Aripiprazole

Aripiprazole affects dopamine and serotonin systems in a more flexible way than other antipsychotics. This often leads to better tolerability, but each person responds differently and the medicine still requires monitoring.

A better side-effect profile for many patient

Compared with older antipsychotics, aripiprazole is less likely to cause:

• Parkinson’s-like movement problems
• Restlessness and motor tension
• Sedation
• Weight gain and metabolic changes
• Hormonal changes such as elevated prolactin
• Heart rhythm issues
• Cognitive slowing or emotional “flattening”

Some people experience far fewer negative sensations on aripiprazole and find it easier to stay on treatment for the long term. That said, side effects can still happen and there is important personal variation.

Possible effects to be aware of

Alongside its favourable profile, aripiprazole can still cause:

• Nausea or vomiting
• Sleepiness
• Low sodium levels (rare)
• Dopamine-linked behaviours such as gambling, overeating or compulsive shopping (uncommon but important to mention)

Sharing any noticeable changes in mood, motivation, behaviour or sleep with your clinician helps ensure the dose is right for you.

Why the dopamine stabilising effect matters

Brain imaging research shows that aripiprazole adapts the level of dopamine receptor activity depending on the baseline activity in each region. This is thought to contribute to improvement in hallucinations and delusions as well as better social functioning, emotional engagement and motivation.

Aripiprazole also influences GABA and glutamate activity in the prefrontal cortex, which may support clearer thinking and improved social interaction.

Mood stabilising properties

Beyond schizophrenia and mania, aripiprazole has been used in other mental health conditions, including bipolar disorder, depression (as an add-on treatment), Tourette syndrome and irritability in autism. Not all of these uses are licensed in the UK, but they reflect the broader research on the medicine’s mechanism.

Effectiveness varies person-to-person

Although aripiprazole has attractive pharmacological features, large studies show that antipsychotics have broadly similar effectiveness overall. What differs is the individual experience. Some people thrive on aripiprazole. Others benefit more from a different medicine. Choosing the right antipsychotic is a shared decision between clinician and patient, based on symptoms, side effects, lifestyle and personal preference.

Aripiprazole Side Effects

Aripiprazole generally has a lighter side-effect profile than many antipsychotics, but effects still occur and vary between individuals.

More common effects include

• Sleepiness or fatigue

• Nausea or vomiting

• Restlessness or difficulty sitting still

• Headache

• Mild dizziness

Less common but important effects

• Low sodium levels (SIADH)

• Impulse control behaviours such as gambling, overeating or compulsive shopping

• Agitation or irritability

If anything feels unusual or out of character, especially around behaviour or motivation, it is important to discuss this with your clinician. Adjusting the dose can often resolve unwanted effects.

Although there is currently no formal CPIC guideline for aripiprazole, clinical sources including the BNF and FDA note clear dosing differences for CYP2D6 poor metabolisers. This reflects how strongly genetic variation can influence aripiprazole exposure. Here are our practical takeaways:

• Let your clinician know about any new medicines, especially antibiotics, SSRIs or herbal supplements such as St John’s Wort.

• Share changes in behaviour, emotional tone or motivation, even if they seem subtle.

• Pay attention to cardiovascular symptoms such as palpitations or dizziness.

• Never hesitate to ask about adjusting the dose. Aripiprazole often needs personal tuning for best effect and lowest side-effect burden.

Related Medications:

Other antipsychotics include:

• Clozapine

• Haloperidol

• Olanzapine

• Perphenazine

• Thioridazine

• Zuclopentixol