Abilify Side Effects: Restlessness, Urges, and What to Report

What should you expect from Abilify?

Abilify (aripiprazole) is an atypical antipsychotic, and in adults its best-known side effect is not sleepiness or weight gain but restlessness — though the label's list of common reactions differs by use and by age. Per the FDA prescribing information for Abilify, it's approved for schizophrenia (adults, and adolescents 13 to 17), manic or mixed episodes of bipolar I disorder (adults, plus children and adolescents 10 to 17), as an add-on to an antidepressant for major depressive disorder in adults, for irritability associated with autistic disorder in children 6 to 17, and for Tourette's disorder in children 6 to 18. You take it once a day, with or without food.

What are the most common side effects?

The label breaks the most common adverse reactions out separately — by use, and by age. For adults it names nausea, vomiting, constipation, headache, dizziness, akathisia, anxiety, insomnia, and restlessness, and notes that akathisia is the one most often seen in adults with schizophrenia. In children and teens, the list runs: somnolence, headache, vomiting, extrapyramidal disorder (movement effects), fatigue, increased appetite, insomnia, nausea, stuffy nose, and weight gain. The MedlinePlus patient information for aripiprazole adds nervousness, heartburn, diarrhea, stomach pain, weight gain, appetite changes, increased salivation, pain in the arms, legs, or joints, and tiredness.

Akathisia deserves a plain description, because the word hides the experience. It is an inner restlessness, an urge to keep moving, pacing, or shifting, that can be mistaken for anxiety or for the illness getting worse. MedlinePlus lists restlessness among the side effects and says to call your doctor right away if it becomes severe. Tell your prescriber about it early, because it is one of the side effects that most often leads people to stop a medicine quietly instead of asking for a change.

Which warnings surprise people?

Two stand out. First, the label warns about pathological gambling and other compulsive behaviors — these urges have been reported in people taking aripiprazole, and it says prescribers should consider lowering the dose or stopping the medicine if they develop. MedlinePlus describes gambling problems and other intense urges, such as excessive shopping, binge eating, or increased sexual urges, and says to call your doctor if you notice them. People rarely connect a new urge to a medicine, which is exactly why it is worth knowing in advance, and worth telling a family member to watch for.

The second is metabolic. The label warns of hyperglycemia and diabetes, dyslipidemia, and weight gain, and asks prescribers to monitor them. MedlinePlus says high blood sugar can develop even in people who have never had diabetes, and lists extreme thirst and frequent urination among the signs to report. If weight matters to you, say so before you start, and read our article on whether psychiatric medications cause weight gain for the wider picture.

What movement side effects should you watch?

Beyond akathisia, the label warns of tardive dyskinesia, involuntary movements that can appear after longer use and can persist, and says prescribers should consider stopping the medicine if signs appear. MedlinePlus does not use the term but tells patients to report uncontrollable movements of the face, tongue, or other body parts right away. The label also warns of neuroleptic malignant syndrome, a rare reaction; MedlinePlus describes its signs as fever, stiff muscles, confusion, sweating, or a fast, pounding, or irregular heartbeat, and says they need immediate care.

Dizziness and falls are their own warning. The label cautions about orthostatic hypotension, a drop in blood pressure on standing, and about falls from drowsiness or unsteadiness. MedlinePlus says not to drive or operate machinery until you know how the medicine affects you, and to avoid alcohol.

Which side effects mean you should call right away?

MedlinePlus says to call your doctor immediately for a rash, hives, itching, or swelling of the face, lips, tongue, or throat; trouble breathing or swallowing; seizures; uncontrollable movements of the face, tongue, or other body parts; fever, stiff muscles, confusion, sweating, or a fast, pounding, or irregular heartbeat; coordination problems or more falls; and signs of high blood sugar such as extreme thirst or frequent urination. The compulsive urges and severe restlessness described above belong on that list too. Not sure how to bring one up? We've written about how to talk to your psychiatric provider about a side effect.

