When antidepressants aren’t enough, add-on therapies may make a difference for those with depression

In the United States, an estimated 17.3 million American adults suffer from major depressive disorder (MDD), or depression. Depression is a serious mental illness characterized by symptoms that last at least two weeks, cause significant functional impairment, and can occur, on and off, anywhere from months to years.

"Although depression affects each individual patient differently, it generally impacts how they feel, think and behave. Depression may also be associated with physical symptoms, such as fatigue, body aches and changes in sleep and appetite," says Dr. Vladimir Maletic, a leading psychiatrist and clinical professor of psychiatry at University of South Carolina School of Medicine.

Depression causes, diagnosis, and treatment

Dr. Maletic explains that depression can affect anyone and does not have a single cause. In fact, current research suggests that depression results from an interaction of life adversity and genetic, biological, environmental, and psychological factors. Diagnosis of depression is primarily based on a comprehensive psychiatric evaluation. Physical exam, imaging studies and lab tests may provide supportive information or help with differential diagnosis. Most commonly a clinician relies on a combination of these diagnostic methods.

"While treatment differs for each patient, it typically includes psychotherapy, medications such as antidepressants, add-on therapies or some combination of these methods for some period of time, as decided by a patient and their health care provider. Quite often additional treatment recommendations include exercise, dietary changes, meditation, and other wellness-promoting practices. Furthermore, it is very important to identify and properly address other psychiatric and general medical disorders as they may worsen the course of illness," says Dr. Maletic.

When antidepressants alone may not be enough

Despite taking an antidepressant, many people may still suffer from symptoms of depression. If a patient has been on an antidepressant and is still dealing with symptoms of depression, it's important that they talk to their health care provider about what treatment options may be right for them. It's essential that patients keep providers informed about their symptoms so they can make dosage adjustments, switch or add on therapies, as needed.

Some patients on an antidepressant may still experience depressive symptoms. This means that a patient may have made some progress with their current treatment regimen, but still struggles with lingering symptoms of depression. This is sometimes called “partial response.”

“Having a partial response to an antidepressant is not uncommon and I encourage patients to speak with their health care team if they continue to experience their depressive symptoms on an antidepressant. It is important that patients know that there are additional options," says Dr. Maletic.

Dr. Maletic says adjunctive or add-on medications may be one of those options.

REXULTI^® (brexpiprazole) works with antidepressants

For adult patients taking an antidepressant for at least two months, but aren't seeing the progress they hoped for, adding REXULTI to their antidepressant medication may help reduce their depression symptoms — without giving up on the progress they’ve already made with their current antidepressant.

REXULTI is a prescription medicine used to treat major depressive disorder in adults. REXULTI is used with antidepressant medicines, when their healthcare provider determines that an antidepressant alone is not enough to treat their depression. REXULTI may cause serious side effects, including an increased risk of death in elderly people with dementia-related psychosis and risk of suicidal thoughts or actions. Please read the IMPORTANT SAFETY INFORMATION below.

"It is always important that patients feel empowered to talk with their doctor, if they’re not seeing the progress they'd hoped for after a couple of months on their current antidepressant, patients should speak with their healthcare provider. Frequent and open communication is especially important for patients suffering from depression,” stresses Dr. Maletic. "There are options for making adjustments to therapies and medications that may help patients achieve adequate symptom relief for depression, which may include the addition of REXULTI."

Learn more at www.rexulti.com.

INDICATION and IMPORTANT SAFETY INFORMATION for REXULTI^® (brexpiprazole)

INDICATION:

REXULTI is a prescription medicine used to treat:

• Major depressive disorder (MDD): REXULTI is used with antidepressant medicines, when your healthcare provider determines that an antidepressant alone is not enough to treat your depression.

It is not known if REXULTI is safe and effective in people under 18 years of age.

IMPORTANT SAFETY INFORMATION

Do not take REXULTI if you are allergic to brexpiprazole or any of the ingredients in REXULTI. Allergic reactions have included rash, facial swelling, hives and itching, and anaphylaxis, which may include difficulty breathing, tightness in the chest, and swelling of the mouth, face, lips, or tongue.

