Exploring What is the Biggest Side Effect of Abilify

October 12, 2025 •

4 min read

Affecting up to 11-12% of patients in some clinical studies, akathisia—an inner sense of restlessness—is one of the most frequently reported side effects associated with Abilify. This article explores what is the biggest side effect of Abilify, its manifestations, and other key considerations for patients and caregivers.

Quick Summary

Akathisia, characterized by intense inner restlessness, is a prominent and distressing side effect of Abilify, frequently impacting patient adherence. Other common issues include weight gain, nausea, sedation, and constipation. Less frequent but serious risks, such as tardive dyskinesia, metabolic problems, and compulsive behaviors, also necessitate careful monitoring.

Key Points

Akathisia is the most distressing side effect: Characterized by an intense inner sense of restlessness, akathisia is often reported as the most difficult side effect to endure, leading to poor treatment adherence.
Weight gain is a common concern: Although Abilify has a lower risk compared to other antipsychotics, significant weight gain can still occur, especially in conjunction with antidepressants.
Impulse control issues can arise: Some patients develop unusual and uncontrollable urges for activities like gambling, shopping, or binge eating. These urges are often reversible upon stopping the medication.
Serious but rare risks exist: Less common but severe side effects include tardive dyskinesia (involuntary movements), metabolic changes (diabetes), and Neuroleptic Malignant Syndrome (NMS).
Side effects often improve over time: Many common side effects, such as nausea or drowsiness, may subside as your body adjusts to the medication over several weeks.
Open communication is crucial: Always discuss any side effects with your healthcare provider, as they may suggest dose adjustments, a different medication, or other strategies to manage symptoms.

Understanding the Biggest Side Effect of Abilify: Akathisia

For many patients, the most profound and challenging side effect of Abilify is akathisia, an internal and external restlessness that can feel unbearable. While other side effects are more common, the subjective distress caused by akathisia is often cited as a primary reason for discontinuing the medication. Akathisia presents as an overwhelming urge to move and an inability to stay still, which can manifest as pacing, fidgeting, or constantly moving legs while sitting. Unlike simple anxiety, it is a specific movement disorder directly linked to the drug's effect on dopamine receptors. The incidence and severity of akathisia can be dose-dependent, and sometimes appear more frequently when starting or increasing the dose of Abilify. Managing this side effect often requires a dosage adjustment or the addition of other medications.

The Impact of Akathisia on Treatment Adherence

The intense distress associated with akathisia can profoundly impact a person's life and their willingness to continue treatment. Patients may mistakenly believe the restlessness is a worsening of their underlying condition, leading to frustration and non-compliance. Effective management involves open communication with a healthcare provider to explore solutions, including reducing the Abilify dose, changing the timing of the dose, or adding a short-term medication to alleviate the symptoms.

Other Common and Serious Abilify Side Effects

While akathisia can be the most distressing, it is important to be aware of other potential side effects. These can range from mild and temporary discomforts to severe conditions requiring immediate medical attention. The table below compares some of the common and serious side effects associated with Abilify.

Comparison of Common vs. Serious Side Effects


Feature	Common Side Effects	Serious Side Effects
Examples	Nausea, vomiting, constipation, headache, drowsiness, insomnia, weight gain, restlessness (akathisia)	Neuroleptic Malignant Syndrome (NMS), Tardive Dyskinesia (TD), compulsive urges (gambling, shopping), metabolic changes (hyperglycemia, diabetes), orthostatic hypotension (low blood pressure)
Incidence	Fairly common, experienced by a significant percentage of patients, especially upon initiation or dosage change	Rare, but potentially life-threatening or permanent
Management	Often managed with lifestyle changes (diet, hydration, exercise) or dose adjustments; may subside over time	Requires immediate medical attention and likely discontinuation of Abilify
Impact	Can be bothersome and affect daily quality of life; may improve as the body adjusts	Can cause long-term, irreversible damage or be fatal if not treated immediately

Management Strategies for Abilify Side Effects

Managing side effects is crucial for a successful treatment outcome. Here are some strategies for addressing various side effects:

For akathisia: If experiencing intense restlessness, notify your doctor immediately. They may recommend lowering the dose or prescribing a different medication to help, such as propranolol.
For weight gain: Monitor your weight regularly. Combat increases with a balanced diet rich in lean protein, fruits, and vegetables, and regular exercise. Your doctor may also consider alternatives or adjunct medications like metformin.
For drowsiness or dizziness: Avoid driving or operating heavy machinery until you understand how the medication affects you. Taking Abilify at bedtime may help mitigate daytime sleepiness. Stand up slowly from sitting or lying down to prevent dizziness from orthostatic hypotension.
For nausea: Taking Abilify with food can help reduce nausea and vomiting. Stick to bland foods and drink plenty of fluids to stay hydrated.
For impulse control issues: Report any unusual and uncontrollable urges for gambling, shopping, or sexual activity to your healthcare provider immediately. These urges typically resolve upon dose reduction or discontinuation.

The Role of Open Communication with Your Healthcare Provider

Regular and transparent communication with your healthcare team is your most important tool for managing side effects effectively. At every appointment, discuss any symptoms, no matter how minor they seem. This allows your doctor to make informed decisions about your treatment plan, whether through adjusting the dose, switching medications, or prescribing additional treatment to manage specific side effects. Never stop taking Abilify abruptly without a doctor's guidance, as this can lead to withdrawal symptoms or a relapse of your condition.

Conclusion: Balancing Risks and Benefits

While the search for what is the biggest side effect of Abilify often leads to akathisia due to its debilitating nature, a range of common and serious side effects exist. Aripiprazole can be a highly effective treatment for many mental health conditions, but its benefits must be weighed against its potential risks. By maintaining open communication with your healthcare team, and understanding the symptoms to watch for, you can better manage your treatment and minimize the impact of side effects, ensuring the best possible outcome for your mental health journey.

WebMD: Aripiprazole Side Effects: Common, Severe, and More

Frequently Asked Questions

Akathisia is a movement disorder defined by a subjective feeling of inner restlessness and an objective inability to sit or stand still. It's considered a major side effect because of the significant distress it causes patients and its potential to lead to non-adherence, despite the fact that other side effects may be more frequent.

Yes, Abilify can cause weight gain, but studies show it is less likely to cause significant weight gain compared to many other atypical antipsychotics. However, weight gain is still a common side effect and a concern for many patients, with some experiencing noticeable changes within the first six months of treatment.

Some of the most common side effects of Abilify include akathisia (restlessness), nausea, vomiting, constipation, headache, and drowsiness. Many of these can improve over time as your body adjusts to the medication.

If you or your family notice unusual and uncontrollable urges for activities such as gambling, compulsive shopping, or binge eating, you should talk to your healthcare provider right away. These behaviors often resolve when the dosage is reduced or the medication is stopped under medical supervision.

Yes, tardive dyskinesia (TD) is a serious and sometimes irreversible side effect associated with long-term use of antipsychotics like Abilify. While the risk may be lower with Abilify compared to older antipsychotics, it can still occur and is characterized by involuntary movements of the face, tongue, or other body parts.

If you experience severe side effects such as a very high fever, stiff muscles, confusion, uncontrolled movements, or signs of an allergic reaction, seek immediate medical attention. Your healthcare provider should be contacted immediately if you suspect a serious reaction.

No, you should not stop taking Abilify abruptly without consulting your doctor. Sudden discontinuation can lead to withdrawal symptoms or a relapse of your condition. Discuss your concerns with your healthcare provider, who can help you safely adjust your dose or switch medications.