What about the boxed warnings?

Abilify carries two. The label states that elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death, and that Abilify is not approved for those patients. It also states that antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies, that all patients started on it should be monitored for worsening and for the emergence of suicidal thoughts, and that it is not approved for depression in the pediatric population. MindVibe sees patients aged 13 and up, in person at offices in Texas and California and by telehealth. The label ties that second warning to antidepressant treatment, so it applies to teens and young adults who take Abilify alongside an antidepressant for depression; for its other uses, the label's own warnings for those conditions apply instead.

If you or someone you know is thinking about suicide or is in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline; it is free, confidential, and available around the clock. If someone is in immediate danger, call 911.

How should you judge whether it is working?

Give it the label's timeline. MedlinePlus says it may take two weeks or longer to feel the full benefit, and the label says that for adults with schizophrenia, dosage increases generally should not be made before two weeks, the time the medicine needs to reach a steady level. If Abilify was added to an antidepressant, the question is whether the depression is lifting beyond what the antidepressant alone had done; our article on what to do when an antidepressant stops working explains how an add-on fits that decision. For schizophrenia, the National Institute of Mental Health's overview of schizophrenia notes that treatment usually combines antipsychotic medication with psychosocial treatments, and that finding the right medicine can take time. Our overview of how schizophrenia spectrum disorders are evaluated and treated covers that process.

Never stop, start, or switch an antipsychotic on your own; MedlinePlus says not to stop aripiprazole without talking to your doctor, and a planned conversation is where a dose change or a switch gets decided. If you are weighing whether it fits, you can book a visit with a psychiatric provider to talk it through.

This article is for educational purposes only and is not medical advice, a diagnosis, or a substitute for care from a licensed clinician. Never stop, start, or switch a medication on your own; talk with your prescriber. In a crisis, or if you are having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or go to the nearest emergency room.

Frequently asked questions

What are the most common Abilify side effects?

It depends on the use and the age. For adults, the FDA prescribing information lists nausea, vomiting, constipation, headache, dizziness, akathisia, anxiety, insomnia, and restlessness, and names akathisia, an inner restlessness with an urge to move, as the one most often seen in adults with schizophrenia. For children and teens it lists somnolence, headache, vomiting, movement effects, fatigue, increased appetite, insomnia, nausea, a stuffy nose, and weight gain. MedlinePlus says to call right away if restlessness is severe.

Can Abilify cause gambling or other compulsive urges?

The label carries a specific warning about pathological gambling and other compulsive behaviors, and says prescribers should consider lowering the dose or stopping the medicine if they appear. MedlinePlus describes gambling problems and other intense urges such as excessive shopping, binge eating, or increased sexual urges, and says to call your doctor if you notice them.

What does "adjunctive" mean when Abilify is used for depression?

Added on. The label approves aripiprazole as an adjunctive treatment for major depressive disorder in adults, meaning it is taken together with an antidepressant rather than instead of one. It is not approved for depression in children or teens.

Does Abilify cause weight gain?

It can. The label's metabolic warning covers weight gain along with high blood sugar and changes in blood fats, and asks for monitoring. MedlinePlus lists weight gain and appetite changes among the side effects and says high blood sugar can develop even in people without diabetes. Whether and how much it happens varies from person to person.

How long does Abilify take to work?

MedlinePlus says it may take two weeks or longer to feel the full benefit, and the label says that for adults with schizophrenia, dosage increases generally should not be made before two weeks, the time the medicine needs to reach a steady level. Early side effects usually arrive before the benefit does.

Can I stop Abilify if the restlessness is bad?

Not on your own. MedlinePlus says not to stop aripiprazole without talking to your doctor. Severe restlessness is a labeled reason to call, and the call is where a dose change or a switch gets decided. Stopping an antipsychotic without a plan can bring back the symptoms it was treating.