Another quetiapine thread.. Sorry!

I have rapid cycling type 2 (which is currently being questioned as type 1 due to some recent factors which I won't go into too much detail about right now). Anyway I'm heading high again (sigh) only this time with terrible psychotic symptoms. Paranoid Delusions (apparently.. Although I still fully believe there is basis to my worries but that's a whole other story) and hallucinations consisting mostly of masked figures standing at my windows

Anyway I raised my concerns with my cpn, Im already on lamotrigine as my mood stabilizer which appears to be helping but clearly not working to it's full potential otherwise I fail to understand why I'm high and psychotic! I take lorazepam on an as and when need basis, and my pdoc and cpn have discussed all this crap that's going on and have put me on quetiapine (the instant release) 25mg twice daily.. Not to be titrated.

This seems so bizzare to me.. For starters we tried quetiapine initially as a mood stabilizer at 150mg titrated up to 600mg (this didn't go well, infact I almost ended up in hospital due I a bad reaction on the final increase) this was the very first psychiatric medicine id tried. Apparently though this time around they're aiming to just ease the psychosis and tame the anxiety that's gong with it.

So here's my questions (if you've got this far without getting lost as I'm not sure how much sense I'm making) a) would 25mg twice daily even do buggar all?
B) why no titrating because all I can't find is info of 25mg solely being a starting dose.
C) will it still have the same doped up effect the higher doses have and the terrible Seroquel hangover feeling in the morning at the lower dose?

Really hope someone has some insight xx

Hi Gemmaleanne,

I'm sure you're really suffering with your mood going high at the moment, and the psychotic symptoms especially. I certainly know how frightening and disorientating they can be.

I was on Quetiapine myself until a couple of months ago, but I started on that because of a mixed episode which didn't include psychotic features (essentially my mood was fluctuating wildly from depressed, baseline and hypomanic on a daily basis). I first titrated up to 300mg within 4 days, and it really settled everything down quickly.

Unfortunately, I don't have any personal experience of it treating bipolar mania. In the past, I've been on Olanzapine and Risperidone for my mania and psychosis, and found Olanzapine in particular to be very effective and fast acting.

I'd get an appointment with your psychiatrist as soon as you can to discuss the Quetiapine dosage if I were you. From a quick search online, apparently the most effective dose for bipolar mania is between 400 and 800mg per day, but obviously only your psychiatrist is able to advise on this, especially as you've already had some adverse effects from Quetiapine in the past.

As for the sedation, I admit I found it a very sedating medication at whatever dose (I got up to 500mg at one point). However, everyone reacts differently to it and this is difficult to predict. For me personally, I've found all the antipsychotics I've taken to be sedating but ultimately worth it to bring down the higher moods or mixed states once the right dosage is found.

I hope you get the answers you need and manage to sort out your treatment soon. Take care.

Hey

Sorry to hear you are not doing well.

I was on 800mg of quetiapine at one point but am currently on 150mg. In terms of your questions I have some thoughts.

Gemmaleanne wrote:would 25mg twice daily even do buggar all?

Everyone is different so I think it is a case of suck it and see here. It does seem like a small dose but I am not a professional and it might be that it does help you - I think it might be god to chart your symptoms so you can objectively see if it is making a difference (and also to make sure you dont have a bad reaction to it).

Gemmaleanne wrote:why no titrating because all I can't find is info of 25mg solely being a starting dose.

This I am not sure about- perhaps it is because they wont keep you on it for long? I think it would be worth asking your Dr about the reasoning here.

Gemmaleanne wrote:will it still have the same doped up effect the higher doses have and the terrible Seroquel hangover feeling in the morning at the lower dose?

Quetiapine is weird and is said to be more sedating at lower doses - I believe this is the case up to about 300mg so yes it might sedate you. Having said that I feel more sedated on the 150mg I am on now than when they restarted it at 25mg. Again i think it is going to be a case of wait and see. hopefully it wont be too bad for you but I def think monitoring this is important.

If it does not suit you perhaps discuss other options with your dr?

Cracked

Thankyou for your replies!

I start the quetiapine tonight, very apprehensive but that's understandable considering my previous experience with the drug. My psych is completely useless so iv given up discussing things with him, he wrote on the prescription 25mg bd, but also put prn underneath which just confused the bejeebers out of me so I rang my cpn, she said to take it with my morning and evening meds, and that the idea is that it'll help smooth out the bumps, relieve some anxiety and hopefuly give some relief to the psychotic symptoms. She said that the hope is that it will have a similar effect on me as the lorazepam does, but that it will be less habit forming, and that hopefully with a little time I won't need the lorazepam anymore. It seems the quetiapine is going to be an ongoing part of my medication for Atleast the time being anyway, although she said it may need to be increased slightly if it doesn't calm some of the psychotic effects.

It seems their concerns are that with me being a rapid cycler they have no idea wether tomorrow I could wake up depressed again, they're keener on getting my mood stabilizer optimised and just minimising and other unpleasant issues rather than gong all out with longer treatment plans. Which I agree to to a extent, but really wish they could see it from my vunerable point of view, it's me who's experiencing the terrifying psychotic issues not them.

Also had my PIP assesment today, that was horrible. Have been left very anxious and it's not had a good effect on my racing thoughts and paranoia. Dreading going to bed tonight x

Hi

I hope the quetiapine does the trick. It would be good not be be on the benzos long term if you can help it tho I know that lorazepam can be really helpful at times. See how it goes I guess. hope it goes well.

Sorry to hear the PIP assessement was difficult. I am not looking forward to having to be reassessed for mine -I think in 2015 as still on DLA.

Take good care of yourself

Hugs

Cracked

If im not doing good. I can take 10 to 50mg during day and it helps. I take 100mg before bed, when not stressed it knocks me out. If im stressed out i suffer thru the quetiapine hitting my system.