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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by UgottaHaveHOPE on April 26, 2006, at 18:31:04
Please help me. I take 200mg of Seroquel for anxiety. Lately I have had some major stressors in my life and 200 is not calming me down. How much could I go up to? And when is the best time to take the doses?
Posted by calmchaos on April 26, 2006, at 19:30:30
In reply to Help with Seroquel, posted by UgottaHaveHOPE on April 26, 2006, at 18:31:04
> Please help me. I take 200mg of Seroquel for anxiety. Lately I have had some major stressors in my life and 200 is not calming me down. How much could I go up to? And when is the best time to take the doses?
I just found out about this message board/experiment and I think its a good idea. Anyway I am also on seroquel and the anti-depressant lexa-pro. I take only one 25mg dose of seroquel in the morning then before i go to bed I take three twenty five mg tablets. Anyway back to your question. I found this info out on this web site its very detailed and should help you out. http://www.rxlist.com/cgi/generic2/quetiap_ids.htm
DOSAGE AND ADMINISTRATION
Bipolar ManiaUsual Dose: When used as monotherapy or adjunct therapy (with lithium or divalproex), SEROQUEL should be initiated in BID doses totaling 100 mg/day on Day 1, increased to 400 mg/day on Day 4 in increments of up to 100 mg/day in BID divided doses. Further dosage adjustments up to 800 mg/day by Day 6 should be in increments of no greater than 200 mg/day. Data indicates that the majority of patients responded between 400 to 800 mg/day. The safety of doses above 800 mg/day has not been evaluated in clinical trials.
Schizophrenia
Usual Dose: SEROQUEL should generally be administered with an initial dose of 25 mg bid, with increases in increments of 25-50 mg bid or tid on the second and third day, as tolerated, to a target dose range of 300 to 400 mg daily by the fourth day, given bid or tid. Further dosage adjustments, if indicated, should generally occur at intervals of not less than 2 days, as steady state for SEROQUEL would not be achieved for approximately 1-2 days in the typical patient. When dosage adjustments are necessary, dose increments/decrements of 25-50 mg bid are recommended. Most efficacy data with SEROQUEL were obtained using tid regimens, but in one controlled trial 225 mg bid was also effective.
Efficacy in schizophrenia was demonstrated in a dose range of 150 to 750 mg/day in the clinical trials supporting the effectiveness of SEROQUEL. In a dose response study, doses above 300 mg/day were not demonstrated to be more efficacious than the 300 mg/day dose. In other studies, however, doses in the range of 400-500 mg/day appeared to be needed. The safety of doses above 800 mg/day has not been evaluated in clinical trials.
Dosing in Special Populations
Consideration should be given to a slower rate of dose titration and a lower target dose in the elderly and in patients who are debilitated or who have a predisposition to hypotensive reactions (see CLINICAL PHARMACOLOGY). When indicated, dose escalation should be performed with caution in these patients.
Patients with hepatic impairment should be started on 25 mg/day. The dose should be increased daily in increments of 25-50 mg/day to an effective dose, depending on the clinical response and tolerability of the patient.
The elimination of quetiapine was enhanced in the presence of phenytoin. Higher maintenance doses of quetiapine may be required when it is coadministered with phenytoin and other enzyme inducers such as carbamazepine and phenobarbital (See Drug Interactions under PRECAUTIONS).
Maintenance Treatment
While there is no body of evidence available to answer the question of how long the patient treated with SEROQUEL should remain on it, the effectiveness of maintenance treatment is well established for many other drugs used to treat schizophrenia. It is recommended that responding patients be continued on SEROQUEL, but at the lowest dose needed to maintain remission. Patients should be periodically reassessed to determine the need for maintenance treatment.
Reinitiation of Treatment in Patients Previously Discontinued
Although there are no data to specifically address reinitiation of treatment, it is recommended that when restarting patients who have had an interval of less than one week off SEROQUEL, titration of SEROQUEL is not required and the maintenance dose may be reinitiated. When restarting therapy of patients who have been off SEROQUEL for more than one week, the initial titration schedule should be followed.
Switching from Antipsychotics
There are no systematically collected data to specifically address switching patients with schizophrenia from antipsychotics to SEROQUEL, or concerning concomitant administration with antipsychotics. While immediate discontinuation of the previous antipsychotic treatment may be acceptable for some patients with schizophrenia, more gradual discontinuation may be most appropriate for others. In all cases, the period of overlapping antipsychotic administration should be minimized. When switching patients with schizophrenia from depot antipsychotics, if medically appropriate, initiate SEROQUEL therapy in place of the next scheduled injection. The need for continuing existing EPS medication should be reevaluated periodically.
Posted by med_empowered on April 26, 2006, at 20:45:56
In reply to Re: Help with Seroquel » UgottaHaveHOPE, posted by calmchaos on April 26, 2006, at 19:30:30
I'm kind of concerned a) that you're taking an antipsychotic for Anxiety--even taking it for a mood disorder is a bit of a stretch and b) that you're up to 200mgs already--that's approaching full neuroleptic-level D2 blockade dosing. Personally, I think you should try a benzo or Lyrica or BuSpar or a different, anticonvulsant mood stabilizer (trileptal, depakote)..the risks of antipsychotic treatment for non-psychotic disorders aren't justifiable, given the safer available alternatives.
