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Rexulti made me very sleepy if I took it in the AM for the first 6 months. I switched it to PM, and the tiredness went away. Just recently moved it back to AM, and this time around I have no sleepiness at all. It could also be an additive effect with the Buspar and Ativan, depending on the timing.

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Thanks dtac.  I took Abilify at night and it kept me awake all night.  So we moved it to am.  Still too awakening for me.  We just swapped out the Rexulti but didn't think if timing.  I guess I could try pm...Worst case I don't sleep that night.

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Abilify was extremely activating for me. I couldn't tolerate above 2mg and be able to sleep at all. At 2mg, I still needed sleep meds, and they were only moderately effective. Rexulti's sedation is paradoxical for me, since it appears to be related to dosing, but only happens in the AM, not PM (and now, not at all.)

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51 minutes ago, Mook said:

I've been on Effexor XR 225mg for 12 years.  Started having issues in February this year.  They upped my Effexor to 300mg, Buspar to 60mg, have me on Ativan and tried me on Abilify but it caused too much restlessness.  Now I'm on Rexulti getting ready to go from 0.5mg to 1mg.  Would it be causing tired, zombie-like feelings or would that be the Ativan and/or Buspar?

A lot of people report an increase in energy on Rexulti. I'm currently on 2 mg, taken in the AM, and I don't think I've felt a single side effect from it.

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53 minutes ago, DopamineSick said:

A lot of people report an increase in energy on Rexulti. I'm currently on 2 mg, taken in the AM, and I don't think I've felt a single side effect from it.

I don't get an energy burst, but it does absolute wonders for my general anxiety and depression. I feel much calmer taking it in the AM.

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My son has taken Abilify for many years. Over a year ago he started taking Rexulti. After about a week, I think, but I am not sure exactly how long it took, he started coming down to our house (he lives in a MIL on our property} to play cards in the evening, something he had not been interested in doing in the previous 13 years since he became ill. For some reason every week or 10 days he would start feeling "off" and he would take some Abilify and then he would do better. He stayed like this for about 9 months and started buying non working washers and dryers and fixing them and selling them and doing quite well. Then he started fooling around with trying to get well with juicing cilantro and after a couple of weeks during which I told him that he was getting worse on the cilantro he went off his medication and we haven't been able to get him back on the Abilify and Rexulti during the past 5 months since then and he has had terrible problems.

The point of all this is that in our experience Abilify and Rexulti are not exactly the same in how they affect our son. The Rexulti improves his socialization very much more than Abilify does, but it doesn't seem to control all of his symptoms as well as both of them together do, but taking Rexulti allows a lower dose of the Abilify. He was probably averaging 2 - 4 mg of Abilify a day while he was taking 2 mg of Rexulti, and doing better that way than he had done for the 13 years since he had his first psychotic break.

I hope this helps someone.

PS I know it sounds odd that juicing cilantro could cause an increase in psychosis, but cilantro is actually a powerful herb that has to be used with caution in large doses. A few people are even affected by the amounts that are sometimes used in food dishes.

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Today is Day 5 on Rexulti for me. This feels NOTHING like Abilify. From Day 1 I could tell that it was calming me down but as the days go on and it builds in my system I can start to see the antidepressant effect a lot more and it's even subtly stimulating above and beyond the Vyvanse or the Trintellix. I find this to calm my intrusive thoughts / ruminations as effectively as olanzapine and loxapine without unnecessary sedation. Abilify on the other hand was agitating from 2mg all the way until I gave up around 7.5mg.

Oddly enough though while it has been very calming, it's almost entactogenic like ecstasy, could be the combination of meds that I'm taking, but I think this is the closest I've gotten to euphoria and positive vibes without actually being hypomanic. Worried and delighted at the same time. lol.

I've taken Latuda, Saphris, Fanapt, Abilify, Zyprexa, Loxitane, and now Rexulti and Rexulti is by far my favorite. No side effects really that I can tell other than adrenergic side effects like mild orthostatic hypotension, reflex tachycardia.

It's also making me more sociable which no other AAP has done for me. I'm more engaged with my coworkers during the day and the tasks at hand. I can finally focus on what's going on around me instead of my internal monologue.

