Obsessive compulsive disorder - OCD treatment and therapy from NOCD
MedicationIs Abilify (aripiprazole) effective for OCD?

Is Abilify (aripiprazole) effective for OCD?

6 min read
Grant Stoddard

By Grant Stoddard

Reviewed by Dr. Jamie Feusner, MD

Oct 23, 2023

Abilify, also known by its generic name aripiprazole, is a medication primarily used to treat schizophrenia, bipolar disorder, and major depressive disorder. It belongs to a class of medications known as atypical antipsychotics. It works by modulating certain neurotransmitters in the brain, which can stabilize mood and reduce delusions and hallucinations if they are occuring.

Let’s explore the potential benefits and limitations of using Abilify as a treatment option for Obsessive-Compulsive Disorder (OCD), a serious—but often misunderstood—mental health condition that affects an estimated 2.5% of people in their lifetimes worldwide. 

As the name suggests, OCD is characterized by two core elements: obsessions and compulsions. Obsessions are unwanted intrusive thoughts, images, feelings, or urges that feel impossible to dismiss, leading to anxiety or other distressing emotions and feelings.

Compulsions are repetitive behaviors or mental rituals that people perform to reduce the distress their obsessions provoke or to prevent an unwanted outcome. Performing these compulsions tends to make people with OCD feel better in the short term. However, they’re inadvertently reinforcing a loop of obsessions, anxiety, compulsions, and relief known as the OCD cycle.   

By examining Abilify’s mechanism of action, reviewing research studies, and considering expert opinions, we hope to give insight into the drug’s effectiveness in managing OCD symptoms.

Understanding OCD

It’s incredibly common to hear someone say they are a “little OCD.” While it’s true that people’s symptoms have a wide range of severity, people diagnosed with OCD feel such distress from their obsessions or are so regularly engaged in compulsions that they experience a significant impact on their daily lives.

When people remark that they or someone they know is a “little OCD,” they’re often referring to a propensity for cleanliness, symmetry, or order—these manifestations of OCD are most often depicted in the media. But millions of sufferers have unwanted, distressing obsessions about causing harm to themselves or others, the stability of their relationships, and taboo themes like pedophilia, to name just a few.

The longer OCD goes untreated, the more severe i’s symptoms become. Unfortunately, the average time it takes from the onset of symptoms to an accurate diagnosis is nearly 13 years. A further 1.45 years—on average—separates that diagnosis from the beginning of treatment. Often, that treatment involves exposure and response prevention therapy (ERP), or medications including selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine) and Zoloft (sertraline) or serotonin and norepinephrine reuptake inhibitors (SNRIs) that are used to reduce symptoms. Other times, however, care providers will prescribe a drug like aripiprazole, better known by its brand name, Abilify. 

What is Abilify (aripiprazole)? 

Aripiprazole is classified as an atypical antipsychotic, a category of medications known for their diverse therapeutic effects on various mental health conditions. Atypical antipsychotics like aripiprazole are different from the older class of “typical” antipsychotics in that they affect neurotransmitter systems differently in the brain.

The medication primarily acts as a partial agonist of dopamine receptors, regulating dopamine levels in the brain. This 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.

Originally approved for schizophrenia and bipolar disorder, aripiprazole’s versatility has led to its use in treating various mental health conditions, including major depressive disorder and, in some cases, OCD (although it’s still considered “off-label” for OCD in the US, as it does not have an FDA indication). Its ability to modulate neurotransmitter activity has established it as a helpful treatment option for disorders with complex neurochemical imbalances.

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.

It should be noted, however, that aripiprazole is unlikely to be among the first medications a provider will prescribe as an adjunct or alternative treatment to ERP. Typically, one or more SSRIs or SNRIs will be tried. Gauging an SSRI or SNRI’s effectiveness can take anywhere from six weeks to 12 weeks, though, in some cases, things continue to improve for many weeks or even months after that. That means that by the time a provider considers augmenting treatment with an atypical antipsychotic like aripiprazole, many months may have passed in the treatment process. 

When a patient is not responding to these other classes of drugs, aripiprazole can offer a lifeline. 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). 

What are the side effects of aripiprazole? 

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: Some people may experience nausea, sometimes leading to vomiting.

Headache: Headaches are a relatively common side effect of Abilify.

Weight gain: Abilify can lead to weight gain in some people. This can vary in severity and may be influenced by factors such as dosage and individual metabolism.

Insomnia or drowsiness: Abilify may cause changes in sleep patterns, leading to either difficulty falling asleep (insomnia) or excessive sleepiness.

Restlessness or tremors: Some people may experience restlessness, jitteriness, or trembling while taking Abilify.

Other, more  serious side effects, while relatively rare, can also occur from aripiprazole.

Comparing aripiprazole with other OCD treatments

As mentioned above, while many medications can be an effective treatment option for OCD on their own, optimal results are often seen when used in conjunction with ERP therapy. That’s because when used on their own, medications only treat OCD’s symptoms, whereas ERP interrupts the cycle that reinforces OCD symptoms, allowing many people to manage their symptoms long-term. While remaining on medication indefinitely is an effective choice for many, it’s important to note that if one’s course of treatment consists of medication alone, OCD symptoms most often return once treatment is stopped.

In ERP, you’ll work with a therapist to identify the situations that trigger your obsessions. You’ll then carefully, intentionally face these triggers—directly or indirectly—starting with the least distressing ones. These exposures are distressing by design, so for people with more severe cases of OCD, medications can be a game-changer, enabling them to fully commit to ERP exercises with the guidance of their therapist.

During these exposures, you’ll refrain from engaging in your compulsive responses, working instead to sit with the discomfort you feel and allow it to pass with time. As these exposures are repeated, you’ll develop a greater tolerance for the distress that comes from your obsessions, and likely experience less discomfort when faced with triggers in the future. This therapeutic approach empowers people to regain control over their lives, reducing the impact of OCD on daily functioning.

It’s important to note that ERP is most effective when guided by a trained therapist, as they provide expertise, support, and structure throughout the process, tailoring your treatment approach to your unique symptoms.

Start getting better today

NOCD therapists are specially trained in delivering ERP and regularly refer members to qualified prescribers who can identify medication that may reduce their OCD symptoms and/or the symptoms of other commonly co-occurring disorders such as depressive disorders and anxiety disorders. 

If you’re considering seeking treatment for OCD or a related disorder, I encourage you to read more about NOCD’s evidence-based approach to OCD treatment.

Learn more about ERP