Is Abilify (aripiprazole) used as an augmenter of antidepressants for Obsessive-Compulsive Disorder (OCD)?

Aripiprazole (Abilify) for Treatment-Resistant OCD

Yes, aripiprazole is strongly recommended as an augmentation agent for antidepressant-resistant OCD, with risperidone and aripiprazole having the strongest evidence among all antipsychotic augmentation strategies. 1

When to Use Aripiprazole Augmentation

Aripiprazole augmentation should be initiated after a patient has failed adequate trials of both:

• SSRIs at maximum tolerated doses for at least 8-12 weeks 1
• Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP) 1

Approximately one-third of patients with SSRI-resistant OCD show clinically meaningful response to antipsychotic augmentation. 1

Evidence Quality and Strength

The recommendation for aripiprazole is based on:

• Guideline-level evidence from the American College of Psychiatry identifying aripiprazole and risperidone as having the strongest efficacy data 1
• Multiple randomized controlled trials demonstrating significant Y-BOCS score reductions 2
• A 2012 double-blind RCT showing significant reduction in Y-BOCS scores (P < 0.0001) with aripiprazole 10 mg/day versus placebo 2

Dosing Strategy

Start aripiprazole at 5 mg/day and titrate up to a maximum of 20 mg/day based on response and tolerability. 3, 4

• Mean effective doses in clinical trials ranged from 10.9-15.2 mg/day 5, 6
• Continue augmentation for at least 12 weeks before declaring treatment failure 3, 2

Expected Response Rates

• Response rate (≥35% Y-BOCS reduction): 41.8% 6
• Partial response rate (25-35% Y-BOCS reduction): 18.2% 6
• Seven out of 10 treatment-resistant patients showed significant improvement (>35% Y-BOCS reduction) in one case series 5

Common Side Effects to Monitor

The most frequently reported adverse effects include:

• Akathisia and inner unrest (most common) 3, 6
• Tremor 3, 6
• Nausea/vomiting 3
• Reduced sleep duration 6
• Asthenia/fatigue 3

Aripiprazole is generally well-tolerated with no significant metabolic side effects compared to other antipsychotics like risperidone or olanzapine. 5

Metabolic Monitoring Requirements

When using aripiprazole augmentation, monitor:

• Weight, blood glucose, and lipid profiles at baseline and regularly during treatment 1
• Vital signs (though no significant changes typically observed) 3

Special Population: Bipolar Disorder with OCD

In patients with comorbid bipolar 2 disorder and OCD:

• Prioritize mood stabilization first with lithium or valproate 7
• Aripiprazole augmentation to mood stabilizers is specifically recommended for treatment-resistant cases 7
• Avoid SSRI monotherapy due to risk of mood destabilization 7
• Aripiprazole added to lithium or valproate showed 41.8% response rate in euthymic bipolar patients with OCD 6

Critical Pitfall to Avoid

Do not add aripiprazole before ensuring adequate SSRI trials (8-12 weeks at maximum tolerated doses). 1 Many patients are prematurely labeled as treatment-resistant when they have not received adequate first-line treatment duration or dosing. Higher SSRI doses are required for OCD than for depression or anxiety disorders. 1

Alternative Considerations

If aripiprazole augmentation fails:

• Consider adding CBT to pharmacotherapy, which has shown larger effect sizes than antipsychotic augmentation alone 1
• N-acetylcysteine has the strongest evidence among glutamatergic agents 1
• Memantine can be considered 1
• Deep repetitive transcranial magnetic stimulation (rTMS) has FDA approval for treatment-resistant OCD 1

Treatment Duration After Response

Maintain treatment for 12-24 months after achieving remission due to high relapse rates after discontinuation. 1, 7