Yahoo Finance ‘I Was Scared to Take an Antipsychotic for My OCD, but It’s Changing My Life’
Aripiprazole, often sold under the brand name 'Abilify', is a type of medication which is typically used to treat psychotic symptoms, such as hallucinations, delusions and confused, disturbed thoughts. So, when writer Lauren Brown was prescribed the drug for an OCD-adjacent condition, she was perplexed.
Here, she shares her story.
After a decade spent trying to get professional help to deal with my dermatillomania – a disorder that sees me pick at my skin with such sustained ferocity that it bleeds – age 25, I found myself breaking down in front of my GP. Through sharp intakes of breath, I told them how helpless and lost I felt.
If you are struggling with your mental health, speak to your GP or call the Mind infoline, on 0300 123 3393
While I had been advised by professionals that my issues were ultimately rooted in anxiety and depression, and who had therefore sought to alleviate my incessant picking through medications such as selective serotonin reuptake inhibitors (SSRIs) and therapies such as cognitive behavioural therapy (CBT), nothing had worked.
Despite all of the effort, my compulsion to repetitively worry away at my own body, inflicting pain and sometimes wounding myself to such an extent that I had to cancel plans, remained.
It was after this moment, in which I expressed the rage and frustration that had built up inside me over years of hoping to 'get better' and little changing, that I was finally referred to my local NHS mental health team and assigned a psychiatrist.
I was jubilant. 'This is it,' I thought. 'At last, my ticket out of the maze of questions about what is going on in my mind.'
Why I was prescribed Aripiprazole
This initial positivity waned, however, when, after a couple of consultations, the doctor mentioned that I might find it helpful to trial taking antipsychotics. Specifically, the tongue-twister of a drug, Aripiprazole, sold under the brand names 'Abilify' and 'Abilify Maintena.'
Just hearing the phrase 'antipsychotics' triggered alarm bells in my head. To be clear: there is no shame in experiencing psychosis. Episodes – typically characterised by hallucinations or delusions – can be caused by myriad factors, including traumatic events, stress, brain tumours or substance misuse. They are also sometimes a result of a long term condition, such as schizophrenia or bipolar disorder.
Going through a psychotic experience is not as rare as you might think. Some experts estimate that between 5 and 10% of people will have one in their lifetime; others put that figure at around 3%. Many will become better, with medical help. 'Someone with psychosis has a short-term (acute) condition that, if treated, can often lead to a full recovery,' reads a page from the NHS, devoted to the matter.
For me, though, the phrase conjured up personal memories. Psychosis runs in my family and one of my parents suffers from delusions. As a small child, I remember coming out of the shower one day to them urgently whispering 'put some clothes on quick, there are cameras in the house'.
As such, the fear of going through such a terrifying experience myself, one day, is something I've lived with for most of my life.
Why are antipsychotic medications sometimes prescribed for OCD?
That's why, although I've never seen or heard something that wasn't really there, when I heard 'antipsychotics' mentioned, I panicked. While this is irrational, I immediately thought the psychiatrist had misunderstood my symptoms and that, somehow, taking this drug might actually make me psychotic.
When I expressed my concerns, however, he explained that the medicine is, though unusually, sometimes prescribed for obsessive compulsive disorder (OCD.) While I don’t suffer from what you might call OCD proper, dermatillomania is an OCD-adjacent disorder, thanks to its repetitive and compulsive properties, which are understood to arise from a desire to self-soothe from anxious feelings. That’s why, he calmly explained to me, he thought it might help.
So, what exactly is Aripiprazole?
Aripiprazole is an atypical antipsychotic drug. The ‘atypical’ means that it’s part of a second generation of antipsychotics that are primarily are used to treat schizophrenia and bipolar disorder. Concocted in a lab in Japan, Aripiprazole was first introduced in the United States in 2002 and here in Europe two years later.
