So, would the following be accurate?
Although the side effects of aripiprazole are frequently significant and occasionally very serious indeed, the 15 to 20 year reduction in life expectancy for people with schizophrenia using antipsychotics will be the result of a number of factors. Those might include use of antipsychotics with worse side effects than aripiprazole, as well as the many consequences of having a very serious psychiatric disease.
I don't want to promote the use of a drug with only anecdotal (and therefore questionable) evidence of efficacy for ME/CFS and the chance of serious side effects, but I guess if someone is taking a low dose of aripiprazole and they and their medical team are carefully monitoring for problems and they are otherwise living a healthy stable life, the likely reduction in life expectancy for them will be very much reduced compared to people with schizophrenia.
The only complication might be that with the inability to be normally active that is part of ME/CFS, the metabolic and cardiovascular side effects could be exaggerated in ME/CFS.
I think guessing is the problem, which defeats the purpose of the forum in my mind (after being told off numerous times for doing this by many members
) We don't want physicians (or psychiatrists) prescribing antipsychotics or any psychiatric medication without 1) clear evidence it will be clinically effective in a large proportion of pwME over a reasonable period of time and this data, including the short term risks and long term harms so they can be carefully considered before consent is given. Ideally, I also think we need to have a reasonable understanding how low dose Abilify works based on further research into ME brain function.
Psychiatrists are looking at neurotransmitter receptors and pathways that are reasonably known in Schizophrenia and BPAD. At least we can see dose dependency and clear clinical outcomes and this has been replicated for many years worldwide so much so that these medications are are funded by countries like NZ and the UK in the public health system because of the very solid evidence base.
Science of course is evolving. We didn't know about the life expectancy problem due to the antipsychotics until 20 years ago with this paper and then all the debate about it, we put it the reduced life expectancy done to smoking, poverty, poor diet, low motivation causing inactivity, lack of social support due to the inherent nature of the disorder etc
We have no long-term data of what an atypical antipsychotic will have on the "healthy population" let alone the ME/CFS population. There is a possibility that the ME/CFS brain may differ from a "healthy" brain, some evidence points to that but we are a long way off knowing comparing it to major mental health disorders.
I think the problem is people think low dose of an antipsychotic (or low dose naltrexone since we are discussing psychiatric medication) should be fine on healthy people, it is only a small dose not like the high doses of major psychiatric disorders but it is not without risks and harms.
I know a few psychiatrists in NZ and Australia who think they can improve ME/CFS by playing around with different psych meds but I have huge doubts about this and have yet to see it, they were likely treating the underlying psychiatric condition premorbid to the ME/CFS. Where are the Case Series (first level of clinical study evidence) printed in our College Journal? (which is the first way to show your peers that this might be a useful treatment and requires further study - none) They are prescribing off label. We do not know what LDA is doing, it might just be giving them a calming state of mind that improves their cognition (for example). They can talk about dopamine, glutamate and a myriad of neurotransmitters and "neuroinflammation" that it may be working on but they don't know. They are just trialling stuff because it might work based on some of the current knowledge which is pretty tenuous at times. Basically they are cowboys (and girls) throwing everything but the kitchen sink at pwME hoping something might work and saying something scientific about receptors and hoping for the best. I doubt it is properly informed consent either.
People with ME are not "healthy" they have a long term chronic illness which has health effects due to our inability to tolerate exercise and the subsequent likely long term effects on our heart, brain and bones, conditions that are often not talked about as there is a lack of epidemiological data. (eg. osteopenia) But if we compare ourselves to healthy people and say then these psychiatric medications should be ok, I think that is problem.
There, of course, is always a risk/benefit ratio that will always be used in this argument because of how severe ME can get and in reality pwME consider and use un-evidenced treatments for ME/CFS everyday, including myself. If people want to take LDA and are well informed and under close medical care, that is their choice and the GP's/Physician's/Psychiatrist's choice.
This is what Google AI says on the topic to just remind people about LDA and the Stanford LDA paper and want confirmation of what I have said. I have bolded the side effects.
"There is no randomized controlled trial (RCT) for the use of aripiprazole in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
Evidence is limited to a 2021 retrospective chart review of 101 patients.
The review suggested that low-dose aripiprazole might help reduce symptoms like brain fog and fatigue, but it was not a controlled trial.
Key details about Aripiprazole and ME/CFS:
- A 2021 study by Stanford Medicine indicated that some patients saw improvements in energy and cognitive function at low doses (mean dose 1 mg) in a cohort of 101 patients.
- The study's authors and health organizations like the ME Association emphasize that randomized, double-blind, placebo-controlled trials are needed to confirm efficacy and safety.
- Reported side effects in the retrospective study included fatigue. Other reported risks include weight gain and movement disorders.
- It is hypothesized that low-dose aripiprazole may modulate neuroinflammation and microglial activation in ME/CFS, but this is not scientifically proven.
As of early 2026, aripiprazole remains an "off-label" option with limited evidence and is not currently recommended as a standard treatment for ME/CFS."
