attended to promptly.
Contraindications for Abilify and Seroquel
Like many other antipsychotic medications, both Abilify and Seroquel may worsen symptoms of depression in some people. If you notice a deterioration in your mental health or an increase in suicidal ideation, thoughts, or behaviors while taking either of these drugs, please seek immediate medical attention.
Neither Abilify nor Seroquel should be taken if you are currently using or have recently used certain types of other medications:
- Monoamine oxidase inhibitors (MAOIs)
- Selective serotonin reuptake inhibitors (SSRIs) These classes of drugs are sometimes prescribed for depression, anxiety, and other mental health conditions, but can have dangerous interactions with antipsychotics such as Seroquel and Abilify.
Always inform your physician about any medications you're currently taking, or have taken recently (within the last month). MAOIs will require a 'washout' period of roughly two weeks to clear out from the system before you can start treatment with Seroquel or Abilify. SSRIs should also be discontinued at least 14 days prior to initiating treatment with either of these (or other) antipsychotics.
How much do Abilify and Seroquel cost?
For the brand-name versions of these medications:
- The price of 30 tablets of Abilify (10 mg) averages around $900, which works out to between $30 and $90 per day.
- The price for 100 tablets of Seroquel (25 mg) is approximately $420, working out to anywhere between $50 and $135 per day, depending on dosage. Packages with higher-dose tablets are available, which can offer cost savings for patients taking higher dosages such as 400 or 600 mg/day.
Asssuming typical dosages, the costs of brand-name Abilify and Seroquel are in a similar range on a per-day treatment basis. Please note that cost should not be your primary consideration when determining which drug is right for you. Generic versions are also available for both of these drugs, offering significant cost savings. In general, generic versions of medications are functionally equivalent to their brand-name counterparts, and have the exact same effects and side effects.
- Aripiprazole (generic Abilify) can be bought in packs of 30 tablets with different strengths, working out to as little as $0.50 per daily dose (regardless of whether the tablet is dosed at 10, 20, or 30 mg)
- Quetiapine fumarate (the generic version of Seroquel) can work out to as little as $0.50 per day of treatment, which might increase to $1.50–$3.00 per day for higher doses (400 mg/day up to 800 mg/day).
Popularity of Abilify and Seroquel
Aripiprazole, both in generic form and as brand names such as Abilify, was estimated to have been prescribed to about 9.5 million people in the US in 2020, accounting for roughly 15% of atypical antipsychotic prescriptions in the US in that year. The use of aripiprazole has been generally increasing in prevalence since its approval by the FDA back in 2002.
Quetiapine, including branded versions such as Seroquel, was prescribed to approximately 7 million people in the US during the same year (2020), thus being slightly less common than aripiprazole. Quetiapine is also commonly used off-label for insomnia due to its sedative properties. The prevalence of quetiapine has remained relatively steady over recent years.
Conclusion
Both Abilify (aripiprazole) and Seroquel (quetiapine) have long-standing records of successful use among patients with mental health conditions like bipolar disorder, schizophrenia, and major depressive disorder. Both drugs are backed by numerous clinical studies indicating their effectiveness over placebo. In certain situations, such as when a ptient doesn't respond well to one drug alone, the two drugs may be used together; however, this should only be done under the explicit direction and supervision by a physician due to the high potential for increased side effects and dangerous interactions. Both Seroquel (quetiapine) and Abilify (aripiprazole) are available in generic form, which offers significant cost savings particularly for those paying out-of-pocket.
The mechanisms of action of Abilify and Seroquel differ. Abilify acts as differentially on dopamine D2 receptors (as both a partial agonist and antagonist) and also exerts influence on serotonin receptors. Seroquel acts as an antagonist at dopamine, serotonin, and adrenergic receptors, and also exhibits potent antihistamine and anticholinergic properties. Either drug can be used alone or in combination with other medications such as other antipsychotics or antidepressants, depending on the condition being treated and individual response to the drugs.
Both Abilify and Seroquel may require an adjustment period, wherein effects might not be immediately apparent after starting treatment. The side effect profiles of the two drugs overlap to a significant degree, but there are also differences due their distinct mechanisms of action. Individual response may vary widely depending on each individual's unique physiology and medical history. Some side effects common to both Seroquel and Abilify include drowsiness, weight gain, and dry mouth, although Seroquel has been more commonly associated with weight gain than Abilify. Patients taking either of these medications, regardless of the condition it's been prescribed for, should closely monitor any changes in their condition and their overall health, especially when beginning treatment. Please seek immediate medical attention if you notice worsening symptoms, increased thoughts about self-harm, or other worrying symptoms.
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Refrences
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