Abilify, an atypical antipsychotic, is sometimes used to treat OCD when first-line treatments like SSRIs aren’t fully effective. Research has shown some people benefit from using atypical antipsychotics as an add-on medication to reduce their OCD symptoms.
Exposure and response prevention (ERP) therapy and medication have been proven to be the most effective treatments for obsessive-compulsive disorder (OCD) .
ERP, a targeted form of cognitive behavioral therapy (CBT) designed specifically for OCD, has been shown to help up to 80% of those who use it. While ERP works by disrupting the cycle of obsessions and compulsions through structured behavioral exercises, medications can ease the intensity of OCD symptoms.
First-line medications for OCD include selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine) and Zoloft (sertraline), Lexapro (escitalopram), Luvox (fluvoxamine), or Paxil (paroxetine). However, there are some instances where a psychiatrist may recommend an atypical antipsychotic such as aripiprazole, also known by its brand name, Abilify.
In this article, we’ll explain how Abilify works, when it might be recommended as part of OCD treatment, potential side effects, and what to consider before starting it.
How Abilify is used to treat OCD
Abilify belongs to a class of medications known as atypical antipsychotics. If the term “antipsychotic” makes you uncomfortable, that’s understandable, as the label can be misleading. Being prescribed Abilify does not mean that you are experiencing psychosis—atypical antipsychotics have shown versatility to treat a range of mental health conditions, including OCD.
Abilify is what’s known as a partial dopamine agonist—these are medications that exert their action in the brain on the same receptors as does the neurotransmitter dopamine. Its unique mechanism allows it to both enhance and inhibit dopamine activity, which can contribute to mood stabilization and symptom management in a number of mental health disorders.
Abilify’s capability to modulate neurotransmitter activity has established it as a helpful treatment option for disorders with complex neurochemical imbalances, and it’s been primarily used to treat schizophrenia, bipolar disorder, and major depressive disorder. Aripiprazole is still considered “off-label” for OCD in the US, as it does not have an FDA indication.
Clinical trials and studies have investigated the efficacy of aripiprazole in treating OCD symptoms when combined with an SSRI. The findings from these studies provide valuable insights into the potential benefits of using aripiprazole for OCD, showing its effectiveness as a treatment option and guiding clinical decision-making—especially for specific groups of people with OCD, or as part of a multifaceted treatment plan.
How long does it take for Abilify to start working?
Abilify is not a first-line medication for OCD, so it’s unlikely to be among the first medications a provider will prescribe. Typically, one or more SSRIs, or clomipramine, or a serotonin-norepinephrine reuptake inhibitor (SNRI) such as venlafaxine will be tried before Abilify.
Gauging an SSRI, clomipramine, or an SNRI’s effectiveness can take anywhere from six weeks to 12 weeks, though one’s symptoms may continue to improve for many weeks or even months after that. By the time a provider considers augmenting treatment with an atypical antipsychotic, many months may have passed in the treatment process, which can be frustrating, to say the least.
However, Abilify can offer a lifeline for people who don’t respond to other classes of drugs. There have been several randomized placebo-controlled trials of adding aripiprazole to SSRIs. These have found that aripiprazole was effective and generally well-tolerated as an augmenting agent (taken in conjunction with at least one other medication).
Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD, explains that atypical antipsychotics may be added to a person’s treatment plan as a supplement, or “augmentation” to other medications, like SSRIs, clomipramine, or venlafaxine. “If the medication is partially effective, reducing symptoms by, for example, 20% or 30%, but the person still has significant symptoms, and they want further symptom reduction, then [an atypical antipsychotic] can be added,” he says.
“The addition of an antipsychotic medication can lead to symptom reduction in the span of four to eight weeks, although sometimes people have a quicker response,” says Dr. Feusner. “Around one third of the people who try the addition of an antipsychotic to their SSRI will have a significant reduction in symptoms.”
According to a review study, one in three patients with SSRI-resistant OCD respond well to atypical antipsychotics.
Side effects
As with any medication, Abilify can cause side effects. While the following is not an exhaustive list, some of the most common side effects include:
- Nausea and/or vomiting
- Headache
- Weight gain
- Insomnia or drowsiness
- Restlessness or tremors
Other, more serious side effects such as a movement disorder called tardive dyskinesia, while relatively rare, can also occur from long-term use of aripiprazole.
Taking Abilify (as well as any other psychiatric medication) should always be carefully monitored by your prescriber, especially during the first few weeks. Let your prescriber know if you are experiencing any side effects or sudden changes in your mood.
Is Abilify right for me?
Psychiatric medication recommendations will depend on your age, health history, what other medications you take, and factors such as pregnancy and breast/chestfeeding. The best way to find out if Abilify makes sense for your OCD treatment is by speaking with your healthcare provider.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Combining Abilify with ERP therapy
While many medications can be an effective treatment option for OCD on their own, the best results are often seen when they are combined with exposure and response prevention therapy. ERP is a behavioral therapy that works by breaking the cycle of obsessions and compulsions, making symptoms less intense and easier to manage independently.
When used on their own, medications only treat OCD’s symptoms, whereas ERP helps foster long-term recovery by helping you develop tools to resist performing compulsions. Some people find it helpful to reduce (but not eliminate) their anxiety or other distress through medication before starting ERP, but the right approach varies depending on the individual’s needs and treatment plan.
Bottom line
Every treatment plan is unique, and finding the right medication, or combination of medications, requires both time and patience. If you’re considering OCD medication as part of your treatment plan, speak with a licensed healthcare professional.
Key takeaways
- Abilify (aripiprazole) an atypical antipsychotic that is sometimes prescribed as an off-label add-on treatment for OCD.
- Abilify may be used as an add-on when SSRIs or other medications don’t fully reduce OCD symptoms.
- Combining medications with exposure and response prevention (ERP) therapy can be a highly effective treatment plan for many people with OCD.