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Lithium vs Abilify
Introduction
For individuals diagnosed with bipolar disorder or schizophrenia, certain medications can help in stabilizing mood fluctuations and managing symptoms. Lithium and Abilify (aripiprazole) are two such drugs that are often prescribed for these conditions. Both have an impact on neurotransmitters in the brain, but they interact differently to bring about their therapeutic effects. Lithium is a mood stabilizer known to affect several neurotransmitter systems; however, its exact mechanism of action remains elusive. It's thought that it may enhance the reuptake of serotonin and norepinephrine thus reducing overactivity in the brain. On the other hand, Abilify works as a partial dopamine agonist and serotonin antagonist which means it stimulates dopamine receptors while blocking specific serotonin receptors in the brain.
Lithium vs Abilify Side By Side
| Attribute | Lithium | Abilify |
|---|---|---|
| Brand Name | Lithium | Abilify |
| Contraindications | Should not be taken with certain types of diuretics known as 'thiazide diuretics'. | Should not be used together with strong CYP3A4 inhibitors such as ketoconazole and clarithromycin without doctor's advice. |
| Cost | The price for 60 tablets of lithium carbonate ER (450 mg) averages around $80, or generic versions starting from about $0.50 up to just over a dollar per day depending on dosage. | The cost of 30 tablets of Abilify (10 mg) averages around $900, or approximately $30/day, with generic versions starting at roughly $3/day and may rise based on dosage requirements. |
| Generic Name | Lithium Carbonate | Aripiprazole |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, vision disturbances, rapid heart rate, chest discomfort, shortness of breath, low sodium levels, severe nervous system reactions like muscle stiffness and tremors. | Allergic reactions, changes in vision, difficulty swallowing, distorted thoughts and unusual increase in activity and talking (mania), fainting spells, fast or irregular heartbeat, increased thirst and/or hunger, unusual bleeding or bruising, seizures. |
| Severe Drug Interactions | Thiazide diuretics can significantly increase the level of lithium in the blood to a potentially dangerous level. | Strong CYP3A4 inhibitors like ketoconazole and clarithromycin. |
| Typical Dose | Oral dosages typically range from 900-1800 mg/day, divided into two to three doses. | Typically begins at a dosage of 10–15 mg/day, taken once daily, can be increased to up to 30 mg/day if necessary. |
What is Lithium?
Lithium, a mood stabilizer that has been a mainstay treatment for bipolar disorder since its FDA approval in 1970, works by altering the distribution of sodium in nerve and muscle cells and influencing reuptake of neurotransmitters. It's prescribed to manage both manic and depressive episodes associated with bipolar disorder. Lithium acts broadly on several different neurotransmitter systems; this broad activity results in a number of side effects including tremor, thirst, or weight gain.
On the other hand, Aripiprazole (the generic name for Abilify), is an atypical antipsychotic approved by the FDA in 2002. It works differently than lithium as it primarily influences dopamine and serotonin receptors in the brain. Unlike other antipsychotics which fully block dopamine receptors thereby leading to more side effects like movement disorders or metabolic syndrome, Abilify selectively modulates these receptors reducing such risks while effectively managing symptoms of bipolar disorder.
What conditions is Lithium approved to treat?
Lithium is approved for the treatment of specific mental health conditions:
- Bipolar disorder, which includes manic episodes and as a maintenance treatment to prevent relapse
- Major depressive disorder (in combination with antidepressants)
- Aggressive or self-harming behavior in patients with various psychiatric disorders.
On the other hand, Abilify is used to treat:
- Schizophrenia in adults and adolescents aged 13 years and older
- Bipolar I Disorder in adults, adolescents aged 10 years and older, including manic or mixed episodes that happen with bipolar I disorder -Treatment-resistant depression as an add-on treatment to an antidepressant for adults -Major Depressive Disorder (MDD) -Irritability associated with Autistic Disorder in pediatric patients (6–17 years of age)
How does Lithium help with these illnesses?
Lithium helps to manage bipolar disorder by stabilizing abnormal activity in the brain. It does this by altering the way nerve cells respond to neurotransmitters, thus regulating mood and reducing extremes of emotion or changes in mood. Neurotransmitters are chemicals that act as messengers in the brain and throughout the body, playing an important role in many bodily functions including mood regulation, cognition, memory, sleep patterns among other things. In individuals with bipolar disorder there is often an imbalance or irregularity of these chemical messengers leading to extreme variations in mood also known as manic or depressive episodes. Therefore, by modifying how neurons respond to neurotransmitters, lithium can help limit the negative effects of bipolar disorder and assist patients manage their condition and stabilize their moods.
