Depression is not as easy as it seems. Living with it is often a challenge. It takes some people a while to find the right treatment for them. Sometimes, a single medication may not provide complete relief. There is a reason for that. Let's understand this from the beginning.
Why does depression occur? How can a medicine like Rexulti help?
Simply put, in Major Depressive Disorder (MDD), the levels of certain chemicals in our brain decrease. We call these neurotransmitters. You may have heard of serotonin and dopamine . These are the main chemical messengers that control things like how we think, plan, feel happy, pay attention, and sleep. So when these are reduced, the symptoms of depression appear.
Antidepressants are commonly prescribed to help restore these chemical levels. But sometimes, even though these medications can reduce symptoms, they can leave symptoms that are too severe to function in daily life. Some people only respond partially to treatment. This is called treatment-resistant depression.
This is when doctors add another medication to the current medication. This is called adjunctive treatment . That is, a medication that is given to "help" the current treatment, to "boost" its effectiveness.
Rexulti (brexpiprazole) is one such adjunctive medication. These belong to a class of drugs called second-generation antipsychotics. These newer drugs have fewer side effects, such as tremors, muscle stiffness, and weight gain, than older drugs. Rexulti works by controlling brain chemicals in a different way, reducing symptoms while also reducing the risk of side effects.
How does Rexulti work inside the body?
Rexulti mainly works by increasing the levels of dopamine and serotonin in the brain. Specifically, this medication binds to certain receptors in the brain and helps release trapped dopamine. It also stimulates the action of serotonin, which can help improve mood and reduce symptoms of depression.
How should I use this medicine?
Rexulti is a pill that you take once a day. It can be taken with or without food. It usually starts with a very low dose, about half a milligram (0.5mg). Your doctor will then gradually increase the dose based on how your body responds, other medications you are taking, and how well your kidneys or liver are working. The maximum dose for depression is 3 milligrams (3mg) per day.
The most important thing is to follow your doctor's instructions exactly. Taking your medication at the right time every day is the only way to balance your brain chemistry, control your symptoms, and function well.
Remember, this medicine does not cure you immediately. It may take several weeks to notice a change in your symptoms. Therefore, consistent use of the medicine is the key to success.
What do studies say about the success of this drug?
Two major studies have been conducted to find out how effective and safe Rexulti is for depression. In these studies, one group of people was given Rexulti and the other group was given a placebo. This allowed researchers to measure the true effects of the drug.
According to the results of these studies, after 6 weeks, most people who took Rexulti in addition to their usual antidepressant medication had moderate to mild depression symptoms.
The table below simply shows the results. The lower the score, the more severe the symptoms.
| Team | Depression level at the start (average score) | Depression level after 6 weeks (average score) | Difference in scores (improvement) |
|---|---|---|---|
| Study 1: Placebo (dummy pill) | 27.3 | 22.1 | -5.2 |
| Study 1: Rexulti 2 mg | 26.9 | 18.5 | -8.4 |
| Study 2: Placebo (dummy pill) | 26.5 | 20.2 | -6.3 |
| Study 2: Rexulti 1 mg | 26.5 | 18.9 | -7.6 |
| Study 2: Rexulti 3 mg | 26.5 | 18.2 | -8.3 |
As you can see from these studies, those who took Rexulti had significant improvements in their symptoms. These studies also confirmed that their ability to function in daily life, with family, in society, and at work/school, improved.
How do I know if the medicine is working?
Within a few weeks or months, you will start to notice a significant improvement in your symptoms. Your family and friends will also notice the difference in you.
- Improved mood
- More energy or motivation
- Better sleep
- Interested in activities that you used to enjoy.
- Decreased anxiety or worry
- Increased appetite
- Better concentration
These changes don't happen overnight. They happen gradually. Therefore, it's important to keep track of changes in your symptoms. How long you need to take treatment varies from person to person. Some people need it for a short period of time, while others need it for a long period of time.
The most important thing is to not stop taking your medication without talking to your doctor because you think your symptoms are getting better. If you do, your symptoms may get worse again. If you don't feel any better after a few months, tell your doctor about that too.
Side effects and how to manage them?
The most common side effects of Rexulti are weight gain, drowsiness, dizziness, flu-like symptoms, and restlessness (an inability to sit still). These do not happen to everyone, but they usually decrease over time.
| Side effect | What you can do |
|---|---|
| Weight gain, increased cholesterol/sugar | Adopt a healthy lifestyle. Exercise, add vegetables, fruits, and lean meats to your diet. Reduce oil, salt, and sugar. Your doctor will regularly check your weight, blood pressure, cholesterol, and sugar levels. |
| Drowsiness or dizziness | If you feel sleepy, take the medicine before going to bed at night. Get up slowly from a sitting or lying position. Avoid driving until you know how the medicine affects you. |
| Restlessness (Akathisia) | This refers to a feeling of being unable to stay in one place and just wandering around. Light exercises like walking and stretching can help. Calm your mind with things like breathing exercises and meditation. Limit things like coffee, tea, and cola, as they can increase this feeling. |
| Heat intolerance | This medicine may reduce the body's ability to cool itself. Avoid extreme heat and dehydration. Wear light clothing and drink plenty of water. |
| Stomach upset, constipation, dry mouth | Take the medicine with food. If your mouth gets dry, drink small amounts of water frequently, suck on ice cubes, or chew sugar-free gum. If you are constipated, drink plenty of water and eat foods high in fiber (wheat bran, beans, fruits). |
These are the most common things that can happen. If any of these discomforts persist or get worse, be sure to tell your doctor.
Can there be problems with other medications? (Drug Interactions)
Yes. Some medications can increase or decrease the effectiveness of Rexulti, or increase the risk of side effects, when taken with Rexulti. For example, some antifungals (e.g., ketoconazole), some antibiotics (e.g., clarithromycin), some antidepressants (e.g., fluoxetine, paroxetine), and even grapefruit juice can change the effects of Rexulti.
Therefore, it is extremely important to tell your doctor about all the medications, vitamins, and herbal products you are taking, so he or she can adjust the dosage of Rexulti to suit you.
What tests should be done during treatment?
Your doctor will do some tests to monitor your health before you start taking the medication and while you are taking it.
- Your weight, height, and waist circumference.
- A complete blood count (CBC).
- Fasting blood cholesterol and sugar tests (Fasting lipid profile and blood sugar).
- Blood pressure.
- AIMS test to check for abnormal movements (e.g., involuntary limb movements).
These tests are the only way to know exactly how the medicine will affect your body.
Take-Home Message
- Rexulti is an "add-on" medication that is given in addition to medications already being taken for depression, to enhance their effectiveness.
- This works by balancing the chemicals in the brain associated with happiness and excitement.
- Take the medicine consistently, exactly as prescribed by your doctor, at the prescribed dosage.
- Even if your symptoms improve, avoid stopping the medication without consulting your doctor.
- Be aware of side effects like weight gain, drowsiness, and restlessness. If they are bothersome, talk to your doctor.
- It is imperative to inform your doctor about all other medications, vitamins, and traditional medicines you are taking.
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