Abilify (aripiprazole) and ADHD

Abilify (aripiprazole) is a medication that is typically not prescribed for ADHD.  It has significant side effects and so far, unproven effectiveness.  However, for certain patients with aggressive tendencies, aripiprazole is trending as a popular off label drug, primarily riding on the coattails of respiridone, a similar medication which has significant clinical trial evidence of efficacy.

Effectiveness

There have been at least 7 studies of ADHD and aripiprazole, however, they have been limited to very small sample sizes (all less than 50) and almost all trials have involved children with other disorders in addition to ADHD (bipolar disorder, Tourette’s, ASD).  Some of these trials have noted an improvement in ADHD symptoms, but at least one did not.  As with many small studies, methodologic flaws were present as well, such as lack of blinding, lack of a control group, etc.  Due to lack of better evidence of effectiveness, aripiprazole is not FDA approved for treatment of ADHD, although it is legal to prescribe it “off label”.

Adverse effects

Aripiprazole generally does not cause significant side effects in children and adolescents.  However, major problems can occur rarely, such as neuroleptic malignant syndrome (generally fatal), suicidal thoughts and acts.   These issues are why this medication should not be considered lightly.  More common issues include chronic insomnia, Parkinsonism (tremors, slowness, speech impairment, etc), behavioral changes, psychosis (impaired sense of reality/hallucinations), and weight gain. 

Should aripiprazole be used for ADHD?

Because of it’s potential for fatal side effects and the lack of evidence proving effectiveness, aripiprazole should not be used as a first line agent for ADHD.  However, for patients struggling with violent tendencies, for example, children who are chronically suspended from school due to lashing out at teachers and other students,  this medication may offer the control necessary to avoid long term psychiatric hospitalization or chronic day treatment. 

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Reference:

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