Aripiprazole - Abilify

I understand @Trish and I’m glad for you saying so. It’s those thoughts as well that makes me worried. Another worry I have is not only whether it would make ME itself worse in the long run, but the side effects on my brain chemistry. My counsellor who knew about Autism warned me that some people wi autism can react very badly to very small doses of psychological drugs. And I already have a few of the more serious side effects that are written on there, which if they got worse, could put me at risk of harm. Like I don’t want to get worse intrusive suicidal thoughts (which I already do have, but do not and will not act on), and if it then changes my brain chemistry, it could be much worse. I already take notrypryline at a low dose and have not noticed any of those issues getting worse, despite this being a warning on the box, but it could interact with that.

The other worry I have is that I wouldn’t be monitored by someone who understands interactions. Like, I take Ivabradine to bring down my heart rate or blood pressure medication but I have regular reviews with doctors who regularly use it, who have seen it in trials, and know how to monitor it and look at side effects. For this, no one knows as it’s so new in ME.

I am also so desperate to get better, especially recently when hospitals are give me such a hard time and I know the reason I’m even in this situation is because of how severe my ME is. If it wasn’t so severe, I would have just been allowed and even able to have surgery anywhere and I wouldn’t be suffering and getting weaker like this. It’s my sensory sensitivities that make it this bad and I’m so angry at myself that it’s like this. Plus the housing situation. So seeing these stories in Pw Very Severe ME is what makes me wonder and think about it. Some of the stories sound amazing, you’re right I think the fact Whitney is well known also makes it more popular, so more people in the groups are talking about it and trying it. But I am also scared of getting worse and the side effects (which I might not know about until it’s too late), and knowing it’s not been studied, and all the things you said too.

 

Just wanted to be clear, this is not just because of Whitney being a famous patient. Well, it probably is to an extent because I wouldn’t have heard about him otherwise as I’m not that active on fb forums. But it’s more because a lot of what he and his parents said regarding his symptoms (sensory sensitivities, difficulty with people, eye contact), is very similar to me, so although his condition is worse than mine, what was described came close to my symptoms. Whereas when I hear of people with different or milder symptoms getting better, I tend not to take as much notice. And I know he’s tried a lot of drugs before that didn’t work or made him worse and he’s been through a lot. So that’s why I was interested - it’s not just that he’s a well known patient, although I know that does have an effect on people including me. I find that when I hear stories I often end up picking up on similarities between me and someone else.

 

Abilify’s potential anti-inflammatory and immunomodulating characteristics...

Aripiprazole as a candidate treatment of COVID-19 identified through genomic analysis. Crespo-Facorro et al. medRxiv (2020)

 

Syk and Src-targeted anti-inflammatory activity of aripiprazole, an atypical antipsychotic. Yoo et al. Biochem Pharmacol (2018)

 

I suspect that dexamethasone completely covers these targets.
I cannot see any need to look for more vaguely a bit sort of anti-inflammatoryish drugs.

 

I think it is likely stronger than placebo, but also I believe it mediates its positive effects via dopamine and serotonine. More like rocket fuel, Abilify is.

 

To me the paper is interesting not in relation to COVID-19, but to possible (hypothetical) mechanism of action in ME/CFS.

 

But we don't have evidence of inflammation in ME/CFS. If Syk kinase was involved I think one would expect some evidence of immune activation like raised CRP and there isn't.

It looks to me as if someone with a financial interest in repurposing aripiprazole because it isn't selling much is trying to dredge up ideas.

 

Abilify is not selling much? Ehm, no.

 

Is anyone else interested in the anti-fungal activity of aripiprazole?

 

If you want antifungals, I think you'd be much safer with ones which don't have psychiatric effects.

 

No doubt, but I still wonder if any of the effect in severe patients for example, is due to well, antifungal activity.

 

Out of patent then?

 

The pharma company that discovered aripiprazole already has a new FDA approved drug for the same indications, brexipiprazole (Rexulti). So I have my doubts that the authors of the paper, if related to the company at all, have this as a principal intent.

 

I think Syk elevated CRP assumes the inflammation is systemic or at least outside CNS?

I believe that Syk and Src are part of a microglial activation pathway. So maybe the “inflammation” (I know, you don’t like this word in relation to microglial activation) is in CNS and you wouldn’t see elevated peripheral CRP.

We do have some limited evidence of microglial activation in ME/CFS, and hopefully another paper coming soon on it (Stanford James lab) which replicates some of the Nakatomi findings.

 

On the other hand I find it extraordinarily difficult to understand why anyone without a commercial motivation would bother to test a drug so obliquely relevant to a severe viral response.

Strategies for repurposing drugs are very complex. Companies may not want to queer a pitch for a potential money-making drug for one condition with studies in another condition that might fail or reveal adverse events.

 

I said like CRP - there are lots of others that are also missing. If the Nakatomi study is replicated that would be very interesting but it is a very long way from providing a rationale for using a drug that might be a little bit anti-inflammatory when major anti-inflammatories like steroids have proved ineffective.

 

Has it been shown that steroids are ineffective in ME/CFS in very short-term usage? I understand they aren’t a usable long-term treatment, but I didn’t know they were proven ineffective for very short-term use, at least for an ME subset.