Edited by browri

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Tonight will be my 13th dose of Rexulti. And my first one at 0.25mg. Dropping down from 0.5mg because while I seem to be adjusting to it really well, it's a pretty potent med. Kind of in your face really because it shuts off your adrenergic response pretty effectively but stimulates at the dopamine receptors at the same time. Strange feeling really. But I still like it overall despite that it's taken a while to get used to. Moving it from morning to evening also helped a great deal.

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I'm on 2 mg of Rexulti and I have never noticed any tangible difference, yet my doctor is keeping me on it. I kind of feel bad because it's so expensive (and I'm also on Trintellix, another very expensive drug). I'm on Medicaid and don't work, so even though I don't pay out of pocket, I would still rather the money go to drugs that actually work for people.

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17 minutes ago, DopamineSick said:

I'm on 2 mg of Rexulti and I have never noticed any tangible difference, yet my doctor is keeping me on it. I kind of feel bad because it's so expensive (and I'm also on Trintellix, another very expensive drug). I'm on Medicaid and don't work, so even though I don't pay out of pocket, I would still rather the money go to drugs that actually work for people.

Wow. 2mg and you don't even feel it? I feel like a whimp now barely being able to handle 0.5mg lol. I don't know how you can miss it. That adrenergic blocking is pretty potent. My copay for a 90-day of Rexulti will be like $180 but after the savings card will be $45 I think. For Trintellix the 90-day copay is $180 as well but the savings card makes it $30. I know though you can't use those savings cards on Medicare and Medicaid.

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32 minutes ago, browri said:

Wow. 2mg and you don't even feel it? I feel like a whimp now barely being able to handle 0.5mg lol. I don't know how you can miss it. That adrenergic blocking is pretty potent. My copay for a 90-day of Rexulti will be like $180 but after the savings card will be $45 I think. For Trintellix the 90-day copay is $180 as well but the savings card makes it $30. I know though you can't use those savings cards on Medicare and Medicaid.

I guess I'm just very treatment-resistant. Nothing seems to want to get in my brain. I should've asked my doctor about getting that Genesight test, although I don't know how much good that would do.

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19 hours ago, DopamineSick said:

I guess I'm just very treatment-resistant. Nothing seems to want to get in my brain. I should've asked my doctor about getting that Genesight test, although I don't know how much good that would do.

I could suggest an alternative actually. The thing about the Genesight test is that it doesn't actually measure anything in the brain to determine how your brain will respond to medications. It only determines which medications your body will metabolize properly. It looks at the CYP liver enzymes. So it can tell if you're a CYP2D6 rapid metabolizer and have to double your dose of antidepressants or something like that. Also, it can be pricey, and insurance often doesn't cover it.

The alternative would be to do an at-home gene test like Ancestry.com or 23andme.com and then test the raw DNA data yourself. It's cheaper that way. Ancestry and 23andme are always running sales which keeps the cost at $99 or below. For the 23andme test, which package you opt for doesn't affect how much of your genome they test. You can just do the Ancestry test and do the health analysis yourself. The extra $99 only gets you reports. However Ancestry.com tests MORE of your genome overall than 23andme does.

Then you can download your raw data from either of these sites and plug it into the Genetic Genie Detox Analysis. One thing to note is that the data from either of those sites isn't complete in regards to detox mutations tested. There are some mutations tested in the Ancestry.com test that aren't in the 23andme test and vice versa. The advantage of the Genesight test is that it tests almost every known detox mutation. So if you want to go this route and be thorough, it would be good to do both the Ancestry.com and the 23andme test and test the raw data for two separate reports that you can provide to your doctor. The other reason why doctors like to use the Genesight test is because it comes with reports that show which psych meds will work based on your mutations which a generic detox analysis won't do. Your pdoc would have to do the research on his own to determine medications that would work. The majority of the "value" in the case of Genesight and 23andme is in the reports they furnish you with.

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1 hour ago, browri said:

I could suggest an alternative actually. The thing about the Genesight test is that it doesn't actually measure anything in the brain to determine how your brain will respond to medications. It only determines which medications your body will metabolize properly. It looks at the CYP liver enzymes. So it can tell if you're a CYP2D6 rapid metabolizer and have to double your dose of antidepressants or something like that. Also, it can be pricey, and insurance often doesn't cover it.

