Yes, Abilify (aripiprazole) and Rexulti (brexpiprazole) are partial dopamine D2 receptor agonists, and they have been associated with Impulse Control Disorders (ICDs) such as:
- Pathological gambling
- Hypersexuality
- Compulsive shopping
- Binge eating
- Punding (repetitive, purposeless behaviors)
Why do they cause ICDs?
The core issue lies in dopaminergic overstimulation in the mesolimbic reward system, especially:
- Dopamine D2 and D3 Receptor Partial Agonism
- Aripiprazole and brexpiprazole partially activate D2/D3 receptors.
- In some brain regions, this leads to enhanced dopaminergic tone, especially in the nucleus accumbens, which governs reward, pleasure, and drive.
- Dose-Response Sensitivity
- Even at low doses, individual differences in receptor sensitivity or metabolism (e.g. via CYP2D6, CYP3A4) can lead to excessive stimulation of these circuits.
- Overlap with Dopamine Agonist Syndrome
- Similar to pramipexole/ropinirole used in Parkinson’s, which also cause gambling and hypersexuality.
Who is at risk?
- Patients with bipolar disorder, schizophrenia, or MDD taking these drugs
- Those with personal/family history of addictions or OCD
- Those with genetic vulnerabilities in dopamine metabolism or transport
Regulatory Warnings
- The FDA issued a warning in 2016 about Abilify-induced ICDs, including serious cases of compulsive gambling, even in people without a prior history.
What can be done?
- Dose reduction or discontinuation usually resolves symptoms.
- Switching to another antipsychotic (like quetiapine or lurasidone) is often effective.
- Clinicians should screen for ICDs regularly during treatment.
Would you like a comparative table of ICD risks across antipsychotics?
