Although Abilify (aripiprazole) has been found to cause less weight gain than other atypical antipsychotics, there is evidence that in certain people it can cause significant weight gain and it may be more likely to cause weight gain in people who are taking it for depression alongside other antidepressants. Side effects such as weight gain may be significant enough for some people to discontinue Abilify, even when it is working well to manage symptoms.

Why does Abilify cause weight gain?

Abilify is likely to cause weight gain in several different ways. If you are someone who has gained weight with Abilify, the way you have gained weight may be different from someone else, for example, you may have noticed that your appetite has increased whereas somebody else may still be eating the same diet but feel that their metabolism has slowed. In most cases, a combination of factors is probably to blame for your weight gain.

Here are some ways Abilify causes you to gain weight:

1. Abilify may increase your appetite or cravings

Some people report on Blog sites that they develop an insatiable appetite with Abilify or are always feeling extremely hungry. No matter what they eat, they never feel satisfied and end up craving something else, usually carbohydrates or sugar. For some, the appetite increase is slight, for others it is significant. Increasing how much food you eat each day will cause you to gain weight.

2. Abilify may affect your blood sugar levels

Postmarketing reports have shown that Abilify (aripiprazole) is associated with high blood glucose (sugar) levels in some people, but this is not consistent and many studies report Abilify (aripiprazole) has a low potential to affect blood glucose levels and cause diabetes. Four case studies reported diabetic ketoacidosis with aripiprazole use: a 44-year-old man who developed DKA within 2 weeks of aripiprazole initiation; a 12-year-old boy who developed DKA within 6 months of initiation; a 34-year-old female who developed DKA within 4 days of administration; and a 33-year-old male who developed DKA within 18 months of aripiprazole initiation. All instances were resolved with aripiprazole discontinuation and appropriate management.

Big spikes in blood glucose levels followed by large drops can cause tiredness and hunger.

3. Abilify may affect your metabolism

Our brain, especially our hypothalamus, is crucial to regulating metabolism. The hypothalamus takes information from nerve cells outside of the brain, hormones, other chemicals, such leptin and ghrelin, nutrients, such as glucose, amino acids, and fatty acids, as well as effects on neurotransmitter receptors, such as 5-HT2C and 5-HT1A receptors, histamine H1 receptors and dopamine D2 receptors to regulate metabolism. Abilify affects some of these receptors more than others, which may slow down metabolism, resulting in weight gain even when dietary and exercise habits have not changed.

4. Side effects may make you less likely to exercise and more likely to eat

Abilify can cause tiredness and drowsiness that may make it difficult for you to stay motivated, get out of bed, or do exercise. If you are unable to do regular exercise this may also slow your metabolism.

5. Abilify may be more likely to cause weight gain when combined with certain other medications

Serotonin (5-HT)2C receptors play an important role in helping to regulate our moods, our activity levels, and our appetite, in addition to some other functions. One review found that when aripiprazole was combined with antidepressants that had high activity at serotonin receptors (such as citalopram, fluoxetine, paroxetine, sertraline, or venlafaxine), it acted as an antagonist at the receptor which resulted in weight gain. But when it was combined with a low serotonergic antidepressant, such as bupropion, there was little or no weight gain.

The authors concluded that this might explain why aripiprazole was found to have a low weight gain potential in studies focusing on schizophrenia and bipolar disorder that had minimal use of antidepressants.

6. Abilify can improve your mood which may make you more likely to go out to eat

Many people start Abilify because their mood is low or they have trouble controlling their thoughts. Once you start to feel better you may feel like socializing and going out more which usually involves dining out or getting fast food.

7. Your genetics may make you more susceptible to weight gain

Some people are just more likely to gain weight than others. Variations in the gene that codes for the 5-HT2C receptor have been linked to a susceptibility to gain weight with atypical antipsychotics. This may explain why there is a wide variation in how much weight people gain (or lose) while taking Abilify. One day there may be a blood test to identify people who are more at risk of gaining weight or other side effects, but currently, there is not one available.

How much weight will I gain with Abilify?

How much weight you end up gaining with Abilify depends on the dose you take, the length of time you take it, what other medications you may be on and what you weigh before you started taking Abilify. Weight gains of 2.2 lb (1kg) to 90lb (40kg) have been reported and weight gains are more likely the higher dosage of Abilify you take if you also take antidepressants such as citalopram or venlafaxine and if you were of normal weight or even underweight to start with. Some people who take Abilify may also experience weight loss.

People who were normal or slightly underweight before starting aripiprazole were more likely to gain weight as reported in a large RCT that included 155 people with aripiprazole; the average weight gain was 2.7kg after 52 weeks. People who were overweight or obese gained an average of 0.7kg and 0.1kg respectively and across the total sample, an average of 1kg was gained.

An analysis of 13 placebo-controlled trials of people with schizophrenia or bipolar disorder showed an average weight loss of 1.5kg in those trials using aripiprazole as monotherapy and an average weight gain of 1.7kg after 14 weeks when aripiprazole was added to ongoing antidepressant treatment.
Children and adolescents found an average increase in body weight of 1.6kg after 42 to 43 days, which increased to 5.8kg after 24 weeks. Another trial in adolescents reported that 32.8% of patients gained at least 7% of their body weight after 26 weeks.

How can I prevent weight gain with Abilify?

Talk to your doctor if you have gained significant weight while taking Abilify about ways to help lose weight which may include:

• Watch your portion size, eat regular meals, and cut down on foods high in sugar and fat
• Weigh yourself every day so you can keep on top of small weight increases
• Exercise daily for at least 1 to 2 hours
• Reducing the dose of Abilify
• Switching Abilify for a different medication
• If you take an antidepressant with Abilify then maybe switch to a different antidepressant, such as bupropion, which has less effect on serotonin receptors
• Adding low-dose Topamax (topiramate) to Abilify treatment as a weight-reducing treatment.

Will I lose weight after stopping Abilify?

Most people do lose weight after stopping Abilify; however, it may depend on how long you have been overweight, and what new medication you are put on. To lose weight, you will still have to follow a heart-healthy diet and exercise every day.

Are there any alternative drugs that do not cause weight gain?

There are usually alternative medications you can take instead of Abilify if you have gained weight while taking Abilify. The choice of medication depends on your condition and what other medications you already take. Talk to your doctor about alternatives to Abilify.