What is Abilify?
Abilify, also known as aripiprazole, is an atypical antipsychotic and a partial dopamine agonist. It works by modulating the activity of dopamine-2 (D2) and serotonin-2A (5-HT2A) receptors in the brain. Unlike lithium, Abilify does not inhibit or enhance reuptake of certain neurotransmitters but instead balances dopaminergic and serotonergic activity. First approved by the FDA in 2002, Abilify is widely used for several psychiatric conditions including bipolar disorder, schizophrenia, major depressive disorder as an add-on treatment to antidepressants when they are ineffective on their own.
Its side-effect profile differs from that of lithium; common side effects can include weight gain and movement disorders among others. However, it's less likely to cause kidney damage which is characteristic with long-term use of lithium. The balancing effect on dopamine makes Abilify particularly beneficial for patients who do not respond well to mood stabilizers like lithium.
What conditions is Abilify approved to treat?
Abilify is approved by the Food and Drug Administration (FDA) for use in managing several mental health conditions. These include:
- Schizophrenia
- Bipolar disorder, specifically manic episodes and as a maintenance treatment
- Major depressive disorder, as an adjunctive therapy to other antidepressant medications when the response from these drugs alone is insufficient.
- Irritability associated with autistic disorder in pediatric patients aged 6–17 years.
It's crucial to note that Abilify should always be used under close medical supervision due to its potential side effects and interactions with other medications.
How does Abilify help with these illnesses?
Dopamine is a neurotransmitter that plays several important roles in the brain and body, including involvement in reward and pleasure systems, memory, and motor control. Its dysregulation has been implicated in conditions such as bipolar disorder and schizophrenia. Abilify works by modulating the levels of dopamine available in the brain, thereby helping to alleviate some of the symptoms associated with these disorders. It acts as a partial agonist at dopamine receptors, which means it both increases or decreases dopamine activity when needed. This makes Abilify unique amongst other antipsychotic medications like lithium which primarily work to suppress excessive dopamine activity only. Moreover, Abilify also affects serotonin levels thus providing more balanced treatment for those who do not respond well to typical mood stabilizers like lithium alone.
How effective are both Lithium and Abilify?
Both lithium and aripiprazole (Abilify) have established histories of success in treating patients with bipolar disorder, though they were initially approved by the FDA several decades apart. Since they act on different neurotransmitters, they may be prescribed under different circumstances. The effectiveness of lithium and aripiprazole in alleviating symptoms of bipolar disorder has not been directly compared in head-to-head trials; however, both drugs have shown efficacy in managing symptoms as per separate studies.
A 2005 meta-analysis reports on lithium demonstrated its effectiveness at preventing manic and depressive episodes starting from the early weeks of treatment. Its side effect profile includes common issues like tremor, increased thirst and urination, which is manageable for most patients. Lithium remains one of the gold standard treatments for bipolar disorder due to its proven efficacy over decades of use. It also appears to reduce suicidal ideation and behavior among those with this condition.
On the other hand, a 2014 review showed that aripiprazole seems to be more effective than placebo in managing acute manic or mixed episodes related to bipolar I disorder but lacks robust data supporting its use during depressive phases or as maintenance therapy post-acute episode resolution. Nonetheless, Abilify might be considered as an additional treatment option when first-line treatments are ineffective or not well-tolerated due to side effects such as weight gain or metabolic syndrome associated with some mood stabilizers like valproate.
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At what dose is Lithium typically prescribed?
Oral dosages of Lithium typically range from 900-1800 mg/day, divided into two to three doses. However, studies indicate that a lower dosage may be sufficient for some individuals in managing bipolar disorder. On the other hand, Abilify is usually started at 10 or 15 mg/day for adults with schizophrenia and can be adjusted within the range of 10–30 mg/day based on individual response and tolerability. Children and adolescents' starting dose is typically lower - around 2mg per day for those aged between 13-17 years old suffering from manic or mixed episodes associated with Bipolar I Disorder. For both medications, dosage adjustments should always be guided by therapeutic response under close medical supervision to ensure safety and efficacy.
At what dose is Abilify typically prescribed?
Abilify treatment typically begins at a dosage of 10–15 mg/day, taken once daily. The dose can then be increased to up to 30 mg/day if necessary and tolerated by the patient. This increase should only occur after a minimum of two weeks since initiating therapy or adjusting the dose. A maximum dose of 30 mg per day may be considered if no significant clinical improvement is observed with lower doses after a few weeks. It's also important that patients take Abilify around the same time each day for consistent effects.
