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Hi all. I saw my (worthless psychiatrist today- I’m seeing a new one in March) 

I suffer from severe anxiety and panic, OCD (ruminating thoughts, racing thoughts, intrusive thoughts), derealization, severe insomnia, agitation and depression. I have tried many many medications. Nothing has helped. 

I specifically went to talk about trying Nardil today. She’s willing to let me try this, but will have to go off Zoloft and remeron for 2 weeks which scares me. Then if Nardil doesn’t help/work, I’d have to wait another 2 weeks to get back on something else. 

She offhandedly asked if I had ever tried rixulti and I told her no. So she pulled out a sample pack for me. I’ve been reading reviews of drugs.com, and it seems that it helps many people with depression, but makes OCD, anxiety, agitation and insomnia worse. Doesn’t sound like a good medication for me. 

Was hoping for some thoughts on this. TIA

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I currently take Rexulti and love it. And I definitely wouldn't say that it makes anxiety, agitation, insomnia, or rumination worse for me. In fact it has improved all of those things for me. Rexulti has a couple studies under its belt now that shows it improves sleep for those with depression. It's always quieted my thoughts and if I have a "flare up" I can increase the dose by just 0.5mg and within 1-3 days the thoughts will quiet down.

Rexulti (unlike Abilify) is sedating (for me) at the bottom end of the dose range and (generally) gets more stimulating as you increase. My advice is to start low and take it very slowly. I started at 0.5mg for 2 weeks and found it was too much and I had to drop down to 0.25mg for like 3-4 weeks, then I increased back up to 0.5mg and it felt totally different the second time around. I've taken up to 1.5mg. My pdoc has said to me that he has a few other patients on it and that he's finding it's a very good medication for anxiety and depression at low doses.

Unless otherwise specified by your pdoc, I would also recommend taking it at night. As you increase you may find a time when you want to move it to the morning, but in the beginning at doses of 1mg and below you'll likely find it more preferable in the evening.

Also, be sure not to compare your experience with Rexulti to your experience with Seroquel or Geodon. Both of those ramp up the norepinephrine system (increased adrenaline) which may explain why you experienced some anxiety/panic with those medications. Rexulti has no affinity for the norepinephrine transporter and actually blocks alpha adrenergic receptors to calm the adrenaline system, the exact opposite of Seroquel and Geodon.

@cakepop makes a good point though. As you get into the higher doses, you may find it to be too much. I maintain pretty well between 0.5mg and 1mg. We briefly increased to 1.5mg during a bit of a mixed episode I was having. We realized that my valproate level was low and corrected that but then we never decreased the Rexulti back down to 1mg. I found after a while that I was a bit depressed, and decreasing back down to 1mg improved my symptoms. So my advice would be to spend a good amount of time on a lower dose before you decide to go up.

Rexulti has a half-life of ~91 hours. Multiply that by 5.5 and you get 500.5 hours / 24 hours = ~21 days. This is how long it takes for Rexulti to reach peak blood levels after reaching a specific dose. Meaning if you start on 0.5mg and stay at that dose the whole time, it will take 21 days to reach steady levels, and there are still changes going on after reaching peak levels. Therefore, you should find a dose, stick with it for a month, and don't ask yourself how you feel until you reach the 1 month mark. It'll take time to adjust and you might be uncomfortable at first, but after about 2 weeks, everything should improve greatly if Rexulti is going to work for you.

Did your pdoc give you a 14-day starter pack with 7x 0.5mg tablets and 7x 1mg tablets or did they give you the 7-day pack with 4x 1mg tablets and 3x 2mg tablets? If you got the 14-day starter pack and your pdoc gave you leeway to slowly work yourself up, I would encourage splitting the 1mg tablets if you find you haven't fully adjusted to the first week at 0.5mg.

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Remember what I said about bridging agents in your MAOI thread. Rexulti would make a good bridging agent between now and when you get to start the Nardil.

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