Current medication-Quetiapine 200mg at Night.
Quetiapine is prescribed for schizophrenia. It is known as a second generation antipsychotic (SGA) or atypical antipsychotic. Quetiapine is used to rebalance dopamine and serotonin to help improve thinking, mood, and behavior.
Quetiapine is also FDA approved for the following indications: Acute treatment of manic episodes of bipolar disorder. Acute treatment of depressive episodes of bipolar disorder. Maintenance (long-term) treatment of bipolar disorder (when used alone or with lithium or valproate) Adjunctive treatment of major depressive disorder. This means quetiapine is used in addition to an antidepressant to help treat depression.
Summary-I was prescribed Seroquel/Quetiapine in approx 2000. Before Quetiapine I had been prescribed Risperidone. Between the years of my first diagnosis 1996 to 2000, my weight had increased from approx 94kg to my heaviest at 162kg. I had also been diagnosed with type 2 diabetes.
My perspective. I can not say my experience with Risperidone was positive. Unfortunately it worked against me in many ways and I often remarked the side effects were like having to deal with a separate illness in themselves. It took some time for me to be offered different medication. When I challenged my psychiatric nurse about my experiences with risperidone, I was lead to believe the experiences were related to my symptoms of schizophrenia. At no time can I recall being told about ‘side effects’ of medication from any person related to the mental health services. Eventually my GP approached the mental health team because of my huge weight gain and I was offered the chance to try Quetiapine.
Experiences with Risperidone. Huge weight gain. Constant nightmares. Memory loss. Parkinson like symptoms. Painful muscle cramps. Dry mouth. Diabetes. Difficulty with sleeping. Restlessness and Agitation.
Quetiapine-I was prescribed 200mg in the morning and 400mg in the evening. I can not say to this day that it helped with any symptoms of my diagnosis but I believe the sedation effect at night has helped me. Once Risperidone was removed, within weeks the nightmares ceased and good sleep was regained. This in itself helped me immensely, and I began to find strength to deal with life and start to focus on my future.
Over a short period of time, all the other disastrous side effects from Risperidone faded and I began to feel in control again. I began to exercise and focus on losing the immense weight I had gained.
I believe Quetiapine did not deal with any symptoms of my diagnosis directly. I dealt with that, by dissecting my own thoughts and learning to understand me, but Quetiapine did ‘quieten my mind’ and offer balance, in a way that suited me and gave me the strength to deal with myself.
My mind has always been very active, replaying conversations or images I have seen during the day and I was unable to switch off. Taking Quetiapine at night helped me to sleep well, and so I could rest from a very active mind and imagination. It offered me the resilience to recover from my experiences and fears.
Information-Wikipedia and NAMI (National Alliance on Mental Illness)
Quetiapine has the following pharmacological actions:
- D1 (IC50 = 1268nM), D2 (IC50 = 329nM), D3, and D4 receptor antagonist
- 5-HT1A (IC50 = 717nM), 5-HT2A (IC50 = 148nM), 5-HT2C, and 5-HT7 receptor antagonist
- α1-adrenergic (IC50 = 94nM) and α2-adrenergic receptor (IC50 = 271nM) antagonist
- H1 receptor (IC50 = 30nM) antagonist
- mACh receptor (IC50 = >5000nM) antagonist
This means Quetiapine is a dopamine, serotonin, and adrenergic antagonist, and a potent antihistamine with clinically negligible anticholinergic properties. Quetiapine binds strongly to serotonin receptors; the drug acts as partial agonist at 5-HT1A receptors. Serial PET scans evaluating the D2 receptor occupancy of quetiapine have demonstrated that quetiapine very rapidly disassociates from the D2 receptor. Theoretically, this allows for normal physiological surges of dopamine to elicit normal effects in areas such as the nigrostriatal and tuberoinfundibular pathways, thus minimizing the risk of side-effects such as pseudo-parkinsonism as well as elevations in prolactin. Some of the antagonized receptors (serotonin, norepinephrine) are actually autoreceptors whose blockade tends to increase the release of neurotransmitters.
Norquetiapine is the active metabolite of quetiapine. It has most of the effects of quetiapine with similar potencies, and is also a potent norepinephrine reuptake inhibitor and muscarinic antagonist. Note that the data below is from another source (the official prescribing info for Seroquel), and the measure is different from the above (Ki vs. IC50). There are still order-of-magnitude discrepancies for D1, α1, H1 and M1.
Common Side Effects
Low blood pressure, feeling dizzy, and/or increased heart rate, especially when standing up
Fatigue, sedation, dry mouth, agitation, increased appetite, constipation
Rare Side Effects
Quetiapine may increase the blood levels of a hormone called prolactin. Side effects of increased prolactin levels include females losing their period, production of breast milk and males losing their sex drive or possibly experiencing erectile problems. Long term (months or years) of elevated prolactin can lead to osteoporosis, or increased risk of bone fractures.
Serious Side Effects
Some people may develop muscle related side effects while taking quetiapine. Symptoms include restlessness, tremor, and stiffness. TD symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.
Second generation antipsychotics (SGAs) increase the risk of weight gain, high blood sugar, and high cholesterol. This is also known as metabolic syndrome. Your healthcare provider may ask you for a blood sample to check your cholesterol, blood sugar, and hemoglobin A1c (a measure of blood sugar over time) while you take this medication.
SGAs have been linked with higher risk of death, strokes, and transient ischemic attacks (TIAs) in elderly people with behavior problems due to dementia.
All antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular heart beat). To minimize this risk, antipsychotic medications should be used in the smallest effective dose when the benefits outweigh the risks. Your doctor may order an EKG to monitor for irregular heart beat.
Neuroleptic malignant syndrome is a rare, life threatening adverse effect of antipsychotics which occurs in 1% of patients. Symptoms include confusion, fever, extreme muscle stiffness, and sweating. If any of these symptoms occur, contact your healthcare provider immediately.
Are there any risks of taking Seroquel for long periods of time?
Tardive dyskinesia (TD) is a side effect that develops with prolonged use of antipsychotics. Medications such as quetiapine have been shown to have a lower risk of TD compared to older antipsychotics, such as Haldol® (haloperidol). If you develop symptoms of TD, such as grimacing, sucking, and smacking of lips, or other movements that you cannot control, contact your healthcare provider immediately. All patients taking either first or second generation antipsychotics should have an Abnormal Involuntary Movement Scale (AIMS) completed regularly by their healthcare provider to monitor for TD.
Second generation antipsychotics (SGAs) increase the risk of diabetes, weight gain, high cholesterol, and high triglycerides.