Posted by UgottaHaveHOPE on April 26, 2006, at 23:03:33
In reply to Re: Help with Seroquel, posted by med_empowered on April 26, 2006, at 20:45:56
What is the difference between Seroquel and Depakote?
I took just 25mg of Seroquel for the longest time, and then things just kind of got out of hand recently.
Posted by med_empowered on April 27, 2006, at 2:09:08
In reply to Re: Med-empowered ... Q, posted by UgottaHaveHOPE on April 26, 2006, at 23:03:33
hi! Seroquel is a "neuroleptic" ((a term that means "to seize the nerves"))--in the US, "neuroleptics" are usually called either "antipsychotics" or "major tranquilizers". There are old ones (like, say, Thorazine or Haldol or Trilafon) and new ones, like Seroquel, Zyprexa, Risperdal, Abilify, Geodon, Clozaril, etc. The old ones have a bad reputation for causing problems like movement disorders (they induce a sort of brain damage that results in "tardive dyskinesia," a persistent set of uncontrallable, involuntary movements, usually of the face, that can persist years after meds are withdrawn).
The new antipsychotics cause TD less often ((probably)) than the old ones, although there is still a risk w/ all of them except maybe Clozaril. So, Seroquel could cause TD.
Seroquel and other antipsychotics work by blocking off dopamine, specifically D2 receptors. Basically, your body is still pumping out dopamine, but the seroquel blocks the receptors, so your brain doesn't pick as much of it up. The old antipsychotics ((Thorazine, etc.)) worked mostly or entirely on these D2 receptors and blocked them TIGHTLY: at usual doses, 80+% of these receptors were blocked. The newer ones tend to block off 60-80%, causing fewer side effects.
The newer antipsychotics also work on serotonin, and block off some receptors there, too...this may be what makes them more helpful for anxiety than older drugs.
Here's the problem: when you block off D2 receptors, your brain will adapt by sprouting new ones; the result can be a need for ever-increasing amounts of the drug to achieve the same results. Also...the antipsychotics can often make anxiety **worse** and sometimes their primary "anti-anxiety" effect is actually just generalized sedation--one reason Seroquel is RX'd so much for anxiety is that it is so heavily sedating. Sounds good, until you realize LOTS of drugs are heavily sedating--Benadryl, for instance--without having any real anti-anxiety effect.
Now for Depakote...
Depakote is an anticonvulsant--it was developed and designed for various forms of seizure disorders. It seems to work on GABA, boosting levels in the body ((among other things...)). It can also cause liver problems, hormonal imbalances, and hair loss. People on Depakote will need to have blood work done, usually every 3months or so ((I think)). Depakote does not cause movement disorders, and may be helpful with panic and anxiety ((because of its effects on GABA)). Since it has a "taming" effect, it may reduce aggression and hostility (kind of like a neuroleptic).
So...there you have it. Here's a good analogy:
Imagine that that your brain is a stereo, pumping out music. If you take an antipsychotic, its like using earplugs--you're basically blocking out a lot of the music, but its still playing. A mood-stabilizer, like depakote, works to turn down the volume overall.
I hope this helps.
Posted by calmchaos on April 27, 2006, at 6:49:58
In reply to Re: Med-empowered ... Q, posted by UgottaHaveHOPE on April 26, 2006, at 23:03:33
> I took just 25mg of Seroquel for the longest >time, and then things just kind of got out of >hand recently.
The drug trails that were done for seroquel I think lasted for the most, 6 weeks. So do we really know if seroquel will still do the job a year later? Latley I have felt a bit more anxious then I normally do so I wondering if I will have to switch to something else a few months down the road. Some people cant be prescribed benzos for there anxiety because they might be a recovering addict. Plus if you take benzos and want to come off it you might need medical attention because of the seizures that go along with withdrawl.
Posted by Caedmon on April 27, 2006, at 8:40:35
In reply to Help with Seroquel, posted by UgottaHaveHOPE on April 26, 2006, at 18:31:04
> Please help me. I take 200mg of Seroquel for anxiety. Lately I have had some major stressors in my life and 200 is not calming me down. How much could I go up to? And when is the best time to take the doses?>
Hi, what type of anxiety? It sounds to be sort of general anxiety, correct? BTW I think Seroquel can work well for certain anxiety patients and it probably carries similar risks for metabolic syndrome as Depakote.
- C
Posted by UgottaHaveHope on April 28, 2006, at 10:45:04
In reply to Re: Help with Seroquel » UgottaHaveHOPE, posted by Caedmon on April 27, 2006, at 8:40:35
Yes GAD. Do you have it, too? What is your story?
Posted by Caedmon on April 28, 2006, at 16:06:18
In reply to Re: Caedmon, posted by UgottaHaveHope on April 28, 2006, at 10:45:04
> Yes GAD. Do you have it, too? What is your story?
I have some anxiety as part of my depression and I have social anxiety. I generally don't ascribe any other diagnoses to myself than those two because it just makes my life simpler that way. :)
- C
Posted by Karla on April 30, 2006, at 20:02:53
In reply to Help with Seroquel, posted by UgottaHaveHOPE on April 26, 2006, at 18:31:04
I take 250mg of seroquel and 30mg of abilify for schiziphrenia. I take 150mg of effexor for depression. I take 1-4 mg a day of xanax for social anxiety. I would recomend a benzo such as xanax for anxiety that is what there made for.
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