Off-Label Use of Second Generation Antipsychotics in Anxiety Disorders and Obsessive Compulsive Disorder

There is a paucity of data to support, next-step" treatments for the many patients with anxiety disorders who remain symptomatic after initial pharmacotherapy. Because of their somewhat improved safety profile, second generation antipsychotics (SGAs) are increasingly used for the treatment of nonpsychotic anxiety. The published literature describing the efficacy of SGAs in patients with anxiety disorders is briefly reviewed, and the efficacy and safety of second generation antipsychotics in these patients is discussed. The literature reviewed was primarily comprised of small open-label trials, thus making it difficult to draw definitive conclusions. There is moderately strong controlled evidence supporting the use of some SGAs, either as adjunctive treatment or monotherapy, in the treatment of anxiety disorders. Despite the limitations of the trials reviewed, atypical antipsychotics represent a promising treatment modality when considering their improved side effect profile compared to conventional agents. The facts to date does not warrant the use of SGAs as first-line monotherapy or as first -adjunctive therapy in the treatment of anxiety disorders. Nevertheless, some patients with highly refractory anxiety disorders may benefit from the judicious and carefully monitored use of adjunctive SGAs. A careful risk-benefit assessment, on a case-by-case basis, must be undertaken by the physician.