Managing the munchies–a typical problem with the atypicals

Are there people out there who have been on Abilify for awhile (3 months to several years) who continue to have an increased appetite from it? Or does this side effect eventually stabilize and no longer be a part of daily life?

I am trying to be patient with being on Abilify b/c I think it is helping with stabilizing my mood, but my cravings for high sugar items are ridiculous, my desire to consume two helpings of my dinner and then some is concerning me that I will be continueing to gain weight and I never had them (even when I was pregnant 6 yrs ago). Also, to help me sleep, I do have to regularly take 3 mg of Clonapin. Those are the only two meds I am currently taking and that may be contributing to my increased appetite.

In addition, I recently had foot/ankle surgery last Wednesday, so now I am not weight-bearing for a good 2 weeks or so nor exercising to keep up with my food intake until I get the okay from the Dr to begin the rehab program. Please tell me about your experience. Thank you so much!!

This is, unfortunately, a common problem with the atypical antipsychotics such as Abilify.  It tends to be even worse with some of the other agents (Risperdal and Zyprexa) but no agent is immune to this.  Add to this the risk of weight gain (independent of increased eating) and the increased risk of developing diabetes and hypercholesterolemia and you have a big problem.  I have found in my own practice that Abilify is less likely to cause these difficulties, but when it happens it happens.  And when it happens, you have to manage it right away.  Again, in my experience with patients, the increased appetite does not go away . . . unless the diet is significantly modified.  Even then, it can be difficult.  

Approaching this from a dietary standpoint is pretty basic.  If you shove a lot of simple sugars into your face, your blood insulin level will sky-rocket . . . and then your blood sugar will plummet . . . and then you will get the double-munchies.  The best way to get off this roller coaster is to cut out all simple sugars.  OOOUUUUUUCCCCHHHH!!!   I know, I know (from personal experience) that is more easily said than done.  but it must be done.  Taking your cues from programs such as the Zone Diet, the Sonoma Diet and the Atkins Diet, jump into it fully and, after a few days, you should see some reduction in the pattern of your sugar craving as insulin levels and glucose levels stabilize.  If it does not, then Abilify may not be the medicine for you, even if it does help.  Other options will need to be tried.

As an aside, Geodon seems more immune from the risk of increased appetite and abnormal glucose metabolism.  Why don’t I use it more often???  In my experience, it makes people too tired and I have more difficulty finding the dose that works and the dose that is tolerated.  I will admit that other docs use it way more and seem to find great success with it.  I continue to use it sparingly because I have not mustered a great deal of confidence in it.  It might, however, be a good next step for you if the Abilify munchies cannot be beat!

–Dan Hartman, MD

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