Vraylar (Cariprazine) for Depression: A Psychiatrist’s Insight into a New Add-On Treatment Option

Depression is incredibly challenging—not only for patients but also for psychiatrists striving to find effective treatments. Traditional antidepressants, primarily selective serotonin reuptake inhibitors (SSRIs), fall short for some. In fact, standard antidepressants alone offer relief to only 40-60% of patients, and full remission to 30%. Understandably, this can be deeply frustrating for patients hoping for relief.

In my psychiatric practice, I’ve frequently encountered situations where individuals haven’t responded adequately to typical antidepressants. In these cases, I often consider an add-on treatment, such as Vraylar (cariprazine), approved by the FDA in 2022 for use alongside antidepressants in adults with major depressive disorder (MDD).

When Is Vraylar the Right Choice?

Determining when to add Vraylar involves assessing several critical factors:

  • Multiple Antidepressant Failures: If you’ve taken several SSRIs as prescribed without sufficient improvement, Vraylar might provide that extra boost needed.
  • Partial Symptom Relief: Sometimes, individuals achieve partial improvement but continue to struggle with significant lingering symptoms. Adding Vraylar can help manage persistent issues such as fatigue, emotional numbness, or lack of motivation.
  • Severe Depression: If your depression symptoms severely disrupt your life—impacting your work, relationships, or daily activities—augmenting your treatment with Vraylar can be a beneficial option.

Understanding How Vraylar Treats Depression

Vraylar operates uniquely by targeting dopamine and serotonin receptors, neurotransmitters involved in mood regulation, motivation, and emotional processing. While we don’t fully understand its exact mechanism in treating depression, clinical trials clearly demonstrate its potential to alleviate symptoms unresponsive to antidepressants alone.

Vraylar is FDA-approved to treat depression when added to an antidepressant.

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In the last two (2) weeks, how often have you been bothered by any of the following problems?

"Is Vraylar an Antipsychotic?"

An essential point I regularly discuss with my patients is the nature of Vraylar itself. Initially approved to treat schizophrenia and bipolar disorder, Vraylar is classified as an “antipsychotic,” which understandably can raise questions.

However, medications frequently have broader therapeutic uses beyond their original indications. Just like SSRIs are not solely antidepressants—they are also prescribed to treat anxiety, PTSD, and OCD—Vraylar has proven useful for conditions beyond psychosis, particularly major depressive disorder and bipolar depression.

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Vraylar Side Effects

While Vraylar can provide significant symptom relief, it’s essential to understand potential side effects:

  • Restlessness (akathisia)
  • Tiredness or fatigue
  • Nausea
  • Insomnia
  • Dizziness
  • Mild weight changes
  • Muscle stiffness or shakiness

Times where the potential benefits are likely to outweigh the potential risks include multiple SSRI treatment failures, partial remission of depressive symptoms on an SSRI that the patient would like to stay on (e.g., low side effect profile with the SSRI that they’re currently on), or depression symptoms that are so severe that they are causing significant disability and/or dysfunction in multiple areas of a patient’s life (e.g., work, school, relationships, hobbies, etc.).

Does Vraylar Cause Weight Gain?

It can. However, compared to other antipsychotics, Vraylar generally carries a lower risk of significant weight gain. Maintaining a balanced diet, staying active, and regular health check-ups (such as monitoring blood sugar and cholesterol levels) can help effectively manage these potential side effects.

Final Thoughts and Recommendations

Choosing an add-on medication like Vraylar is always a collaborative decision, involving thorough discussions between you and your psychiatric clinician. The goal is to balance potential benefits with risks, with a focus on optimizing your quality of life.

Understanding your medication options may help you achieve better outcomes in managing your depression.

Dr. Buchholz discloses no financial relationships with any pharmaceutical companies related to this content.

References

  1. AbbVie. (2022, December 16). U.S. FDA approves VRAYLAR® (cariprazine) as an adjunctive treatment for major depressive disorder. https://news.abbvie.com/2022-12-16-U-S-FDA-Approves-VRAYLAR-R-cariprazine-as-an-Adjunctive-Treatment-for-Major-Depressive-Disorder

  2. Earley WR, Burgess MV, Khan B, Rekeda L, Suppes T, Tohen M, Calabrese JR. Efficacy and safety of cariprazine in bipolar I depression: A double-blind, placebo-controlled phase 3 study. Bipolar Disord. 2020 Jun;22(4):372-384. doi: 10.1111/bdi.12852. Epub 2019 Nov 6. PMID: 31628698; PMCID: PMC7318333.

  3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: Learn More – How effective are antidepressants? [Updated 2024 Apr 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361016/

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Key Takeaways Key Takeaways

  • Vraylar functions by uniquely influencing dopamine and serotonin receptors to address depressive symptoms that traditional antidepressants may miss.

  • In clinical trials, Vraylar effectively reduced persistent sadness, fatigue, and loss of interest in activities for many participants who hadn’t fully responded to antidepressants alone.

  • Being classified as an “antipsychotic” medication should not cause concern; many medications, including Vraylar, are prescribed to treat multiple conditions beyond their initial indications.

Authored By 

Andrew Buchholz, DO MPH FAPA

Dr. Andrew Buchholz, MPH FAPA, helps individuals in Virginia navigate mental health challenges through compassionate, evidence-based psychiatric care. As a prescriber at LifeStance Health, he works with adults, teens, and seniors, offering medication management and individual therapy tailored to each...

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