Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Rexulti is a prescription medication approved by the Food and Drug Administration (FDA) to treat schizophrenia, and to treat depression when combined with other drugs.
The generic version of the drug is called brexpiprazole, and we’ll use these terms interchangeably throughout this article because they refer to the same active drug ingredient.
Is Rexulti actually proven to be effective for both depression and schizophrenia? Is it more effective for one or the other? Does the drug cause concerning side effects? And how do real users describe its effects?
In this article we'll answer all of these questions and more as we review clinical studies on Rexulti to give our take on whether it's effective for depression and schizophrenia, document its side effects, explain whether the drug causes weight gain and share real, unsponsored user reviews of Rexulti.
Is Rexulti Effective for Depression?
As referenced in the intro to this article, Rexulti is only approved by the FDA to treat depression as an adjunctive therapy, meaning it’s taken in combination with another antidepressant. It is not approved to treat depression alone.
A medical review published in the CNS Drugs journal examined the efficacy of Rexulti as an adjunctive therapy for major depressive disorder (MDD). The researchers analyzed data from over 30 clinical trials.
The study authors found that Rexulti combined with an antidepressant was more effective for treating depression than an antidepressant alone. They noted that Rexulti adjunctive use “significantly improved the symptoms of depression.” Not only did adjunctive Rexulti improve symptoms of depression, but the drug also caused improvements in secondary health categories that often overlap with depression, including anxiety, irritability and sleep issues.
A separate meta-study from 2016 analyzed whether adjunctive Rexulti was effective for treating depression in patients with both anxiety and depression. The drug was found effective at a dose range between 2 milligrams (mg) and 3 mg daily.
We will conclude from the available medical research that Rexulti is effective for treating depression when used as an adjunctive therapy, and may also be effective for patients with both anxiety and depression.
Is Rexulti Effective for Schizophrenia?
Unlike its use for depression, Rexulti can be prescribed as a standalone treatment for schizophrenia. A medical review published in the well-respected Drugs journal analyzed data from many clinical trials on Rexulti as a schizophrenia treatment.
The medication was found to be effective, increasing patient response rate by 10%. This means that around 10% more patients experienced reductions in schizophrenia symptoms on Rexulti than on placebo pills.
A more recent medical review replicated these positive results, finding Rexulti to be effective for schizophrenia. Patients taking Rexulti experienced fewer psychiatric symptoms related to schizophrenia, and relapsed fewer times over the course of the treatment.
We will conclude from the available research that Rexulti is effective for treating schizophrenia.
Rexulti Side Effects
Rexulti does cause side effects in some patients, and these side effects can be severe. A meta-study from 2017 documented the most common side effects of the drug. Restlessness was experienced by 4-14% of patients, headache by 4-10% of patients, sleepiness by 2-6% of patients, and tremor by 2-5% of patients.
These side effects are relatively mild. However Rexulti may cause more severe side effects in some patients.
Rexulti’s FDA label has a “black box” warning, shown above, which is the most severe type of warning issued by the FDA. The black box warning indicates that Rexulti may increase the mortality rate for elderly patients with dementia-related psychosis, and can increase suicide risk in patients aged 24 and younger.
In light of this information it may be beneficial for patients aged 24 and under and for elderly patients to speak with their doctor about alternative schizophrenia or depression medication which doesn’t confer this risk.
Real, Unsponsored Rexulti User Review
One of the most popular YouTube reviews on Rexulti is published by a creator named "joeytalks." He explains the effects of the drug that he experienced, and side effects he experienced:
Does Rexulti Cause Weight Gain?
Patients are often curious about whether Rexulti causes weight gain as a side effect. This is a good question, given that many antipsychotic medications do cause weight gain as we documented in our aripiprazole reviews article on another drug used for schizophrenia.
Rexulti does appear to cause weight gain based on medical studies. A review published in the International Clinical Psychopharmacology journal examined the effects of Rexulti on body weight in patients using the drug for depression and for schizophrenia.
Both groups experienced weight gain, but average weight gain was lower in the group using Rexulti for depression than for schizophrenia. Depressed patients gained an average of 4.63 pounds after one year on the drug. Schizophrenic patients gained an average of 7.05 pounds after a year on Rexulti.
