From the Guidelines
Aripiprazole is not a first-line treatment for anxiety disorders, but it may be considered as an adjunct therapy in certain cases, particularly when other treatments have not been effective, as supported by studies such as 1. Aripiprazole (brand name Abilify) is primarily an antipsychotic medication, but it may be prescribed off-label for anxiety, particularly when other treatments have not been effective. It's usually used as an adjunct therapy alongside antidepressants or other anxiety medications. Some key points to consider when using aripiprazole for anxiety include:
- Typical dosages for anxiety range from 2 to 15 mg per day, taken orally.
- The medication should be started at a low dose and gradually increased under a doctor's supervision.
- Aripiprazole works by modulating dopamine and serotonin activity in the brain, which can help stabilize mood and reduce anxiety symptoms.
- It may be particularly helpful for individuals with anxiety that co-occurs with bipolar disorder or depression. However, it's essential to note that aripiprazole can have significant side effects, including weight gain, metabolic changes, and movement disorders, as reported in studies such as 1. Therefore, it should only be used for anxiety under close medical supervision and after careful consideration of risks and benefits, as recommended by guidelines and studies such as 1 and 1. Patients should always consult with their healthcare provider before starting or changing any medication regimen for anxiety treatment. Some alternative treatments for anxiety that may be considered as first-line options include:
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as supported by studies such as 1 and 1.
- Cognitive-behavioral therapy (CBT) and other forms of psychotherapy, as recommended by guidelines and studies such as 1 and 1.
From the FDA Drug Label
Anxiety 17 13 Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down.
The FDA drug label does not provide direct evidence that aripiprazole (Abilify) helps with anxiety. While anxiety is mentioned as a potential symptom to be monitored, there is no indication that the medication is used to treat anxiety. In fact, the label warns of the emergence of anxiety as a potential side effect. Anxiety is listed as an adverse reaction in the label, with an incidence of 17% in patients treated with aripiprazole, compared to 13% in patients treated with placebo 2. Therefore, it cannot be concluded that aripiprazole is effective in treating anxiety.
From the Research
Efficacy of Aripiprazole in Anxiety Treatment
- Aripiprazole has been found to be effective in treating anxiety disorders in open-label trials, although randomized, controlled trials are lacking 3.
- Atypical antipsychotics, including aripiprazole, have been shown to be helpful in addressing anxiety and depressive symptoms in individuals with schizophrenia and schizoaffective disorders, and have been used in the treatment of mood and anxiety disorders 4.
- Aripiprazole may be useful in the treatment of bipolar depression, major depressive disorder, treatment-resistant depression, and possibly anxiety disorders, with a lower adverse effect burden than other atypical antipsychotics 5.
Augmentation of Selective Serotonin Reuptake Inhibitors (SSRIs)
- Aripiprazole may be effective as an augmentation for patients with persistent depressive and anxiety disorders despite initial SSRI treatment, with 59% of subjects showing significant improvement in depression and anxiety symptoms 6.
- Adjunctive aripiprazole has been found to be effective in reducing residual anxiety symptoms in depressed patients taking SSRIs, with 80% of subjects experiencing a greater than 50% reduction in symptoms 7.
Mechanism of Action
- Aripiprazole's mechanism of action, including its action as a 5-HT1A partial receptor agonist, 5-HT2C partial receptor agonist, and 5-HT2A receptor antagonist, as well as its action as a dopamine D2 partial receptor agonist, may be important in the treatment of depressive and anxiety disorders 5.