What to expect with Seroquel

December 29, 2011 2:46 PM

I've been prescribed Seroquel (Quetiapine). This is the first antipsychotic I've been given. What can I expect? What helps?

I've been told I might be tired, which is not ideal as I also have trouble with anaemia and want to try and exercise more. Crazymeds seems to suggest that it's the fast track to type II diabetes, which may be slightly hyperbolic but if I'm likely to gain weight it would be useful to know (I was prescribed sodium valproate which made me absolutely ravenous).

I'm being started on a low dose and working up, but it would be good to know what to expect so I can keep an eye on anything problematic when I go back to see the doctor in a few weeks. I'm planning a short trip to Amsterdam on my own in three weeks time (nb. no getting high involved) and have an interview which will require giving a presentation - will either of these be affected?

posted by anonymous to health & fitness (20 answers total)

As with all psych meds, people's reactions differ, so don't take this as gospel or anything. But for me, Seroquel was a big fat 5-year-long sleeping pill. I gained remarkable amounts of weight, slept many, many hours, and didn't exactly emerge with the greatest mental health. That said, sleepiness and hunger were far less weird side-effects than some of the other drugs had on me. In fact, thinking back, although the lethargy came to define my life while I was taking it, it was still way more benign than, say, the shakes or brain-freezes.

I absolutely agree with exercising more. Work with your doc to figure out the best timing of your dose--maybe something like taking it a few hours before bed will let you sleep well but still be functional during the day. Eat wisely--I know what you mean with the valproate, and Seroquel was much the same way. Don't stock the pantry with snacks, or really anything easy to pop out of a box and eat. I didn't get diabetes or anything, but I did get fatter than I'd ever been, precisely because I surrounded myself with "safe" food (i.e., simple starches mostly).

I would ask the doc to please leave you on the lowest possible dose (what is that, 25 mg?) until after your presentation, just so you don't have any trouble thinking through it.

(And again, everybody has different reactions--Seroquel is known for its sedating effects, but yours may simply not be as extreme as mine, so I don't say any of the above to discourage you from giving it a fair try!)
posted by mittens at 3:03 PM on December 29, 2011

It was extremely helpful for a member of our family--dramatically reduced racing thoughts, improved concentration, minimized anxiety. She had no weight gain and adjusted time of dosing so largest dose was an hour before bed time. a]Also, her total and hdl/ldh split of cholesterol and triglycerides remained normal/good. Under your physicians direction you can titrate dose gradually so you should be fine in Amsterdam--also--i would encourage you to keep in contact with your physician regarding fine tuning the dose and timing. Best of Luck
posted by rmhsinc at 3:08 PM on December 29, 2011

It sounds like you know this, but Crazymeds tends to self-select for people who have experienced the worst possible side effects. If you're reading the forums, make sure you keep that in mind. I take a bunch of drugs that have discussions there and, although I'm prone to side effects, I've rarely seen anything on the scale that some Crazymeds forum posters describe. I love the site -- it can be enormously reassuring to know there are others going through what you are going through -- just remember that, and I say this as one of them, those people are at least a little crazy.
posted by The Bellman at 3:11 PM on December 29, 2011 [2 favorites]

I was prescribed a very low dose (50mg) for anxiety and to help me sleep. 25mg is enough to knock me out. I'm assuming you have a much higher target dose, so expect a long few weeks of building tolerance to the sedative effects. It also put me in a drunk-like fog, I certainly would not be expecting to give a presentation a few weeks into adjusting to this drug. Also it always gave me the munchies, so weight gain is a concern, and the risk of diabetes. You sound like you are much higher functioning than the typical person taking high doses of Seroquel. It seems like an odd choice if you've never tried any other antipsychotic. Seroquel is a very controversial drug. I don't know exactly why you've been prescribed this drug, but you may want to research Abilify as a better option (or another atypical antipsychotic) without the massive side effects of Seroquel.
posted by catatethebird at 3:54 PM on December 29, 2011

In answering, pardon the overuse of "I" when trying to relate this to you:
I was prescribed it 4 weeks ago for depression/anxiety. It has helped me be smooth but also maybe a tad flat in affect. I can find myself staring out the window a bit and lose track of time. Still, I focus at work. Dosage is not super high...150mg. (Some people are seriously jacked up on doses but I'm not the doctor.) On the plus, i am not hungry as when on something, say geodon? Like above poster, I would HIGHLY recommend exercise and even stretching/yoga. I am returning to it, but again, the struggle is getting yourself out of bed to do it as I do feel a bit drugged.