This data suggests that overweight and obese patients may wish to speak with their doctor about alternative schizophrenia or depression medications that are not associated with weight gain.
Should I Take Rexulti Generic?
Patients are often curious about whether they should take the generic or branded version of a drug, given that generic versions are often much cheaper. This consideration is typically more significant for patients without health insurance.
In the case of Rexulti, the generic version of the drug is not yet commercially available according to GoodRx. Sometimes drug manufacturers hold a patent that allows them to be the exclusive retailer of a medication for a set number of years.
We do recommend that patients on Rexulti speak with their doctor every year or so about whether a generic version has become available, because medical research proves that generic versions of drugs are equally effective to branded versions, and can be significantly cheaper.
If a patient is based in the U.S., the cost of Rexulti will vary significantly based on whether or not they have health insurance. According to Rexulti’s official website, patients with health insurance through a private program or through government programs like Medicaid will pay somewhere between $3.76 and $30.60 per month.
The above-linked Cost resource page on Rexulti’s site suggests that patients on government health programs typically pay less than patients on private health programs.
For patients without health insurance, the average retail price of Rexulti is currently $1,685.83 according to SingleCare.
Given the vast price difference between the uninsured and insured price, we would definitely recommend that patients considering this medication speak with their health insurer about whether it’s covered.
The dosage of Rexulti varies based on the condition it’s being used to treat.
According to the FDA label linked previously in this article, the typical starting dose of Rexulti for depression is 0.5 mg per day, and the maximum dose is 3 mg per day.
The typical starting dose of Rexulti for schizophrenia is 0.5 mg per day, and the maximum dose is 4 mg per day.
Doctors will typically start patients on the lowest dose in the therapeutic range because this will minimize the risk of side effects. If the patient experiences benefit on the lowest dose, this is a beneficial outcome and they can typically continue using that dose. Some patients may experience no benefit on the lower doses, and their doctor may titrate their dose up to the maximum allowed over the course of weeks or months.
Our Mental Wellness Recommendation
We recommend a platform called Brightside to patients on a mental health journey. It's an online therapy and medication platform that connects patients with licensed therapists and doctors from the comfort of their home.
A medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.
Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.
Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.
The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.
Interested patients can check out Brightside at this link to the brand's website.
Rexulti User Reviews
Over 300 patients have reviewed Rexulti on Drugs.com, which is a website that allows patients to publish personal reviews about prescription medications.
The average rating of Rexulti for depression at the time of writing this article is 6.4/10, and the drug’s average rating for schizophrenia is 5.1/10.
The top positive review of Rexulti for depression is published by a user named “Kay” who claims that the drug fixed their depression symptoms and improved their quality of life:
“It took me almost 2 years & many drugs until I was put on Rexulti, & it has honestly changed my life. I am happy, can take care of my children and most importantly I am not wanting to end my life anymore. I didn’t think a medication could help me. Depression is a very serious disease but there CAN be relief.”
The top negative review of Rexulti for depression comes from a user named “lrivera1902” who claims the drug was ineffective and caused weight gain:
“I took rexulti for 5 months. I gained 20lbs even doing weight watchers. I stopped taking it because it was not working anyways. I hate antipsycotic drugs. I have struggled with my weight for years and they do nothing but add to the problem. I would rather learn to deal with my depression then take anymore drugs at this point in my life.”
The top positive review of Rexulti for schizophrenia is written by a user named “SAJ” who claims the drug was effective and improved their sleep:
“Dr. switched me to Rexulti because of studies showing it helps with PTSD and within 3 days I felt so so much better. I was less paranoid, less agitated, no voices, no paralysis, no EPS. Way better than Abilify ever was. I also started to sleep 6-8 hrs straight every night. It is like it just reset something in my brain and I began to sleep again.”
The top negative review of Rexulti for schizophrenia comes from a user named “Shell” who is writing on behalf of her daughter and claims the drug caused significant side effects:
“She developed hiccups on and off with this med and her body temperature was going hit and cold she then became very confused and could not focus then extremely depressed and I took her to the emergency room where 16 hrs later she had a grand mal seizure.”