What is a good adjunct to brexpiprazole (Rexulti) for treating depression?

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Last updated: February 14, 2025View editorial policy

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From the FDA Drug Label

The efficacy of brexpiprazole in the adjunctive treatment of major depressive disorder (MDD) was evaluated in two 6-week double-blind, placebo-controlled, fixed-dose studies of adult patients meeting DSM-IV-TR criteria for MDD, with or without symptoms of anxiety, who had an inadequate response to prior antidepressant therapy (1 to 3 courses) in the current episode and who had also demonstrated an inadequate response throughout the 8 weeks of prospective antidepressant treatment (with escitalopram, fluoxetine, paroxetine controlled-release, sertraline, duloxetine delayed-release, or venlafaxine extended-release)

Brexpiprazole can be used as an adjunct to antidepressant therapy (ADT) for treating depression.

  • Examples of antidepressants used in the studies include:
    • escitalopram
    • fluoxetine
    • paroxetine controlled-release
    • sertraline
    • duloxetine delayed-release
    • venlafaxine extended-release 1

From the Research

Adjunctive Treatment Options for Brexpiprazole (Rexulti) in Treating Depression

  • Brexpiprazole is a serotonin-dopamine activity modulator that has been approved by the US FDA for adjunctive therapy with antidepressant treatment (ADT) in patients with major depressive disorder (MDD) 2.
  • Studies have shown that adjunctive brexpiprazole is effective in improving depressive symptoms in adults with MDD who have demonstrated an incomplete response to previous treatment with ADT 2, 3, 4.
  • Brexpiprazole has been found to be generally well tolerated in clinical trials, with a lower potential for activation-like adverse effects, such as akathisia, compared to other medications 2, 5.

Efficacy in Patients with Anxious Distress

  • Adjunctive brexpiprazole has been shown to be efficacious in reducing depressive symptoms in patients with MDD and anxious distress 3, 4.
  • Brexpiprazole has been found to improve symptoms of anxious distress, including tension, restlessness, concentration, and apprehension, in patients with MDD 3.
  • The medication has also been shown to improve functioning in patients with MDD and anxious distress, as measured by the Sheehan Disability Scale 4.

Potential Benefits and Future Research

  • Brexpiprazole may be a viable option for treating patients with MDD who have inadequate response to ADTs, particularly those with anxious distress 3, 4, 5.
  • Further research is needed to determine the long-term efficacy of brexpiprazole and to establish its place in therapy compared to other treatments 5.
  • Ongoing and future trials, such as the study examining the effects of adjunctive brexpiprazole on sleep-wake and circadian parameters in youth with depressive disorders, may provide additional insights into the benefits and potential uses of brexpiprazole 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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