Rexulti - MDD, BPD

[mmaryland]

Does anyone else have experience with Rexulti completely destroying their depression? For me, Rexulti almost had a same day anti-depressant effect and controls depressive episodes acutely and astoundingly fast. I literally feel anti-depressant effects in as little as 3 hours after I take it. When I look back to when I was on it, I now realize that I didn't have a single bout of depression during that time, it just was not super effective in controlling mania. I think Rexulti is a hell of an anti-depressant, a way improved drug than abilify with less than half the side effects, no lethargy or cognitive impairment either which is always surprising to find in an antipsychotic. I know it has an indication for adjunctive therapy in adults with MDD but none for bipolar depression... maybe Lundbeck is just waiting for close to the expiration of the patent before the release new clinical trial data and extend their patent after they get the bipolar depression indication approved, but that's just a thought.

Anyone else have a similar experience with Rexulti, brexpiprazole? Please let me know about your time on the medication and if it sat well with you or not so much. Interested in if others are also getting this rapid and significant anti-depressant effect from this drug or if it's just me

[Blahblah]

Never tried Rexulti, but once it goes generic I'd be curious to try, especially if it really helps with depression and doesn't cause same side effects as Abilify (namely weight gain/increased appetite). How long were you on it? Did you go onto Lamictal instead, for more help with mania?

[Iceberg]

@mmaryland same experience except it took a little longer to kick in. Was going well at 2mg but then mania started and the rexulti just couldn't keep up. Shame - I really liked it 

[mmaryland]

5 hours ago, Blahblah said:

Never tried Rexulti, but once it goes generic I'd be curious to try, especially if it really helps with depression and doesn't cause same side effects as Abilify (namely weight gain/increased appetite). How long were you on it? Did you go onto Lamictal instead, for more help with mania?

You'll be waiting a long time for generic Rexulti to come out. You could always try to get a prior authorization approved through your insurance and then it would be covered under your formulary. I was on it from May 2017 to November 2017, so 6 months, starting at 2mg, then going back down to 0.5mg because of akathisia and then 1mg for a month, 2mg for a 2 months, then upped to 3mg for a month, and increased to the max dose of 4mg for the last 2 months. It wasn't controlling my mania, despite being on 1,350mg of Lithium daily. I was still having to take Seroquel to help me sleep so being on two AAPs was not something my psychiatrist wanted to continue for too long. Rexulti was amazing with respect to having literally no cognitive impairment or memory problems, hyperglycemia, no extreme elevated appetite like the other AAPs I had been on. If anything, I found it improved my outlook on life and helped me gather my thoughts, become more insightful, didn't induce any anxiety, never caused oversedation, basically felt nothing like any AAP I have ever taken. If only Rexulti had the capability to control mania or hypomania it would be the perfect medication for bipolar disorder.

My psych. took me off it because I was still taking Seroquel 100mg to sleep at night in addition to Rexulti 4mg during the day, and switched me to Latuda about a week before Thanksgiving 2017. I was given 7 day free samples of 20mg, 40mg, and 60mg. I believe I started out with 40mg, and made sure to always eat with it. My psych. thought the Latuda would be sedating enough to help with my sleep, but it wasn't and I still was taking Seroquel 50-100mg at bedtime. All the while I had been on Lithium 1,350mg since February 2017, which didn't help with sleep either. I decided to take myself off Lithium and decreased my dose during my Winter break. I was off it completely by late December/early January 2018. Then we tried just Seroquel 100mg at bedtime and wow how stable I was, only I had no personality, emotions, feelings, empathy, or interest in communicating or participating in everyday activities/interactions.

So I got switched to Saphris while introducing Lamictal in January 2018. I am now on 100mg of Lamictal, but only stayed on Saphris 5mg for maybe a week? I just really thought hard about if I honestly needed to also be treated with an AAP. This is when I proposed to my psych. to stop it, upon my agreement to take Seroquel or Saphris when I felt hypomania or manic episodes coming on. We also agreed to discontinue Valium 20mg at bedtime, which had been used since July 2017 to prevent benzo withdrawal seizures from Xanax and was successful in that aspect, and try to replace the Saphris and Valium at bedtime with Ativan 2mg or Halcion 0.25, I was given a small prescription for each and was to see which one I felt was better for helping get my sleep schedule on track. Well, Halcion took the win, but during this time I was also out of Xanax for 1.5-2 weeks and without the Valium being in my system I suffered a benzodiazepine withdrawal complication seizure. So now back on the Valium while tapering the Xanax, Halcion at night, with 100mg Lamictal every morning

Lamictal has surprised me. I've been having really good control of my moods. I have infrequent acute depressive moods but haven't had really any highs or lows since being on it actually. 

[browri]

I LOVE REXULTI!!!!!  

Been through Latuda, Saphris, Abilify, Fanapt, Zyprexa, loxapine, and now Rexulti (not necessarily in that order). This really is nothing like my experience with Abilify at all. Not agitating. Much more calming. Definitely a much more profound effect on my depression. I started on 0.5mg, but I found after two weeks that it was too much for me so I dropped down to 0.25mg and I've been here ever since.

No akathisia.

Of all the winters in my memory I have been the least depressed this winter. I think I've been taking Rexulti since September. I've been able to actually get through this winter without falling apart.

On its own not sure it would be a great mood stabilizer but as an adjunct to valproate I find it to be the perfect mix. Just in case my signature changes I'm currently on a mix of Depakote/Trintellix/Rexulti/Vyvanse. I think from a mood stabilizer perspective, Depakote was the single best decision I made. However, from an antipsychotic adjunct to an antidepressant, Rexulti has been the best. Come about mid-March as winter starts coming to a close, my doctor and I will notch down my Trintellix and Vyvanse doses and increase my Rexulti dose to 0.5mg in prep for spring mania. It happens like clockwork.

@Iceberg I think Rexulti has definitely helped to smooth the waves, but I don't see it aborting a manic episode at all. That's what the Depakote is for. 

@mmaryland you have a good point about the patents. And this will be of interest to you @Blahblah. Currently the furthest expiration of patent exclusivity for brexpiprazole is 07/2020. If they didn't get any more indications for this, they would still likely get a pediatric extension for 6 months which would push it to 01/2021. However, as @mmaryland said, they're on track for:

bipolar depression

agitation in autism

manic and mixed episodes in bipolar disorder

agitation in dementia including Alzheimer's (although that last study they did didn't go to well for them, additionally antipsychotic use in the elderly population isn't generally looked on too favorably because of the safety profiles)

treatment-resistant depression indication similar to olanzapine. Some of the trials they're doing are specifically looking at whether brexpiprazole works when 2 or more previous treatments failed (they're trying to cannibalize olanzapine, quetiapine, and aripiprazole here).

Keep in mind of course that while exclusivity may expire, the patents themselves don't expire for a while after that so all the generic companies get to pay royalties to Otsuka and Lundbeck much like they are still paying Otsuka royalties for generic Abilify and will from the looks of it until 2027 specifically because of the patent they got for the MDD adjunct indication in 2014.

Abilify came out in 2002 and they managed to secure royalties until 2027 but the first generic was available in April 2015. The earliest for brexpiprazole appears to be 2015 also expiring in 2027 with exclusivity expiring July 2020. If we use aripiprazole's history to determine what things will be like for brexpiprazole then that means we won't see generic brexpiprazole until like 2028, a year after royalties on aripiprazole stop (funny how that just "works out"), then it will continue to be one of the "non-preferred generics" until 2040 because of the patent royalties.