Nearly 20 million adults in the U.S. experience major depressive disorder (MDD) each year, and for many, traditional antidepressants are not enough. This is where brexpiprazole (Rexulti) comes in—it is prescribed as an add-on treatment for depression and is also used to manage schizophrenia.
Brexpiprazole is an atypical antipsychotic that helps regulate certain neurotransmitter levels in the brain. This article provides a comprehensive guide to brexpiprazole, exploring its approved uses, benefits, potential side effects, and how it compares to similar medications.
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What Is Brexpiprazole?
Brexpiprazole is a prescription medication approved for the treatment of major depressive disorder and schizophrenia.
Overview of Brexpiprazole
Brexpiprazole (Rexulti) is an atypical antipsychotic approved by the FDA in 2015. It is used to improve symptoms in people with treatment-resistant depression and schizophrenia, offering a more balanced approach with fewer movement-related side effects compared to older antipsychotics.
The FDA has approved brexpiprazole for:
- Major Depressive Disorder (MDD): as an add-on treatment when antidepressants alone are not enough.
- Schizophrenia: to help manage symptoms like hallucinations, disorganized thinking, and social withdrawal.
Ongoing research is exploring other possible uses, but for now, brexpiprazole is only FDA-approved for depression (as an add-on therapy) and schizophrenia. Patients should consult a healthcare provider for personalized medical advice.
How Brexpiprazole Works
Brexpiprazome targets two key neurotransmitters (dopamine and serotonin) that influence mood, thinking, and emotions. It works by:
- Partially activating dopamine D2 receptors – helping stabilize dopamine levels.
- Partially activating serotonin 5-HT1A receptors – which can improve mood.
- Blocking serotonin 5-HT2A receptors – helping reduce symptoms of schizophrenia.
- Blocking certain adrenergic receptors – which may help with anxiety and restlessness.
Because it works on multiple pathways, brexpiprazole may have fewer side effects than older antipsychotic medications. Responses to treatment vary among individuals.
Uses and Benefits of Brexpiprazole
Brexpiprazole is mainly prescribed for depression and schizophrenia, but researchers are also studying other possible benefits. Patients and providers should be aware of its approved uses and potential applications.
Treating Depression
Many people with Major Depressive Disorder (MDD) do not fully respond to antidepressants alone. In these cases, doctors may prescribe brexpiprazole as an add-on treatment to improve symptoms.
- Studies show that adding brexpiprazole to an antidepressant can help improve mood, energy levels, and overall well-being.
- Doctors may prescribe it when standard antidepressants do not provide enough relief.
Patients should only take brexpiprazole for depression under the supervision of a healthcare provider.
Treating Schizophrenia
Schizophrenia is a serious mental health condition that affects thinking, emotions, and behavior. Brexpiprazole is FDA-approved to help manage schizophrenia symptoms in adults.
- Clinical trials have shown that brexpiprazole helps reduce both positive symptoms (hallucinations, delusions) and negative symptoms (social withdrawal, lack of motivation).
- Compared to older antipsychotics, brexpiprazole may cause fewer movement-related side effects, making it a preferred option for some patients.
Other Possible Uses
The following uses are currently being studied but have not yet been approved by the FDA:
- Generalized Anxiety Disorder (GAD): Research suggests it may help reduce symptoms of chronic anxiety.
- Bipolar Disorder: Preliminary findings from studies indicate it may stabilize mood swings in people with bipolar depression.
- Agitation in Dementia: Researchers are exploring whether it can help reduce aggression and restlessness in Alzheimer’s patients.
Brexpiprazole should only be used for its FDA-approved purposes unless prescribed off-label by a doctor.
Side Effects and Risks
Like any medication, brexpiprazole has possible side effects and risks. Understanding these can help patients and healthcare providers make informed treatment decisions.
Common Side Effects
Most patients tolerate brexpiprazole well, but some common side effects include:
- Weight gain
- Drowsiness or fatigue
- Restlessness
- Constipation or nausea
- Dry mouth
Not everyone experiences these side effects, and some may go away over time. Patients experiencing persistent or severe side effects should consult their healthcare provider to discuss possible adjustments or alternative treatments.
Serious Risks
While rare, some serious side effects require immediate medical attention. These include:
- Neuroleptic Malignant Syndrome (NMS): A potentially life-threatening condition causing high fever, muscle stiffness, confusion, and irregular heartbeat.
- Tardive Dyskinesia (TD): Uncontrollable movements of the face, tongue, or body, which may become permanent.
- Suicidal thoughts: Brexpiprazole carries an FDA-boxed warning about an increased risk of suicide in young adults.
Patients should contact their healthcare provider immediately if they experience any serious symptoms.
Managing Side Effects
Patients taking brexpiprazole can reduce side effects by:
- Taking the medication exactly as prescribed.
- Reporting unusual symptoms to their doctor.
- Avoiding alcohol while taking the medication.
- Staying hydrated and eating a balanced diet to prevent digestive issues.
If side effects become bothersome, a doctor may adjust the dose or suggest alternative treatments.
Comparing Brexpiprazole with Other Medications
Brexpiprazole is one of several medications used to treat depression and schizophrenia. Understanding how it compares to similar drugs can help patients and doctors choose the best treatment.
Brexpiprazole vs. Aripiprazole (Abilify)
Brexpiprazole and aripiprazole work in similar ways, but there are some important differences:
- Brexpiprazole may cause less restlessness compared to aripiprazole.
- Aripiprazole has been available longer, so doctors have more long-term data on its safety.
- Some patients who experience side effects with aripiprazole may do better on brexpiprazole.
Both medications can be effective, and the choice depends on individual response and doctor recommendations.
Cost and Accessibility
Brexpiprazole is a brand-name drug, which may make it more expensive than generic alternatives like aripiprazole. Insurance coverage varies – patients should check costs and available options with their provider.
Patients concerned about cost should discuss alternatives or financial assistance programs with their doctor.
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Key Takeaways:
- Brexpiprazole is FDA-approved for major depressive disorder (as an add-on) and schizophrenia. It helps when traditional antidepressants alone are not enough and improves symptoms of schizophrenia.
- It works by balancing dopamine and serotonin levels in the brain. This helps regulate mood, thinking, and emotional stability while reducing psychotic symptoms.
- Brexpiprazole may have fewer movement-related side effects than older antipsychotics. It is designed to be tolerable, though some patients may still experience restlessness or weight gain.
- Common side effects include drowsiness, weight gain, and restlessness. While most are mild, some patients may experience more serious effects that require medical attention.
- Serious risks, though rare, include neuroleptic malignant syndrome (NMS) and tardive dyskinesia (TD). Patients should be aware of these risks and seek medical help if they experience unusual symptoms.
- Brexpiprazole is often compared to aripiprazole (Abilify) but may cause less restlessness in some patients. Doctors may choose between these medications based on individual response and side effect profiles.
- Patients should take brexpiprazole as prescribed and consult their doctor about any concerns.
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