Abilify and Seroquel withdrawal is a problem many patients with mental health disorders such as major depressive disorder (MDD), bipolar disorder (BD I/II), schizophrenia, and other mental health disorders experience when they discontinue use of these medications.
Abilify and Seroquel: What are They?
Both Abilify and Seroquel are psychiatric medications commonly used to treat the following mental health disorders:
- Major depressive disorder (MDD)
- Manic episodes associated with bipolar disorder (BD I/II)
- Schizophrenia
- Tourette’s syndrome (in some children)
- Irritability associated with autism spectrum disorder (in some children)
Here’s the data on Abilify and Seroquel prescriptions from 2020. Abilify and Seroquel are brand names. The active medications in each are called aripiprazole and quetiapine, respectively.
- Abilify (aripiprazole): 8.2 million prescriptions for 1.3 million patients
- Seroquel (quetiapine): 10.5 million prescriptions for 1.8 million patients
Providers prescribe these medications because for many patients, they reduce symptoms and improve quality of life. However, patients and providers must weigh the benefits of these medications against their side effects, which can be significant.
That’s why many patients seek to discontinue use of these medications. Problematic side effects of Abilify, Seroquel, and similar antipsychotic medications include, but are not limited to:
- Tardive dyskinesia (loss of ability to control facial movements, including tics, lip smacking, tongue movements, blinking)
- Sexual problems
- Sedation
- Dizziness
- Akathisia (loss of ability to stay still)
- Dry mouth
- Weight gain
- Reduced brain volume
- Shortened life span
Many people do not know about these withdrawal effects before discontinuing use. That’s not surprising. The best practice guideline statements from the American Psychological Association (APA) do not mention the negative consequences of discontinuing use, i.e., withdrawal. In addition, information on withdrawal from antipsychotics does not appear on the official drug information page provided by the manufacturer of Abilify of the Food and Drug Administration (FDA) black box warning page for Abilify. The same is true of Seroquel: neither the manufacturer nor the FDA black box warning lists any information on withdrawal from Seroquel.
Discontinuation of Abilify and Seroquel
Researchers estimate that a high rate of patients taking these medications attempt to stop, and about 75 percent attempt to stop within 18 months of initiation.
Aside from mention of Abilify and Seroquel withdrawal symptoms in newborns with mothers taking antipsychotics – published on the National Alliance on Mental Illness (NAMI) website (Abilify and Seroquel) – there is very little information on withdrawal from antipsychotics from official sources. We located only one publication that included withdrawal in practical use guidelines for clinicians.
However, information on Abilify and Seroquel withdrawal is easy to find on websites like Healthline and VeryWellMind, as well as in several peer-reviewed journal articles published in the past five years – but these are articles specifically about withdrawal, and not proactive warnings about the potential negative consequences of discontinuing use.
That’s somewhat reassuring, but leads to an important question:
“Why?”
That’s a topic for a different article.
The rest of this article will address why patients discontinue taking antipsychotic medications to treat their mental health disorders, describe the negative consequences of Abilify and Seroquel withdrawal, and report the potential techniques for mitigating the symptoms associated with Abilify and Seroquel withdrawal.
Abilify and Seroquel Withdrawal: The Symptoms
Evidence from a review on antipsychotic (AP) medication shows discontinuation of medications such as Abilify (aripiprazole) and Seroquel (quetiapine) leads to withdrawal symptoms common to all central nervous system drugs. Symptoms typically appear within a few days of discontinued use and may include:
- Nausea
- Tremors
- Anxiety
- Agitation
- Headaches
- Irritability
- Aggression
- Sleep disturbances
- Decreased concentration
Data from a publication called “The Experiences of 585 People When They Tried to Withdraw from Antipsychotic Drugs” offers real-world information about the withdrawal experience of people who discontinue use of antipsychotics. As the title implies, the aim of the study was to “document the self-reported experiences of a large international sample of people who tried to come off APs.”
To accomplish this goal, researchers recruited 585 patients from 29 countries. Each patient completed a questionnaire called “The Experiences of Antidepressant and Antipsychotic Medication Survey” adapted specifically for this study from a questionnaire designed by researchers in New Zealand called “Views on Antidepressants,” which was designed to document patient experiences with antidepressant treatment.
Here are the top-line results from the study on antipsychotics:
- 72% reported withdrawal effects after discontinuing use
- 52.4% reported the symptoms as severe
- 25.7% reported trying to discontinue use 4 or more times
- 24% took more than a year to discontinue use
Here’s a result that’s genuinely shocking:
No patients in the study reported receiving any information from prescribers about withdrawal effects, dependence, rebound psychosis, or the need to reduce medication dosage gradually when discontinuing use. That’s not a type: not a single patient reported hearing anything about withdrawal or complications associated with withdrawal.
And here’s a result that’s encouraging:
26% report positive effects of discontinuing use, such as feeling more alive and more like themselves.
