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Those of you who take Aripiprazole for bipolar, what dose are you on?

HLon99

HLon99

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Hi forum hope you are all having a good day,

I've been taking Aripiprazole for the better part of a year now to control (hypo)mania and psychotic features associated with bipolar disorder. I was initially prescribed a low dose, 5mg and it worked remarkably effectively. Within 2-4 weeks, I was totally stable. However, after a few months, I started taking only half a pill (2.5mg) as I started to feel that it caused me to feel a bit flat and dull in my emotions (emotional blunting).

I told my psychiatrists about this and they were OK with it, as long as it works. I am medication compliant and fairly responsible with how I manage my condition; I always keep my doctor in the loop about any changes and we trust each other. However, since then I had two mild hypomanic episodes, one for a week in November 2020 and one just yesturday (which is resolving now). I'm now concerned that maybe 2.5mg doesn't offer enough protection and that I should go back up to 5mg.

I read that the minimum effective dose of Aripiprazole is between 10-15mg and upwards. I'm most likely go back up to 5mg, which is something I can do myself. However, I'm debating whether I should ask for 10mg . Pros and cons as followed:

Pros of going up to 10mg:
- Bring it in line with the proven recommended dosage.
- Minimises the chances of relapse, which is important for me since I have a lot of things going on in my life within the coming months and a lot of pressure, which an episode will compromise.

Cons:
- More side effects: this includes things like dulling my emotions, cognitive and movement problems. I also found that on higher doses my balance and coordination goes a bit off.
- Tolerance: The more you use medication, the more tolerance you develop in the long run. If I jump the gun on the med increase now, I'll develop a greater tolerance. Perhaps it would be better to save 10mg for a rainy day.
- Middle ground: I can go for a middle ground and go from 2.5mg to 5mg. I can do this without the hassle of contacting my doctor as I have the full 5mg pills, I just choose to take half. Its worked pretty well in the past and I seem to be very responsive to medication.

Right now, I feel like going for the middle ground of 5mg is the reasonable choice, but of course one can never be sure with bipolar. I realise you are not proffesionals, but I would find it helpful if you can share your experiences. What dosage are you on? Does it work for you? Does anyone have experience with low doses of medication and how does that work for you?

Any input will be much appreaciated.

As always, all the best,
-H
 
K

keith74

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Hi H,
Glad to hear you are feeling a bit better today. I'm hardly an expert on meds but from what i see in one of my books on bipolar meds, the "typical" bipolar adult dose ranges from 15-30mg for aripiprazole (monotherapy). So 2.5mg seems like quite a nominal dose, even in conjunction with a mood stabilizer. It is great that you respond well to such a low dose but looks like right now you can use a bit of a boost. My wife's psychiatrist is typically cautious at ramping up dosage of meds so looks like 5mg right now is a good idea while you decide how further up to go. I guess you can make the call based on how to react to the 5mg. You likely also want to talk to your doc.

Good luck with everything
 
Passionflower

Passionflower

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I thought that aripiprazole was 'activating' at 5mg and antipsychotic or mood stabilising at 10mg and above
 
HLon99

HLon99

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I thought that aripiprazole was 'activating' at 5mg and antipsychotic or mood stabilising at 10mg and above
Thank you for your response.
That's the usual idea, but the truth is no one really knows how Aripiprazole works. Its one of the newest drugs that has been developed and works differently to other antipsychotics.

Even at 5mg, it occupies/blocks up around 50-55% of the D2 receptor. Its typically thought that antipsychotic effects happen at 65% and above, but I'm sure 55% will do something. Other drugs such Quetiapine/Seroquel only bind to a maxiumum level of 58-60% but still work. Most of the new atypical antipsychotics work in unorthadox ways. Sorry for the technical jargon.

Bottom line is, I feel like I'm very responsive to medication and if I go up from 2.5mg back to 5mg I should be fine. The original psychiatrist that prescribed me this med really knew his stuff and I respected his opinion, so I'll take and run with that for the time being. But in my next scheduled session, I'll let my doctor know about this episode and we can discuss my options moving forward. Hope you are doing good.
 
O

On Fire

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As you said, save 10mg for a rainy day. Go with 5mg.
 
G

Galaxy

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Yes think I'd go with trying 5mg for now. Seems like you have good insight and are making wise decisions so you can hopefully reassess after some days on the 5mg and see where you're at
 
calypso

calypso

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Hiya. I'm on 15 mg and it does blunt me a lot. I'm not sure that I have got used to the drug and not sure I have a tolerance build up. If you feel 5mg does it for you then stick with that. The less meds we need the better in my opinion.
 
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