REXULTI may cause serious side effects, including:

• Stroke in elderly people (cerebrovascular problems) that can lead to death.
• Neuroleptic Malignant Syndrome (NMS): Tell your healthcare provider right away if you have some or all of the following symptoms: high fever, stiff muscles, confusion, sweating, changes in pulse, heart rate, and blood pressure. These may be symptoms of a rare and serious condition that can lead to death. Call your healthcare provider right away if you have any of these symptoms.
• Uncontrolled body movements (tardive dyskinesia). REXULTI may cause movements that you cannot control in your face, tongue or other body parts. Tardive dyskinesia may not go away, even if you stop taking REXULTI. Tardive dyskinesia may also start after you stop taking REXULTI.
• Problems with your metabolism such as:
  • high blood sugar (hyperglycemia): Increases in blood sugar can happen in some people who take REXULTI. Extremely high blood sugar can lead to coma or death. If you have diabetes or risk factors for diabetes (such as being overweight or having a family history of diabetes), your healthcare provider should check your blood sugar before you start taking REXULTI and during your treatment.
    Call your healthcare provider if you have any of these symptoms of high blood sugar while taking REXULTI:
    
    

    feel very thirsty	feel sick to your stomach	need to urinate more than usual
    feel very hungry	feel weak or tired	feel confused, or your breath smells fruity

  • increased fat levels (cholesterol and triglycerides) in your blood.
  • weight gain. You and your healthcare provider should check your weight regularly.
• Unusual urges. Some people taking REXULTI have had unusual urges, such as gambling, binge eating or eating that you cannot control (compulsive), compulsive shopping and sexual urges.
  If you or your family members notice that you are having unusual urges or behaviors, talk to your healthcare provider.
• Low white blood cell count
• Decreased blood pressure (orthostatic hypotension). You may feel lightheaded or faint when you rise too quickly from a sitting or lying position.
• Seizures (convulsions)
• Problems controlling your body temperature so that you feel too warm. Avoid getting over-heated or dehydrated while taking REXULTI.
  

  Do not over-exercise.	In hot weather, stay inside in a cool place if possible.
  Stay out of the sun. Do not wear too much or heavy clothing.	Drink plenty of water.

• Difficulty swallowing that can cause food or liquid to get into your lungs.

Do not drive a car, operate machinery, or do other dangerous activities until you know how REXULTI affects you. REXULTI may make you feel drowsy.

Before taking REXULTI, tell your healthcare provider if you:

• have diabetes or high blood sugar or a family history of diabetes or high blood sugar. Your healthcare provider should check your blood sugar before you start REXULTI and during your treatment.
• have high levels of cholesterol, triglycerides, LDL-cholesterol, or low levels of HDL cholesterol
• have or had seizures (convulsions)
• have or had low or high blood pressure
• have or had heart problems or a stroke
• have or had a low white blood cell count
• are pregnant or plan to become pregnant. It is not known if REXULTI may harm your unborn baby. Using REXULTI in the last trimester of pregnancy may cause muscle movement problems, medicine withdrawal symptoms, or both of these in your newborn.
  • If you become pregnant while taking REXULTI, talk to your healthcare provider about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 1- 866-961-2388 or visit http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/
• are breastfeeding or plan to breastfeed. It is not known if REXULTI passes into your breast milk. You and your healthcare provider should decide if you will take REXULTI or breastfeed.

Tell your healthcare provider about all the medicines you take or recently have taken, including prescription medicines, over-the-counter medicines, vitamins and herbal supplements. REXULTI and other medicines may affect each other causing possible serious side effects.

REXULTI may affect the way other medicines work, and other medicines may affect how REXULTI works.

Your healthcare provider can tell you if it is safe to take REXULTI with your other medicines.

Do not start or stop any medicines while taking REXULTI without talking to your healthcare provider first.