What are the most common side effects for Lithium?
The most common side effects of Lithium can include:
- Drowsiness, dizziness
- Hand tremors (unintentional trembling or shaking)
- Increased thirst and urination
- Gastrointestinal issues such as diarrhea, vomiting, nausea
- Changes in appetite and weight gain
- Dry mouth
- Decreased libido (sex drive)
And for Abilify:
- Weight gain
- Blurred vision
- Nausea, constipation or vomiting
- Headache and light-headedness
- Insomnia (difficulty falling asleep or staying asleep)
Both medications may cause more severe side effects that require immediate medical attention. It's crucial to remember that these aren't exhaustive lists; individuals might experience different side effects based on their health status and other factors.
Are there any potential serious side effects for Lithium?
While both lithium and Abilify are used to manage bipolar disorder, it is important to be aware of the potential side effects:
- Increased thoughts about suicide or self-harm
- Signs of allergic reaction or severe skin reaction: hives, difficult breathing, swelling in your face or throat, fever, sore throat
- Vision disturbances such as blurred vision; seeing halos around lights can occur with lithium use.
- Rapid heart rate, chest discomfort or shortness of breath could be a sign of an abnormal heart rhythm.
- Low sodium levels - Lithium has been associated with causing low sodium levels in the body. Symptoms may include headache, confusion, slurred speech and severe weakness.
- Severe nervous system reactions like muscle stiffness and tremors can occur with either medication. With Abilify this might present as restlessness (akathisia) while with lithium it might manifest as hand tremors.
If you experience any symptoms suggestive of serotonin syndrome - agitation, hallucinations among others while on these medications consult your healthcare provider immediately. Some antipsychotics including aripiprazole (Abilify) have been associated with risk for developing this condition although it's extremely rare when taken alone without other serotonergic drugs.
Please remember that not everyone experiences these side effects and many people tolerate these medications quite well under careful monitoring by their health care providers. Do not stop taking prescribed medication without consulting your doctor due to potential withdrawal effects and symptom relapse.
What are the most common side effects for Abilify?
While taking Abilify, you might experience the following side effects:
- Nausea, vomiting, upset stomach
- Dizziness or lightheadedness
- Weight gain
- Disturbances in sleep patterns (insomnia or excessive sleeping)
- Feeling anxious or restless
- Headache
- Constipation
- Increased salivation or drooling
- Blurred vision
-Tremors, muscle stiffness or spasms. Remember that each individual may react differently to medication and it's critical to consult your healthcare provider if any of these symptoms persist.
Are there any potential serious side effects for Abilify?
Like most medications, Abilify has a potential for side effects. These can include:
- Allergic reactions like rashes, itching or hives, swelling of the face, lips, or tongue
- Changes in vision
- Difficulty swallowing
- Distorted thoughts and an unusual increase in activity and talking (mania)
- Fainting spells
- Fast or irregular heartbeat (palpitations), chest pain or tightness
- Increased thirst and/or hunger
- Unusual bleeding or bruising
- Seizures (convulsions)
If you experience any of these symptoms while taking Abilify, it is important to seek medical attention immediately.
Contraindications for Lithium and Abilify?
Both lithium and Abilify, along with most other mood stabilizers or antipsychotic medications, may worsen symptoms of depression in some people. If you notice your depression worsening, or an increase in suicidal ideation, thoughts, or behavior, please seek immediate medical attention.
Neither lithium nor Abilify should be taken if you are taking certain types of diuretics known as 'thiazide diuretics', as these can significantly increase the level of lithium in your blood to a potentially dangerous level. Additionally, abilify should not be used together with strong CYP3A4 inhibitors such as ketoconazole and clarithromycin without doctor's advice. Always inform your healthcare provider about all the medications you are currently on; it will ensure safe use of either Lithium or Abilify by preventing harmful drug interactions.
How much do Lithium and Abilify cost?
For the brand name versions of these drugs:
- The price for 60 tablets of lithium carbonate ER (450 mg) averages around $80, which works out to about $1.33/day.
- The cost of 30 tablets of Abilify (10 mg) is significantly higher, averaging around $900, or approximately $30/day.
Therefore, if you are required to take a higher dosage range for lithium carbonate ER (upwards of 900mg per day), then it still remains less expensive on a per-day treatment basis compared to Abilify. However, please bear in mind that cost should not be the primary determining factor when deciding which medication suits your needs best.
In terms of generic versions:
- Generic Lithium Carbonate ER is available in packs starting from 30 capsules and above with approximate costs ranging from about $0.50 up to just over a dollar per day depending on dosage.