*and for me, something that may not be the smartest to recommend to you, is that i have espresso in the morning for the boost at the gym. Take that with a grain of salt. (For those with no mood issues, a bit of caffeine has beneficial effects with exercise but you can find links saying the opposite as with anything on the net. For some it can cause anxiety (which is what you may be trying to avoid) but for me, for some odd reason, an espresso shot does not hit me like straight coffee. Energy but not anxiety. And I only do it if I am going to the gym before work. I just have to be careful not to play yin-yang with the caffeine and seroquel, though. Finally, taking the med right after supper and getting 8-9 hrs tops in sleep is what helps me....and I get up when the alarm goes off on a regular basis, even on days off.

Hope this helps. Feel free to memail me if you want. Good luck!
posted by snap_dragon at 4:06 PM on December 29, 2011

um, scratch the caffeine. I think that was a poor thing to throw in there for you. Just want you to get the heart pumping and brain chemicals going with exercise.
posted by snap_dragon at 4:07 PM on December 29, 2011

I had a crappy experience with it. I gained about 50 pounds (going from a 5'7" 125 to 175) in 3 months despite increasing exercise and being very careful with my diet. I completely ballooned up. It didn't do anything for my mental state except make me feel incredibly fuzzy and tired. Oh, and I had horrifically realistic nightmares (like being buried alive type of horrors) as well.

I got off it as quickly as I could.

But of course, this was MY experience and mine alone. But it was terrible.
posted by kinetic at 5:01 PM on December 29, 2011

I actually looked up the email I sent to my former pdoc about this drug:

As far as the Seroquel is concerned, I feel like a zombie during the day - extremely groggy and slow - and now that I've reached the therapeutic dose, it no longer has the strong sedative effect at night so once again I'm not sleeping.

Further, I became more depressed and irritable as the dosage increased.

However, the caveat is -- it's been established since that time that I am not bipolar and your results may not be the same as mine. Best of luck to you.
posted by sm1tten at 5:31 PM on December 29, 2011

I love my Seroquel. I started at 25mg a day, and after two years moved up to 100mg per day. It has worked well for my depression with anxiety. It was prescribed to me in part for sleep issues. I take the non-xr, right before bed, and I sleep well. I do need to get at least seven hours of sleep after taking it. I haven't had any issues with weight gain, but my doctor and I are alert for blood sugar issues. I am slightly hypoglycemic, and for the first few months of taking it, I had to be sure to eat every four hours or get dizzy. Also, you can't eat grapefruit. I miss it.
posted by freshwater at 6:06 PM on December 29, 2011

I haven't tried Seroquel, but I came in to mention the same thing The Bellman said above. I too love crazymeds, and it's an excellent resource. But don't worry too much about getting all the side-effects they list. For example, they were really emphatic about The Rash (their capitalization) with Lamictal, more so than most sites. I did not get that, and Lamictal seems to be my miracle drug (so far). People come to the internet to complain more often than they do to post positive reviews.

Good luck with the Seroquel. I hope it works out all right for you.
posted by Because at 6:06 PM on December 29, 2011

Another horrible experience with Seroquel here. Big, fat sleeping pill--emphasis on big and fat. I was on it for a year and gained fifty-plus pounds, despite being very, very careful not to change my eating habits. It turned me into a total zombie--I wasn't as swing-y and angry, but I wasn't happy or interested in anything, either.

I've been off it for eighteen months and still have the eye twitch that I developed while on the meds--something that my doctor has admitted is not uncommon, in his experience.

It seems like if you're one of the people it works for, it's a magic pill; if you're one of the people it doesn't work for, it's the next closest thing to hell, and the effects can be long-lasting, even once you're no longer on the meds.