Dr. Hamilton McBrien, a consultant psychiatrist at the London-based The Soke Mental Health and Wellness Centre, tells me that the drug has been shown to be effective in the prevention of the manic episodes of bipolar disorder; to be an effective augmentation treatment for depression and to reduce irritability and overactivity in children with autism.
When it comes to my experience, he adds, low dose Aripiprazole has been evidenced as an effective treatment for OCD that does not respond to the usual treatments, like SSRIs.
While this medication can work well, it's important to note that the side effects can be nasty, in some cases. While I have luckily not noticed any of the below, the NHS outlines that nausea, insomnia, restlessness and urges such as an abnormally high sex drive or the need to spend money, can occur, in some people.
How does Aripiprazole work?
The impact of this type of drug on the brain is, Dr McBrien tells me, 'complex.' It works on a variety of neural pathways to stabilise levels of the hormone and neurotransmitter, dopamine (the 'feel good' hormone, which releases a flood of pleasure when you smell freshly baked cookies, have sex, or hear music you really enjoy – and motivates you to seek out such rewarding experiences, again) in your brain.
Although this 'reduced dopamine activity in certain neural pathways provides the antipsychotic effect,' – its primary purpose – it is not the only result of the medication. 'The effect is not specific to the neural pathways thought to be responsible for psychotic symptoms,' he adds.
It is this reality that means that the medications can have an impact on other mental health conditions, he explains. 'As well as [atypical antipsychotic's] effects on receptors for dopamine, they impact on a wide range of other neurotransmitter systems, explaining not only their efficacy in other conditions but also their side effects.'
He adds that, when it comes to anxiety disorders, it is possible that the antihistamine and anticholinergic sedative properties of some of these drugs are calming – and so are responsible for the anxiety-reducing impact.
My experience with Aripiprazole
The story is a complicated one, then. Essentially, right now, we don't know precisely how and why atypical antipsychotics help with anxiety and OCD. For me, however, the benefits have felt clear, ever since I opened the box of tablets that initially sat on my table, untouched, for a month.
The way I’d describe the effect is that it takes the edge off my urge to pick my skin. Before, this compulsion was roaring loud and urgent, whereas now I have the space to take a breath and, hopefully, deploy some of the coping tactics I learned previously in CBT – such as turning the lights out, or setting a timer when I am in a triggering area of the house, such as standing before the bathroom mirror.
If you deal with a condition like mine, and are curious about trying this medication, know that it is prescribed on a case-by-case basis, and only after careful consideration of the various factors at play.
Dr McBrien says: 'In terms of what I’d say to a patient, I’d review their current medication and response to it, involving them in a discussion about their views on progress and their goals, assessing how impaired they still were with OCD symptoms.
'This would be to help establish the risk/benefit ratio of further medication and possible side effect burden. I would explain the partial nature of their response to treatment to date, and the range of additional "off-label" treatments, explaining the potential gains in symptom improvement and possible key side effects. I would offer written material and offer the opportunity for further questions and time for them to consider the variety of options.'
If the medicine were to be prescribed, he says, the benefits, such as a reduction in OCD symptoms, would be closely monitored and balanced against any of the side effects I mentioned previously. The key is ensuring that it is more helpful than it is problematic – this is a decision that Dr McBrien says that the patient would take the lead on.
How Aripiprazole has made me feel,
Aripiprazole is not a silver bullet. But I live with a touch more peace, now. After a decade of relentless stress, thanks to my condition, it has made things less all-consuming. For that, I'm thankful.
Where to find help for your mental health
If you're struggling with your mental health and need help, try these resources:
Call the Mind infoline, for signposting on where to seek help: 0300 123 3393
Go to your GP, and explain your symptoms - they can offer you medical help
You can refer yourself for an online NHS therapy programmes nhs.uk/service-search
If you just want to talk to someone, call the Samaritans 116 123
Lauren Brown is a writer, journalist and author of Hands: An Anxious Mind Unpicked (Harper North, January 2022), a debut memoir about her dermatillomania. Preorder it now.
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