- Aripiprazole - the generic form of Abilify – can start off at prices as low as roughly $3/day and may rise based on dosage requirements and quantity purchased upfront.
It's important to consult with your healthcare provider regarding dosages and any potential side effects before making decisions solely based on cost efficiency.
Popularity of Lithium and Abilify
Lithium, a mood-stabilizing drug often used in treatment of bipolar disorder, was prescribed to around 1.5 million people in the United States in 2020. Once considered a cornerstone for treating bipolar disorder, lithium accounted for approximately 10% of prescriptions within this category of drugs. Though it has long been recognized as effective in managing manic episodes and preventing relapse, its usage has seen a general decline over the past decade due to concerns about side effects and toxicity.
Aripiprazole (brand name Abilify), an atypical antipsychotic also used frequently in the management of bipolar disorder among other conditions such as schizophrenia and depression augmentation, was prescribed to approximately 9 million people during that same year. Aripiprazole represents nearly 30% of total prescriptions for atypical antipsychotics making it one of the most commonly-prescribed treatments within this class. The increasing prevalence might be attributed to its lower risk profile compared to typical antipsychotics and wide range indications approved by FDA.
Conclusion
Both Lithium and Abilify (aripiprazole) have long-standing records of usage in patients with bipolar disorder, schizophrenia, and major depressive disorder. They are supported by numerous clinical studies and meta-analyses indicating their effectiveness over placebo treatments. In some cases, the drugs may be combined for a more comprehensive approach to managing symptoms, but this should always be under careful supervision of a healthcare provider due to potential interactions.
Their mechanisms of action differ - Lithium acts primarily on the central nervous system where it influences various neurotransmitters like dopamine and glutamate while Abilify is classified as an atypical antipsychotic that works primarily by balancing levels of serotonin and dopamine in the brain.
Lithium has been considered a first-line treatment option especially for bipolar disorder due to its proven efficacy in stabilizing mood swings over many years. However, it requires regular blood tests because there's only a small difference between an effective dose and a potentially toxic one. On the other hand, Abilify is often used when patients don't respond well or can't tolerate typical antipsychotics or mood stabilizers like lithium.
Both drugs are available in generic form which represents significant cost savings especially for those who must pay out-of-pocket expenses. Both Lithium and Abilify require time for effects to become noticeable; hence patience is required during initial stages of therapy.
The side effect profile differs between these two medications: common side effects associated with lithium include increased thirst & urination whereas weight gain may occur with Abilify use. For both medications close monitoring is crucial particularly when starting treatment; seek immediate medical help if you notice worsening depression or suicidal thoughts.
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Refrences
- Zupancic, M., & Gonzalez. (2012, January). Aripiprazole in the acute and maintenance phase of bipolar I disorder. Therapeutics and Clinical Risk Management. Informa UK Limited.http://doi.org/10.2147/tcrm.s22579
- Sajatovic, M., Gyulai, L., Calabrese, J. R., Thompson, T. R., Wilson, B. G., White, R., & Evoniuk, G. (2005, April). Maintenance Treatment Outcomes in Older Patients with Bipolar I Disorder. The American Journal of Geriatric Psychiatry. Elsevier BV.http://doi.org/10.1097/00019442-200504000-00006
- Davies, M. A., Sheffler, D. J., & Roth, B. L. (2004, December). Aripiprazole: A Novel Atypical Antipsychotic Drug With a Uniquely Robust Pharmacology. CNS Drug Reviews. Wiley.http://doi.org/10.1111/j.1527-3458.2004.tb00030.x
- Sachs, G., Sanchez, R., Marcus, R., Stock, E., Mcquade, R., Carson, W., … Iwamoto, T. (2006, January 9). Aripiprazole in the treatment of acute manic or mixed episodes in patients with bipolar I disorder: a 3-week placebo-controlled study. Journal of Psychopharmacology. SAGE Publications.http://doi.org/10.1177/0269881106059693
- Severus, W., Kleindienst, N., Seemüller, F., Frangou, S., Möller, H., & Greil, W. (2008, February 6). What is the optimal serum lithium level in the long‐term treatment of bipolar disorder – a review?. Bipolar Disorders. Wiley.http://doi.org/10.1111/j.1399-5618.2007.00475.x
- Vestergaard, P., Poulstrup, I., & Schou, M. (1988, October). Prospective studies on a lithium cohort. Acta Psychiatrica Scandinavica. Wiley.http://doi.org/10.1111/j.1600-0447.1988.tb06363.x