Quetiapine dose increase
November 30, 2012 7:36 AM   Subscribe

Mental health medication - Quetiapine (aka Seroquel, Xeroquel, Ketipinor) dosage for Depression, Anxiety and Cyclothymia/Bi-polar. I take a low (75mg) dose and my Dr is pushing for 200mg to 300mg... is being scared a good enough reason to resist trying? Does anyone have experience of this kind of treatment plan?

I take Duloxetine (aka Cymbalta, Ariclaim, Xeristar, Yentreve, Duzela) 60mg and Quetiapine 75mg currently. The Duloxetine has been very effective over the last 18 months and has helped me recover well from a extended suicidal (and generally very bleak) time in my life. I have since become a father and am working with my wife to address my periods of "elated mood" (maybe every 2 months currently) and infrequent bouts of mania (maybe every 2 to 3 years throughout my life). During these infrequent periods of mania I act very irresponsibly (normally in terms of finance and travel) and we don't think I could look after a child if it happened again.

My psychiatrist has given me 75mg Quetiapine as a trial dose, I have been on this for 3 months I can really feel a difference, and think I may be more stable as a result. I am certainly less depressed and anxious. He, however, tells me that this is not a therapeutic dose and that I will still be prone to mania and my more general Cyclothymic problems. He wants to increase my dose to 200 (in 25mg steps) and then perhaps 300mg after that. I feel very afraid that 75mg has already changed how I feel and my sense of "me". 200mg seems a big jump again.

So my question would be - is the increased dosage really as big as it feels to me? Will it "just" alter my mood, or is my sense of self going to be affected too.

Unfortunately my mental health nurse (with whom I do therapy and CBT) is provided by the same office as my psychiatrist, so her well reasoned attempts to get me to at least try the new dose aren't convincing as I can't see her as independent.
posted by anonymous to Health & Fitness (12 answers total) 1 user marked this as a favorite
I don't have personal experience, but it sounds bull. I would generally (IANYTherapist) say that mania would be triggered by the depressive periods... if you're feeling better, then you're addressing the cause. Sure, it *could* happen -- but you know yourself. If you feel it's been successful, why change?
posted by DoubleLune at 7:41 AM on November 30, 2012

Quetiapine in my opinion is a horrible drug - it is known for weight gain and I felt like I had been shot by a horse tranquilizer the entire time I was on it. Another side effect is seizures - my husband observed me having seizures while I was sleeping. At that point I discontinued the drug.

You are receiving non-standard treatment for cyclothymia. The treatment protocol varies by region. However, first line treatment should be a mood stabilizer of some description. Where I live now it's lithium, where I lived previously it was lamotrigine (Lamictal). I take Lamictal now, augmented with klonopin for sleep, and I have been stable for years.

The discussion to have with your doctor is why you have non standard treatment for a cyclic mood disorder with manic features. Perhaps get a second opinion. I really think they are doing you a disservice by not offering mood stabilizers.
posted by crazycanuck at 7:44 AM on November 30, 2012 [2 favorites]

You have the right to refuse. IANAD, but work with and have family members in the metal health system. If I where you, and this is NOT meant to replace medical advice, or meant to be any advice other than personal preference, I would assert you will remain on the current dosage and only if symptoms persist or increase will you consider increasing the dosage. Given that Cyclothymia is subthreshold bi-polar maybe (and that is a big maybe) a lower dose will be all you need.

Having said that, they may well be correct that true therapeutic dosages for you would be closer to the 200-300mg range, it generally seems to be for bi-polar symptoms at least.

(Seroquel is called an atypical antipsychotic but is fairly standard treatment for bi-polar and Cyclothymia as well I think - Nothing non standard there)
posted by edgeways at 8:17 AM on November 30, 2012 [1 favorite]

say that mania would be triggered by the depressive periods

I am also not a mental health professional, but this is not my understanding of mania at all. You really, really need to talk to your mental health professionals about this. Here are some questions to ask:

- If you go up to the recommended dose and you dislike the side effects or don't feel like yourself, can you try something else?

- If you go up to the recommended dose and you dislike the side effects or don't feel like yourself and do switch to something else / go back down, how long will it take for the medication to leave your system (so you feel better again)?

- What other medications are available? Why is your doctor suggesting this particular medication? (I believe some of other options to treat bipolar disorder are lithium, Abilify and Lamictal, although I have zero idea if any of those are appropriate for you).

For what it's worth, I know someone who was one several hundred mg of Seroquel a day for bipolar disorder, she did not have any weight gain, she felt like herself, it worked well for her. That's anecdotal; Seroquel doesn't work for everyone, it might not work for you. It is a medication that affects people very differently - I know a lot of people use it as a sleeping aide and fall asleep on 12.5 - 25mg dose; I tried it as a sleep aide (prescribed, of course), and even at 100+mg it didn't help at all.