The alternative would be to do an at-home gene test like Ancestry.com or 23andme.com and then test the raw DNA data yourself. It's cheaper that way. Ancestry and 23andme are always running sales which keeps the cost at $99 or below. For the 23andme test, which package you opt for doesn't affect how much of your genome they test. You can just do the Ancestry test and do the health analysis yourself. The extra $99 only gets you reports. However Ancestry.com tests MORE of your genome overall than 23andme does.

Then you can download your raw data from either of these sites and plug it into the Genetic Genie Detox Analysis. One thing to note is that the data from either of those sites isn't complete in regards to detox mutations tested. There are some mutations tested in the Ancestry.com test that aren't in the 23andme test and vice versa. The advantage of the Genesight test is that it tests almost every known detox mutation. So if you want to go this route and be thorough, it would be good to do both the Ancestry.com and the 23andme test and test the raw data for two separate reports that you can provide to your doctor. The other reason why doctors like to use the Genesight test is because it comes with reports that show which psych meds will work based on your mutations which a generic detox analysis won't do. Your pdoc would have to do the research on his own to determine medications that would work. The majority of the "value" in the case of Genesight and 23andme is in the reports they furnish you with.

Thanks for the info. I read that the Gensight test is free if you have Medicaid or Medicare.

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22 hours ago, DopamineSick said:

Thanks for the info. I read that the Gensight test is free if you have Medicaid or Medicare.

Nice! I'm actually surprised by that.

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On 11/29/2017 at 11:08 AM, DopamineSick said:

Thanks for the info. I read that the Gensight test is free if you have Medicaid or Medicare.

On 11/30/2017 at 10:03 AM, browri said:

Nice! I'm actually surprised by that.

I recently had it done and it was 100% covered by my Medicaid. The results were interesting. It found out that there is a significant gene-drug interaction with Rexulti, which I was on and at the max dose 4mg for 2 months, 5 months total treatment with Rexulti. I am a poor metabolizer of CYP2D6, which meant that I had increased risk for side effects and likely require a lower dose as my serum levels would be much higher than would be in a normal metabolizer. This also meant that I shouldn't take Paxil, whoops took that 3 different times for almost a year total, same goes for Prozac and Remeron. It goes to show you how the genetic test doesn't necessarily tell you which medication will work, but which medications will have the fewest and least severe adverse reactions based on your genotypes and phenotypes. Paxil worked great for me, but didn't go well with my bipolar and manic episodes. Rexulti at 3-4mg was great for bipolar depression but didn't do much for my mania or hypomania; I still needed seroquel to sleep. Once I got off it I realized how much it was helping with my bipolar depression. It was very tolerable, despite my serum levels probably being much higher due to my CYP2D6 poor metabolization. 

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14 hours ago, mmaryland said:

I recently had it done and it was 100% covered by my Medicaid. The results were interesting. It found out that there is a significant gene-drug interaction with Rexulti, which I was on and at the max dose 4mg for 2 months, 5 months total treatment with Rexulti. I am a poor metabolizer of CYP2D6, which meant that I had increased risk for side effects and likely require a lower dose as my serum levels would be much higher than would be in a normal metabolizer. This also meant that I shouldn't take Paxil, whoops took that 3 different times for almost a year total, same goes for Prozac and Remeron. It goes to show you how the genetic test doesn't necessarily tell you which medication will work, but which medications will have the fewest and least severe adverse reactions based on your genotypes and phenotypes. Paxil worked great for me, but didn't go well with my bipolar and manic episodes. Rexulti at 3-4mg was great for bipolar depression but didn't do much for my mania or hypomania; I still needed seroquel to sleep. Once I got off it I realized how much it was helping with my bipolar depression. It was very tolerable, despite my serum levels probably being much higher due to my CYP2D6 poor metabolization. 

And this is the value in GeneSight folks. They have built their business around doing a saliva test that everyone else is already doing and then furnishing doctors with reports full of information that it would have taken that doctor HOURS to glean from raw genetic data through a manual process of pulling up and reading scientific studies PER SNP in your genome (which I will remind everyone is composed of 10 million SNPs, granted the doctor in this case would only be looking at ~30 of them for a detox analysis, but still).