Now let’s drill down on these results, and learn more about the withdrawal experiences of the patients in this study.
Abilify and Seroquel Withdrawal: Additional Data
The underlying method for gathering the data in this study was self-reported patient questionnaires. Above, we offered the general, top-line results. Here, we offer patient responses to specific questions about the withdrawal experience:
Abilify and Seroquel
- 81.7% of patients taking Abilify reported withdrawal symptoms
- 67.7% of patients taking Seroquel reported withdrawal symptoms
Type of Symptoms
- 72% of all patients reported classical withdrawal effects similar to those associated with withdrawal from central nervous system medications:
- 52% of these categorized those effects as severe
- 26% had tried four or more times to discontinue
- 23% took at least one year to successfully withdraw completely. In response to the open question
Frequency of Symptoms
- 73% of all patients reported experiencing the following symptoms most frequently:
- Insomnia
- Nervousness
- Extreme emotion
Positive Symptoms
- 26% of all patients reported one or more positive outcomes, most frequently:
- More energy/alive
- Clearer thinking
Psychotic Symptoms
- 80 respondents reported psychotic symptoms upon withdrawal, in the absence of a primary or secondary diagnosis of psychosis, including:
- Hallucinations/voices
- Paranoia
- Delusions
Length Of Time to Withdraw From Medication
- 0–1 days: 34.7% of patients
- 2–7 days: 6.3% of patients
- 1–4 weeks: 6.7% of patients
- 1–2 months: 12.3% of patients
- 3–12 months: 16.0% of patients
- 1–2 years: 14.2% of patients
- 3–5 years: 6.0% of patients
- 6–10 years: 1.9% of patients
- Over 10 years: 1.9% of patients
Symptoms Reported by Ten or More Patients
- Insomnia/sleeplessness
- Anxiety/nervousness
- Extreme/labile feelings
- Cognitive problems
- Nausea/vomiting
- Akathisia/restlessness/agitation
- Suicidal thoughts/urges
- Aches/pains/cramps
- Dizziness/fainting
- Weight loss
- Low appetite
- Depression
- Headaches
- Tremors/shaking
- Sweating
- Irritable
- Agitation
- Anger/rage/aggression
- Crying
- Sensitivity to light
- Sensitivity to sound
- Heart palpitations
- Vivid/bizarre dreams
- Tiredness/exhaustion
That’s a long list of serious symptoms. The authors of the study indicate the overwhelming number of problematic symptoms associated with Abilify and Seroquel withdrawal are caused by the nature of the medications themselves.
Here’s why.
Abilify and Seroquel: Mechanism of Action and Withdrawal
One mechanism by which antipsychotics work is creating a dopamine blockade, which reduces the amount of available dopamine in areas of the brain associated with mental health disorders. When discontinuation reduces or eliminates, removes, or reduces this blockade, the resurgence of dopamine can overload the brain. This overload can cause many of the symptoms listed above, as well as withdrawal psychosis, which is frequently misidentified as relapse to schizophrenia or another psychotic disorder. In many cases, providers quickly reinstate the medication which caused the dopamine abnormality and the abnormal dopamine resurgence often mistaken for relapse of psychosis, rather than a withdrawal symptom.
This is a problem which can complicate and exacerbate the experience of an individual in treatment with one of these medications. One researcher, quoted in the study above in a paper published in 2006, concluded the following:
“Evidence suggests discontinuation of some antipsychotic drugs may precipitate the new onset or relapse of psychotic symptoms. Whereas psychotic deterioration following withdrawal of antipsychotic drugs has traditionally been taken as evidence of the chronicity of the underlying condition, this evidence suggests that some recurrent episodes of psychosis may be iatrogenic.”
To clarify, the word iatrogenic describes an “illness/pathology caused by medical examination or treatment.” To explain, what this means is that in some cases, the attempt to discontinue an antipsychotic medication like Abilify or Seroquel can result in withdrawal symptoms that are mistaken for relapse to psychosis of the onset of a new psychotic disorder. Without knowledge of the withdrawal profile for medications like Abilify and Seroquel, providers don’t associate these symptoms with the medication or treatment, i.e., their iatrogenic nature, but instead assign them to the onset of a new pathology or a relapse of the treated pathology in the patient.
How This Information Helps
Our goal is to share information in order to raise awareness about two current psychiatric medications. We recognize the therapeutic benefits of Abilify and Seroquel in reducing the symptoms associated with several complex mental health disorders. However, we also recognize an absence of information about Abilify and Seroquel withdrawal on their respective product information pages and on other resources that typically provide comprehensive information about the risks and benefits of various medications.
With regards to Abilify and Seroquel, the information we provide in this article can help our providers and patients make informed decisions about any treatment plan for mental health disorders or co-occurring alcohol/substance use disorders and mental health disorders that may require antipsychotic medication. The more we know, the better we can help, and the more our patients know, the better they can help us support them in reaching long-term, sustainable recovery.
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