Can Rexulti (brexpiprazole) be used for Obsessive-Compulsive Disorder (OCD) and anxiety?

From the Guidelines

Rexulti (brexpiprazole) should not be used as a first-line treatment for OCD or anxiety disorders, as SSRIs and SNRIs are the preferred first-line options due to their established efficacy and safety profiles. For OCD, first-line medications are typically SSRIs like fluoxetine, sertraline, or fluvoxamine at higher doses than used for depression, usually for at least 12 weeks before assessing full effectiveness 1. For anxiety disorders, SSRIs and SNRIs are generally the first choice, as recommended by the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical Practice Guideline for Social Anxiety Disorder (2021) 1.

Some key points to consider when treating OCD and anxiety disorders include:

• The importance of using evidence-based treatments, such as SSRIs and SNRIs, which have been shown to be effective in reducing symptoms of OCD and anxiety disorders 1
• The need to carefully assess the potential benefits and harms of treatment, including the risk of side effects such as weight gain, akathisia, and metabolic changes 1
• The importance of shared decision-making between medical professionals and patients, taking into account the individual's unique needs and circumstances 1

If these standard treatments don't provide adequate relief, a psychiatrist might consider adding Rexulti as an augmentation strategy, typically starting at a low dose (0.5-1mg daily) and gradually increasing if needed. However, this use would be considered experimental, and patients should discuss the potential benefits versus side effects with their doctor before trying this approach. The rationale for using Rexulti in these conditions relates to its action as a partial agonist at dopamine and serotonin receptors, which may help modulate these neurotransmitter systems involved in OCD and anxiety.

From the Research

Rexulti for OCD and Anxiety

• Rexulti (brexpiprazole) is an atypical antipsychotic that has been studied as a potential treatment for obsessive-compulsive disorder (OCD) and anxiety disorders 2, 3.
• A study published in 2024 found that brexpiprazole augmentation was effective and well-tolerated in treatment-resistant OCD patients, with 50% of patients achieving a 25% improvement in YBOCS total score 2.
• Another study published in 2015 discussed the development and approval of brexpiprazole for the treatment of major depressive disorder and schizophrenia, but did not specifically address its use in OCD or anxiety disorders 3.
• Research on the pharmacologic treatment of OCD suggests that selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment, but up to 60% of patients may not respond to adequate treatment trials with SSRIs 4.
• A systematic review and meta-analysis published in 2019 found that SSRIs were effective in treating OCD in adolescents and children, but noted that combination treatment with cognitive behavioral therapy (CBT) may be more effective than SSRI monotherapy 5.
• A meta-analytic review published in 2018 compared the efficacy of benzodiazepines and serotonergic antidepressants for adults with generalized anxiety disorder, and found that benzodiazepines were the most effective treatment, although SSRIs and SNRIs were also moderately effective 6.