Remember that if you try a medication and it doesn't work for you, you can stop taking it (under your doctor's supervision).
posted by insectosaurus at 8:21 AM on November 30, 2012 [2 favorites]

First of all, this is an excellent article by Metafilter's Own (tm):
The Most Important Article on Psychiatry You Will Ever Read
and it deals with quetiapine and dosages specifically.

I've been on quetiapine for the last couple of months and it has given me my life back. I can't speak to weight gain -- it's been weight neutral for me, but I also exercise nearly every day and watch what I eat, and my doctor said he was not concerned about that aspect of it for me.

I have had the experience that it did not control the hypomania until we started getting around 300 mg total daily for me. Lower doses were sedating and helped me sleep very well, but I was still having anxiety and hypomania (both of which are super un-fun while you're sedated).

200 or 300 are both really low doses relatively for using quetiapine for bipolar disorder [edit: as monotherapy; I don't know about in combination with other drugs]. As you'll learn in the article above, it functions mainly as an antihistamine until you get around 300 mg, at which point it begins to behave like an antipsychotic.

Ultimately it's up to what you will tolerate; I'm tolerating wicked dry mouth, sedation, constipation, occasional tiny hallucinations out of the corners of my eyes, and I'd probably tolerate one of my toes falling off, quetiapine has so changed my life for the better. I was/am a little spooked about the weight gain/diabetes/QT interval stuff, but on the whole, I will keep being careful, and the benefits (not crying all the time, not hypomanic either) are worth the vigilance for me. YMMV.
posted by fiercecupcake at 8:56 AM on November 30, 2012 [1 favorite]

(Oh, and I forgot to address this: my sense of self is plenty intact. I feel more like myself than I have in at least a year. Myself, minus the horrible mood swings and crying jags and insecurity and anxiety. I was just thinking about this last night. It's like I got handed my life back.)
posted by fiercecupcake at 8:59 AM on November 30, 2012

I am not your nurse, but I am *a* nurse, and have some experience with patients taking this class of medication. All medications have side effects, and I think it's natural for you to feel some anxiety about increasing your dose, but 200mg a common, reasonable, therapeutic amount of quetiapine for someone with a mood disorder. Your provider is approaching the dosing correctly (starting lower and titrating up), so feel confident about that, as well as the fact that you are perceiving some benefit from 75mg. I predict that at 200mg you will have a good chance at feeling some lasting benefit, and if you are troubled by side effects you can either a)hang on for a bit, keeping in mind that side effects are not MAIN effects, and may well pass, or b)ask for help decreasing dosage and/or stopping the medication.

It's worth it to pursue this. It takes some trial and error, but it's worth it when a person finds a medicine or combination of medicines that help them feel and function better. You owe it to yourself, your wife and your child to find a way to avoid subsequent periods of mania and hypomania. I wish you luck.
posted by little mouth at 9:02 AM on November 30, 2012

Two more things you may have already found, but if not, they could be useful:
Seroquel overview at Crazy Meds
Seroquel forum at Crazy Meds
posted by fiercecupcake at 9:25 AM on November 30, 2012

When it comes to bipolar disorder, antipsychotics are best suited for treating acute mania. They can also be used for maintenance treatment, but the data supporting this use is pretty limited. The dose for quetiapine can be pushed as high as 800mg/day if necessary, but antipsychotics are not very well tolerated drugs in terms of side effect profile, so risk/benefit must always be considered. My own view is that, for just about every condition but schizophrenia, there are better options available.

Studies like STEP-BD have found no evidence to support antidepressant efficacy for bipolar disorder. At best, they are second- or third-line agents. SNRIs like duloxetine are particularly problematic—some clinicians believe they have a greater likelihood of precipitating mania compared to SSRIs.

Lithium and/or a mood stabilizer like valproate would be a better choice, but I am not a doctor, and I'm especially not your doctor. I don't know the details of your problem, your health/family history, your response to prior medications, etc, etc. If you really have doubts, you should consider getting a second opinion from another psychiatrist.
posted by dephlogisticated at 9:33 AM on November 30, 2012

I'm on 200mg. It makes me sleep a lot more than I used to which can be a problem, but other than that it's great. I was on 300mg for a while, which I found a little zombiefying, but since lowering the dosage I've felt fine.
posted by Chenko at 10:58 AM on November 30, 2012

This may be a left fielder, but you mention becoming a father. Do you have a new baby? When my son was a newborn and I was having a hard time, my (bad) provider tried to throw a scary array of drugs at me.

I would advise not going along with anything that sets off alarm bells for you.
posted by gentian at 3:53 PM on November 30, 2012

Medications can really have different effects on different people and psychiatric meds more so than most. I'm a bit shocked that people are feeling like they can tell you what would be the best drug for you. Certainly there are other options but I would take generalizations like this from the interwebs with a grain of salt.
posted by treehorn+bunny at 3:28 PM on December 1, 2012

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