I'd never caution someone not to try it, but I would say that if you feel that it's not working for you, don't be talked into continuing with it if you're not comfortable doing so. I didn't feel much effect (other than tiredness) at first, and so was bumped to a higher dose. When that made me more of a zombie, I was switched to XR. When that was ineffective, it was a higher dose of XR. Etc. I don't regret trying Seroquel, but I do regret staying on it for as long as I did, and continuing to try different formulas and dosages when I felt that it wasn't really working for me.

YMMV--I sincerely hope that it helps you, because for the people who it helps, it seems to be a fantastic drug.
posted by MeghanC at 6:11 PM on December 29, 2011

Well, now I'm trying to figure out if Seroquel itself causes the weight gain (affecting metabolism?) or affects some people's appetite and they eat more. (One poster said he watched his intake and still gained). I suggested to the op the importance of exercise but am now not sure how much it will help his/her weight if the med directly arrests metabolism. I don't want to hijack this from op but thought this might be something someone would know.
posted by snap_dragon at 6:45 PM on December 29, 2011

I've only been on Seroquel for about two weeks now. I stepped up to 150 mg xr. I had to step up a bit more slowly (25,50,75, 100, 150). I've dealt with the prednisone hungerrr and I just started another round of asthma related prednisone, so it's hard for me to know how much impact is prednisone and how much seroquel.

I will say I have to take it prior to 8pm or I cannot get up in the am. It doesn't knock me out at night like it was at first. I only experience the flatness in the morning while still waking up.
Oh and thus far, my sex drive has not been negatively impacted. In fact it's better since I'm not ruminating and fighting negative obsessions.

I resisted it for a few years -- primarily because I was working and didn't have the time to get used to it, it's an anti psychotic and "i'm not that crazy" :p, I was scared of the weight gain issues (history of bulimia). I also felt that some of my emotional responses were realistic for the health issues I have been dealing with. However, not obsessing on the wtf amigonna do, ohmygod my life is over....will let me start to deal and make plans. It's sometimes hard for me to get through my brain that yes it is normal to be upset, but when that upset means I'm unable to function -- well that is not denying that I have crap to be upset about, it's getting myself feeling and functioning better.

My partner is noticing benefits already. My thinking is less chaotic, I'm better focused, I'm not obsessing and picking/scratching/etc, even in conversation I'm more logical and have better problem solving skills. I thought my pdoc was nuts when he said this could help the incessant "itching" (not like rash itching, more like creepy ugh get it off). It's really bizarre and I know this is not everyone's experience.

I just want to put out a (thus far) positive experience.
Oh and yeah i've heard of people on 600 mg doses :O My understanding is the higher the dose the more likely the diabetes tendency (and weight gain). My p doc didn't mention sugar monitoring (periodic blood tests) and my GP suggested I do so.

Oh as far as dealing with the HUNGERRRR, at least with prednisone, I found drinking water a lot helps, soda water is an awesome option. I also find that two things that seem to turn that down are oatmeal (not the instant flavor kind, plain and then you add a reasonable mix in) or @ 4oz of milk. The other hard thing is to learn to ignore the I'm hungry when you know you just ate 2 hrs ago and do something busy and distracting. Oh I'm also another drink caffeine to survive the mornings. I have several meds with sleepy side affects. I know it can tend to add to hypomania, but I have to function so it's a balancing act. OTOH, my asthma meds can jack me up, so that's another balancing act.

As far as your presentation, I agree with the other posters, you don't want to step up just before it. Also, I'm hoping you have an afternoon slot, since that is when you'll be at your best:)

Feel free to PM me!
posted by Librarygeek at 7:31 PM on December 29, 2011

I've been on Seroquel (regular, not XR) for a year and a half now. I'm definitely in the "miracle drug" category. I have type 2 bipolar disorder, and am at my therapeutic dose of 300mg at night (about an hour or two before I want to go to bed) and 50mg during the day with an "as-needed" 50mg for break-through anxiety which I don't need very often.

