Vraylar (cariprazine) is a powerful antipsychotic medication that is approved by the Food and Drug Administration (FDA) to treat schizophrenia, bipolar disorder, and major depressive disorder (MDD). Cariprazine works in the brain to balance serotonin and dopamine, which can positively impact mood, thinking, and behavior.
Although Vraylar is not officially approved to treat anxiety, studies suggest it may be beneficial. Doctors may prescribe Vraylar off-label to help with anxiety if other treatments have not worked.
This article discusses Vraylar’s uses and the research showing its effect on anxiety. It also discusses when doctors may prescribe it for anxiety.
The FDA has officially approved Vraylar for the following uses in adults:
- Schizophrenia: A long-term mental illness characterized by psychosis (like hallucinations and delusions).
- Bipolar I Disorder: This involves:
- Manic or mixed episodes: Vraylar is used for short-term (acute) treatment when a person experiences intensely high, irritable, or mixed moods.
- Depressive episodes (bipolar depression): Vraylar is used to treat the low moods and despair associated with bipolar I disorder.
- Major Depressive Disorder (MDD): Vraylar is used as adjunctive therapy, meaning it is taken alongside a standard antidepressant when the antidepressant alone has not been enough.
Vraylar is usually started at a low dose of 1.5 milligrams (mg) daily, which a doctor may increase to a maximum of 6 mg daily, depending on how a person responds.
Anxiety is extremely common among people with depression and bipolar disorder, often making those conditions harder to treat. Research has shown that when Vraylar successfully treats the main mood disorder, it often reduces the co-occurring anxiety as well.
A 2023 study examined the effect of cariprazine on anxiety symptoms in patients with bipolar I depression. This was a pooled post hoc analysis, meaning researchers took data from existing large studies and re-analyzed it for a new purpose.
952 participants with different baseline levels of anxiety took either 1.5 mg of cariprazine or a placebo daily for 6 weeks.
Regardless of people’s anxiety score at the start of the study, cariprazine significantly reduced overall anxiety compared to the placebo. This reduction applied to both the physical (somatic) and mental (psychic) aspects of anxiety. Caraprazine was not associated with worsening anxiety in either group.
Another post hoc analysis in 2025 evaluated how adding cariprazine to an antidepressant affects anxiety in patients with MDD. The analysis looked at data from a study involving 751 adults with MDD who had not responded adequately to standard antidepressant therapy. Each day for 6 weeks, people took one of the following drug regimens:
- 1.5 mg cariprazine with an antidepressant
- 3 mg cariprazine with an antidepressant
- placebo with an antidepressant
People taking cariprazine at either strength showed significantly reduced anxiety symptoms, regardless of their initial level of anxiety.
These studies suggest that Vraylar can have a beneficial impact on anxiety when prescribed for an approved condition or used alongside an antidepressant.
More research is necessary to find out whether Vraylar is a suitable treatment option for people diagnosed with generalized anxiety disorder without one of the approved conditions.
While Vraylar is not approved for anxiety disorders, doctors may prescribe it off-label for anxiety symptoms, especially when anxiety occurs alongside schizophrenia, bipolar disorder, or MDD. Off-label means it is prescribed for a condition the FDA has not approved it for.
A doctor may prescribe Vraylar when first-line treatments for anxiety are not working well enough.
Standard treatment approaches for anxiety include:
- counseling or talk therapy
- antidepressants, such as selective serotonin reuptake inhibitors (SSRIs)
- benzodiazepines
- other antipsychotics or beta-blockers
Talk with a doctor
Vraylar may cause serious side effects and has several drug interactions, so it is essential to talk with a doctor before taking Vraylar or any other medication.
The doctor will review your medical history and any medications and supplements you are currently taking. They may also ask whether you have experienced severe side effects from medications and any alcohol or illegal drug use.
Vraylar is not usually prescribed to treat anxiety on its own. However, studies show it helps to reduce anxiety symptoms that occur alongside depression or bipolar disorder. Taking a 1.5 mg dose of Vraylar might help with both mood and anxiety at the same time, especially if a person has high anxiety.
Before prescribing a treatment for anxiety, a doctor will consider a person’s medication history, their previous reactions to antipsychotics, and lifestyle factors. They must weigh the potential benefit of Vraylar against the potential or severe side effects, which are common to all atypical antipsychotics.