In the end, if your insurance will pay for it in full and you have had issues responding to certain medications, you should definitely do it. If insurance only partially covers it, and you end up coughing up $50-200 in coinsurance, then you might as well do genetic testing through AncestryDNA or 23andme who are going to test more of your genome and furnish you with more information than a company like GeneSight, which only cares about specific parts of your genome. If you don't have Medicare or Medicaid and your private insurance won't cover it in full, do the Ancestry test for the fun of it and use that data for the Detox Analysis at GeneticGenie. If there are any missing that might be suspect, you can get the 23andme test done and try the report with that data instead. If you want to start out doing just one of them, I would recommend Ancestry. They actually test more SNPs than 23andme does. So your GeneticGenie reports will be more complete with Ancestry data. Their AncestryDNA tools and overall historical information are much more thorough than the ancestry info provided by 23andme, which is generally speaking more technical. Additionally, Ancestry breaks down into more specific regions than 23andme does and that's because Ancestry overall has a much larger "pool" of genetic data for reference.

Will point out one critical difference though between GeneSight and Ancestry/23andme speaking specifically about the USA but may be pertinent in other countries if GeneSight is available there: GeneSight is bound by HIPAA thus they are legally obligated to protect your genetic data in a fashion that is consistent with the rest of the medical industry. And your data is subject to doctor/patient confidentiality. Ancestry and 23andme on the other hand are only bound by their Privacy Policy, which they can change as they see fit unlike a law which is quite a bit more rigid. Additionally, law enforcement can subpoena Ancestry or 23andme for your genetic data. So as you can see there are risks that I had to put out there as a disclaimer.

As for me and Rexulti, we're getting along just fine. Today is 6 weeks on the dot at 0.25mg and overall the decrease really helped. It doesn't help with outright mania but it has had a positive effect on my depression and it keeps my mood relatively level more akin to Lamictal than Depakote. That being said Rexulti and Depakote together seem to be a good mood-stabilizing combo

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My GeneSight test came back mostly useless. Pdoc gave me a choice of Latuda or Vraylar As I keep telling him, probably losing my insurance soon, but he doesn't want me to worry about cost right now, he will give me samples. Now granted, I am the one that quit Lithium after a week because it wreaked havoc with my migraine meds.

-M

Edited by HaloGirl66PartDeux

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4 hours ago, HaloGirl66PartDeux said:

My GeneSight test came back mostly useless. Pdoc gave me a choice of Latuda or Vraylar As I keep telling him, probably losing my insurance soon, but he doesn't want me to worry about cost right now, he will give me samples. Now granted, I am the one that quit Lithium after a week because it wreaked havoc with my migraine meds.

-M

Sunovion (Latuda) has a patient assistance program to help with med cost. If you're losing your coverage, it would be a good idea to contact them. Allergan (Vraylar) doesn't seem to have such a program. 

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15 minutes ago, Persona_Is_Life said:

Sunovion (Latuda) has a patient assistance program to help with med cost. If you're losing your coverage, it would be a good idea to contact them. Allergan (Vraylar) doesn't seem to have such a program. 

Awesome to know. TY! Hopefully I can find another job but of course, there are other issues.

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On 8/27/2015 at 2:55 AM, zsepthenne said:

FINALLY, found a few others on Rexulti!

I've been on it for 2 weeks now. Titrated up to 1mg about four days ago, and I can't believe it, but it's working. I know there's concern about it being a patent extender, but it doesn't come close to my previous experience with Abilify,  which gave me awful akathesia and made me feel like I had windchimes in my head. In short I wouldn't throw it under the bus until you give it a try. 

My side effects have been very minimal so far. Anyone else have any side effects worth mentioning?  Or any good results yet? 

I'm keeping my fingers crossed that it keeps working for me. So few meds work for my depression that I'm worried it'll end. 

Hey all, new poster.  Treatment-resistant depression for...ever.  Just tried Rexulti and am humbled & amazed to feel like myself again.  Hanging at 1mg, felt a bit sleepless at more.  Please note patent extenders are not solely that--typically they are an isomer (variant) of the original which are sort of the essential core of the drug, with fewer side effects.  Still sucks that pharma does this, but for those who need the treatment it's a lifesaver.

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