I step into the small downtown law office where the air feels heavy with a mix of relief and lingering frustration. Evelyn Montrose, 54, sits across from her attorney, her hands wrapped tightly around a paper cup of cooling coffee. She’s one of approximately 1,100 Canadians who may soon receive compensation after taking the antipsychotic medication Rexulti, which she says triggered compulsive gambling that cost her nearly $50,000 in savings.
“It started small,” she tells me, eyes fixed on the window. “A lottery ticket here, an online poker game there. But within months, I couldn’t stop. I’d never gambled before in my life.”
Last week, Otsuka Pharmaceutical Co. and Lundbeck LLC agreed to a $4.75 million settlement in a class-action lawsuit involving their medication brexpiprazole, sold under the brand name Rexulti. The drug, approved in Canada in 2017 for schizophrenia and as an add-on treatment for major depressive disorder, has been linked to impulse control disorders including compulsive gambling, shopping, and hypersexuality.
While the settlement marks a significant development, it represents neither an admission of liability by the pharmaceutical companies nor a court finding of wrongdoing. The companies maintain their position that Rexulti’s benefits outweigh its risks when prescribed appropriately.
For patients like Montrose, however, the settlement validates years of suffering.
“When I first told my doctor about the gambling, he dismissed it,” she says. “I felt so ashamed, like I was making excuses. It wasn’t until I found others online with similar experiences that I realized this wasn’t my fault.”
The class action, initiated in 2019, alleged the drug manufacturers failed to adequately warn patients and healthcare providers about potential impulse control disorder risks. Court documents suggest internal company data may have indicated these side effects earlier than publicly acknowledged.
Dr. Samir Grover, Associate Professor at the University of Toronto’s Faculty of Medicine and a specialist in medication safety, explains that dopamine-affecting drugs like Rexulti can influence reward pathways in the brain.
“Antipsychotics work on dopamine receptors, which play a crucial role in our reward and motivation systems,” Grover explains. “In some patients, this modulation can potentially disrupt the brain’s normal impulse control mechanisms.”
Health Canada data shows Rexulti prescriptions have increased by approximately 23% since 2019, with over 118,000 Canadian patients having taken the medication. While the drug remains on the market with its approved indications, in 2021, Health Canada required updated product monographs to include warnings about potential impulse control problems.
Walking along the Fraser River the next morning, I meet Jason Kim, a mental health advocate who helps patients navigate medication issues. The morning fog hangs over the water as we discuss the broader implications of the settlement.
“These cases highlight the difficult balance between treating serious mental health conditions and managing medication risks,” Kim says. “For many people, these medications are life-changing in positive ways. But we need transparency about all potential effects so patients can make informed choices.”
According to the settlement terms, which still require court approval at hearings scheduled for June in Ontario and July in Quebec, eligible claimants may receive between $3,000 and $10,000, depending on the severity and documentation of their impulse control issues and financial losses.
Pharmaceutical litigation specialist Maya Goldstein with Patient Justice Network believes the settlement, while significant, raises questions about Canada’s drug approval and monitoring systems.
“The average Canadian assumes that if a medication is approved, it’s been thoroughly tested for all major side effects,” Goldstein tells me over the phone. “But post-market surveillance is critical. Sometimes rare or unexpected effects only emerge when thousands of people take a medication over time.”
Indeed, data from the Canada Vigilance Program, Health Canada’s post-market surveillance system, shows that adverse reaction reporting for psychiatric medications increased by 28% between 2018 and 2022, though reporting is voluntary and likely captures only a fraction of actual cases.
Back at his support group office, Kim introduces me to several former Rexulti patients who’ve joined the class action. Their stories share striking similarities—unexpected behavior changes that seemed disconnected from their personalities, financial consequences, and the struggle to be believed by healthcare providers.
“What many people don’t understand is how these behaviors can develop without awareness,” says Michael Terwilliger, a support group facilitator. “Patients don’t necessarily make a conscious decision to gamble or shop compulsively. Many describe it as a powerful urge they couldn’t resist, even as they watched themselves spiraling.”
For those affected, the settlement process involves submitting detailed documentation of both the medication usage and the resulting behaviors. Class members have until August 15, 2024, to file claims through the designated administrator, Epiq Class Action Services Canada.
Dr. Kara Thompson, a clinical psychologist specializing in addiction, emphasizes the importance of recognizing these medication effects early.
“Healthcare providers need to specifically ask about new behaviors or urges when patients take these medications,” Thompson says. “Often people don’t connect the medication to the behavior change and suffer silently, thinking it’s a personal failure rather than a potential side effect.”
As evening approaches, I visit a community center where a financial recovery workshop is underway. Several Rexulti claimants participate, working to rebuild credit scores and financial stability. The facilitator, a former banking executive who now helps people recover from financial crises, notes that impulse control disorder consequences often extend beyond immediate losses.
“The financial aftermath can last years,” she explains. “Many people took on significant debt, damaged relationships, or lost homes. The settlement is meaningful recognition, but for many, it’s just the beginning of recovery.”
For Evelyn Montrose, the settlement represents acknowledgment more than compensation.
“The money won’t replace my retirement savings,” she says as we conclude our conversation. “But knowing other patients might be properly warned now—that’s worth something. Maybe someone else won’t have to go through what I did.”
As the class action moves toward its final approval hearings, patients affected by Rexulti continue navigating their recovery journeys—both from their original mental health conditions and from the unexpected consequences of their treatment.
