Living with depression or schizophrenia can deeply affect every aspect of life, from relationships to work to simple daily motivation. Rexulti (brexpiprazole) offers a modern treatment option designed to help restore emotional balance and reduce distressing symptoms in people struggling with these conditions. As a newer-generation antipsychotic medication, Rexulti is often prescribed to support mood stabilization, improve clarity of thought, and enhance overall quality of life.

Approved by the U.S. Food and Drug Administration (FDA) in 2015, Rexulti belongs to a class of medications known as atypical antipsychotics. It’s typically used as an adjunct therapy for major depressive disorder (MDD) or as a primary treatment for schizophrenia. Its balanced approach to dopamine and serotonin regulation helps patients achieve symptom control with fewer sedative or movement-related side effects than older antipsychotic medications.

What does Rexulti do?

Rexulti is prescribed for:

• Major depressive disorder (MDD): Used along with antidepressants when symptoms like low mood, loss of interest, or fatigue do not fully respond to antidepressant therapy alone.
• Schizophrenia: Helps reduce symptoms such as hallucinations, disorganized thinking, and emotional withdrawal.

By restoring balance to brain chemicals that influence mood, behavior, and perception, Rexulti can help patients experience more stable emotions, clearer thinking, and improved daily functioning.

Clinical studies have shown that Rexulti, when combined with antidepressants, can lead to significant improvements in depressive symptoms and overall quality of life compared with antidepressants alone (FDA, 2015; Mayo Clinic, 2024). In schizophrenia, many patients report a calmer mood, reduced paranoia, and improved ability to engage in everyday activities.

How does Rexulti work?

Rexulti works by modulating dopamine and serotonin receptors in the brain, two key neurotransmitters involved in mood, motivation, and cognition. Specifically, it acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at serotonin 5-HT2A receptors.

In simpler terms, Rexulti helps balance chemical signals in the brain that are either overactive (as in schizophrenia) or underactive (as in depression). This fine-tuning reduces extreme mood swings, stabilizes thought patterns, and helps patients feel more emotionally grounded.

Clinically, this mechanism matters because it provides the benefits of dopamine regulation without causing the intense receptor blockade that can lead to stiffness, restlessness, or excessive sedation; side effects often seen with older antipsychotics.

Rexulti side effects

Like all prescription medications, Rexulti can cause side effects, though many are mild and manageable. Understanding them helps patients make informed decisions and know when to reach out for support.

Common side effects:

• Weight gain
• Drowsiness or fatigue
• Headache
• Dizziness or lightheadedness
• Restlessness (akathisia)

Less common side effects:

• Constipation
• Increased appetite
• Anxiety or sleep disturbances

Serious but rare side effects:

• Uncontrolled muscle movements (tardive dyskinesia)
• Increased blood sugar, cholesterol, or triglycerides
• Signs of neuroleptic malignant syndrome (severe muscle rigidity, fever, confusion) — a medical emergency

Patients should contact a doctor immediately if they experience severe stiffness, rapid heartbeat, confusion, or unusual involuntary movements.

Who should avoid Rexulti:

• Individuals with a history of allergic reaction to brexpiprazole
• Patients with significant liver or kidney impairment may require dosage adjustments
• Rexulti is not approved for use in children under 13 years old for depression or under 18 for schizophrenia

The medication carries a boxed warning regarding increased risk of suicidal thoughts in young adults, a risk shared by most antidepressant and adjunctive treatments. Regular follow-up with a healthcare provider is essential to monitor safety and emotional well-being (NIH, 2024).

Rexulti dosage

Rexulti is available as an oral tablet taken once daily, with or without food. The dose is individualized based on the condition being treated, patient response, and other medications in use.

Because Rexulti affects brain chemistry and metabolism, healthcare providers often monitor:

• Mood and behavioral changes, especially during early treatment
• Weight and blood sugar levels over time
• Lipid profile and blood pressure for patients on long-term therapy

Regular communication with your healthcare provider helps ensure the dose remains both effective and safe.

Special considerations:

• Older adults with dementia-related psychosis should not take Rexulti due to increased mortality risk.
• Patients taking strong CYP2D6 or CYP3A4 inhibitors (certain antidepressants or antifungals) may need lower doses to prevent side effects.

Does Rexulti have a generic version?

As of 2025, no FDA-approved generic version of Rexulti (brexpiprazole) is available in the United States. It is currently sold only as the brand-name product developed by Otsuka Pharmaceutical and Lundbeck. However, international versions may exist in other markets.

Once a generic version becomes available, it will meet the same rigorous FDA standards for quality, strength, and clinical effectiveness as the brand-name product. Patients can also inquire about manufacturer assistance programs or copay savings cards that help reduce out-of-pocket costs.

Conclusion

Rexulti provides a well-tolerated, effective treatment option for adults living with major depressive disorder or schizophrenia. Targeting key brain receptors that regulate mood and cognition helps reduce symptoms and support long-term emotional stability.

While every patient’s experience may differ, many find Rexulti easier to tolerate than older antipsychotic medications, especially regarding movement and metabolic side effects. Consistent follow-up, healthy lifestyle choices, and open dialogue with a healthcare provider can further enhance treatment success.

When prescribed and monitored by a qualified professional, Rexulti can be a safe and empowering part of a broader mental health plan, helping patients regain clarity, connection, and confidence in their daily lives.

References

1. U.S. Food and Drug Administration. (2015). Rexulti (brexpiprazole) prescribing information. Retrieved from https://www.fda.gov
2. Mayo Clinic. (2024). Brexpiprazole (oral route): Uses and side effects. Retrieved from https://www.mayoclinic.org
3. National Institutes of Health. (2024). Brexpiprazole – Drug information. Retrieved from https://medlineplus.gov