The last three months have been hard. Very hard. I’ve been suffering from an acute manic episode and not the kind where I have fun all the time. There has been an increase in the amount of shopping I’ve done, but nothing so big as booking a last minute vacation, drinking heavily or getting a new tattoo. This is good news. The bad news is that I’ve still been highly irritable, my thoughts are racing and I feel like I’m crawling out of my own skin. When I first approached my psychiatrist with this problem, she decided to try out a new drug called brexpiprazole (Rexulti) to see if it would help treat my acute mania.
That was 5 weeks ago. I spent the first week at the lowest dose of 0.5mg in order to titrate up to a therapeutic dose. During this time I still suffered from symptoms but remained hopeful. Change does not come overnight.
After the first week my dosage increased to 1mg daily. At that point I thought I started seeing results, so my psychiatrist left me on that dose and told me to come back in a month. I had a total of just over a week where I felt almost symptom-free.
But then the symptoms began to come back. Anxiety, anger, negative energy I couldn’t get rid of, a brain on constant quick-fire and an increase in panic attacks- all of these have been weighing on me for months. It is now so bad that it’s interfering with my ability to work. That’s what I reported to my psychiatrist at the end of this month-long trial. That was yesterday.
During that conversation I also mentioned that not only did the drug not seem to be working, I was also experiencing some side effects. Of the listed side effects of the drug, I’m experiencing weight gain, increased appetite, drowsiness, anxiety, restlessness and physical agitation. Some of these may not be side effects. They may just still be symptoms of a manic episode. Either way, it doesn’t matter. I shouldn’t have to tolerate them.
After I told my psychiatrist that I didn’t think it was working and I was gaining weight and feeling like my skin was crawling half the time, she said she didn’t think the drug was for me. She told me to discontinue it and we would try something else.
That something turned into putting me back on aripiprazole (Abilify) but at a higher dosage. I responded well to it last time I took it and hope to see that change again. I do still have to titrate up to a therapeutic dose so I won’t likely see results for at least a week. As with the Rexulti, I’m holding out hope.
There may be a very simple explanation as to why Rexulti did not work for me. That is that it is not actually approved to treat bipolar disorder. The U.S. Food and Drug Administration has only approved brexpiprazole as a treatment for schizophrenia and as an adjunct medication for major depressive disorder.
Now, it is an antipsychotic and antipsychotics are used to treat bipolar disorder all the time. In fact, almost half of bipolar disorder patients take antipsychotics regularly. So, it wasn’t a shot in the dark to see if this medicine would work. It just didn’t work for me, and there is no currently published research to say that it might work for anyone else with bipolar disorder.
I contacted Otsuka, the company that makes Rexulti to ask them if there is any ongoing or planned research to see whether or not the drug should and could be used to treat bipolar disorder. As of the writing of this article, I have not heard from them except to send me to clinicaltrials.gov, which lists all ongoing studies. They are currently 40 listed trials going on right now including research on treatment for:
- Sleep disturbance
- Irritability in major depressive disorder
- Anxiety in major depressive disorder
- Inadequate response to treatment for major depressive disorder
- Maintenance drug therapy for schizophrenia
- Acute schizophrenia
- Agitation associated with dementia for Alzheimer’s disease
- Post-traumatic stress disorder
- Various other studies regarding these same disorders
So, the study and use of Rexulti to treat bipolar disorder is not yet on the table for a wide market. It is a new drug and these studies and trials take a while to recruit, complete and publish. In the future, Rexulti may prove to work on a decent amount of people with bipolar disorder. For now, suffice it to say it did not work in this case study.
Image credit: Porsche Brosseau