I *definitely* need at least 7 hours of sleep (8 or 9 is ideal) or I will spend the day feeling like a zombie. I do notice being hungry a lot more and in the beginning there were lots of strong cravings for junk food, but both of these side effects have lessened over time. I've gained 10lbs so far, but they were a much needed 10lbs as I've been underweight for most of my life due to fast metabolism and bipolar-anorexia (I didn't *chose* to stop eating, I just didn't notice).

My moods are stable. I'm SLEEPING (like real, *restful* sleep!). And overall, Seroquel has been a good experience for me.

I asked a related question regarding Seroquel and weight gain/diabetes a while back.
posted by MuChao at 7:33 PM on December 29, 2011 [2 favorites]

I was prescribed Seroquel last spring for depression and anxiety. My dose was 50 mg XR to be taken at night and 25 mg of the regular release to be taken as needed--including just chipping off a bit and taking that--during the day for freakouts. I hated it. It just knocks me flat on my ass. I couldn't wake up in the mornings at all unless I took it a full 12 hours or more before I wanted to wake up. And the 25 mg pills would put me to sleep within a quarter hour. I took it for about a week and slept 16+ hours or more each day.

I still have the 25 mg pills for use as sleeping pills or for anxiety flare-ups, but I rarely rarely take them. I actually chipped off about a 1/4 of a pill Christmas morning because I was a shaky mess (I think I had too much caffeine Christmas eve and couldn't sleep all night...) and it turned me into a zombie. I honestly can remember almost nothing about the first half of the day. And I was so sleepy and cranky for the rest of the day it was pretty awful.

I hope it works better for you! I would echo what MeghanC says about not dancing around with doses forever if you get the strong impression out of the gates that it's not working for you, though. I've been on 4-5 different meds and it's usually pretty clear to me fairly early on whether they're going to work, like there is a difference between a jangly side effect that just has to work itself out (or be gotten used to) and something that is just plain wrong.
posted by looli at 10:14 PM on December 29, 2011

A family member was on Seroquel for several years. The weight gain was a big problem, the tiredness less so. But it worked - gave good control over the psychosis. Once things got better, the psychiatrist gradually lowered the dose and then took them off the Seroquel. Still hasn't lost the weight (and now has weight related health problems.)
posted by metahawk at 12:30 AM on December 30, 2011

Nthing the sleeping and massive wanting to EAT ALL THE FOOD issues. By the time I was yanked off it, I was on 600mg a day. It didn't give me more restful sleep or really help with the mood issues either.
posted by sperose at 6:00 AM on December 30, 2011

I have been taking 150XR every day for the better part of a year, I think.

I started on it at a time when my temper was starting to worsen, which I didn't like, and it nipped that in the bud pretty much.

To me it feels like a good mood stabilizer, but not my miracle drug--anxiety remains. I get some mild to moderate grogs in the morning, but I can usually blame that on not taking my pill early enough the night before. Other than that, no side-effects that I have noticed. Though, sometimes it's difficult to parse effects and side-effects when you've had that sort of endless menagerie of drugs coursing through your brains that you get on the journey to the right meds.
posted by TheRedArmy at 8:21 AM on December 30, 2011

I've been on 50mg XR for depression (along with Effexor) for a couple years. Yes, it can make me sleepy (along with a couple other drugs that can make me sleepy), but I take at night as advised by my doctor. I sleep ten to 12 hours per night, two hours of which started after taking the Seroquel*. It hasn't made me gain weight (I'm already overweight). I'm also diabetic, so no fears on that end, ha!

My advice is to take the Seroquel at night and weigh yourself once a week to see if you are gaining weight. If that bothers you talk to your doc about other options. Regarding the anemia - also talk to your doc about that. Are you female? You might try taking an iron supplement during your period. You can overdose on iron so be careful whatever is decided.

*In spite of this I also have occasional bouts of insomnia, go figure.
posted by deborah at 8:00 PM on December 30, 2011

Seroquel has been a wonder drug for me, but it did mean about 60 lbs of weight gain.
posted by soft and hardcore taters at 11:04 AM on December 31, 2011