Seroquel (quetiapine)

US Brand Name: Seroquel
Seroquel’s Generic Name: quetiapine fumarate
What is Seroquel: An Antipsychotic, specifically an atypical antipsychotic
Read up on these sections if you haven’t done so already, because they cover a lot of information about multiple medications that I’m not going to repeat on many pages. I’m just autistic that way about not repeating myself.
FDA Approved Uses of Seroquel – Seroquel is officially prescribed for:
Schizophrenia (Efficacy of Seroquel in three trials, in addition to what’s in the PI sheet) – approved September 1997.
Bipolar mania (One year vs. unnamed mood stabilizer, plus PI sheet data) – approved 13 January 2004 for acute bipolar mania, as both monotherapy (taken all by itself) and to be used in combination with lithium and Depakote (divalproex sodium) to treat bipolar mania.
In August of 2004 Seroquel (quetiapine fumarate) received approval for 12-week treatment of bipolar disorder.
Some Other, Off-Label Uses of Seroquel – Seroquel is also prescribed to treat the following, but without official approval:

Anxiety. Children with Tourette’s disorder. (Sorry adults, no one seems to care.)
Autism. (Loser! Didn’t do squat, and the kids hated it. Same in this study.)
Obsessive-Compulsive disorder (OCD) (augmenting an SSRI).
Alcoholism. 
Treating tardive dysdinesia.
Treatment-resistant (refractory) major depressive disorder (augmenting a variety of antidepressants in this study, showing how the combination works in the real world, it’s just a matter of finding the right cocktail for you).
Parkinson’s Disease symptoms. (Just the most recent of a buttload of studies out there on Seroquel and Parkinson’s)
Insomnia (the only study I could find, but Seroquel totally rules for insomnia.)
Click on the links to see the various trials, studies and case reports for approved and off-label uses.

Seroquel’s pros and cons:
Pros: If you’re agitated, jumping out of your skin and you just can’t sleep, then Seroquel (quetiapine fumarate) might be just what you’re looking for. At least, if your doctor recommends you try it and you feel like that, you probably should. As the mildest of all antipsychotics it doesn’t really carry the “antipsychotic” stigma as heavily as the other meds. Doesn’t mess with your prolactin as much as any other atypical antipsychotic. Also the least likely to cause EPS and TD.

Cons: You’ll sleep until next Tuesday. Of course, that could be a good thing, depending on how your life is at this moment. Other than the sleep thing, it takes longer than any other atypical antipsychotic to work. You might come down with type 2 diabetes. You’ll probably gain weight. But those things are going to be issues only if you take Seroquel (quetiapine fumarate) at medium-to-high dosages for a long time. Except for the sleeping – that’s more of a low-to-medium dosage thing from day one.

Chances Seroquel Will Work, How Seroquel Compares to Other Meds, and How Seroquel Works
Odds of Seroquel working for all forms of schizophrenia – pretty damn good. Expect to see relief from symptoms within a week or two.

Odds of Seroquel working for bipolar mania – OK, I guess. There aren’t many studies out there with Seroquel (quetiapine fumarate) as the only med used to treat bipolar disorder. As far as the anecdotal evidence goes, people are reasonably satisfied with this med when it does work for bipolar mania. It does do a good job at boosting an antidepressant’s effect on the depression side of things and often can work as a stand-alone mood stabilizer, dealing with both mania and depression, despite being approved to treat only mania. While I think Seroquel (quetiapine fumarate) is best suited as an add-on for bipolar disorder where sleep and/or anxiety and/or agitation are secondary issues, I’m just not too big on antipsychotics as monotherapy (i.e. the only med you take) for bipolar disorder. But it does alone work to stabilize a lot of people. If anticonvulsants don’t do it for you, Seroquel can be your med in the long run.

Odds of Seroquel working for panic / anxiety disorders – really good. Atypical antipsychotics aren’t front-line meds for panic / anxiety, but they work really well for some forms of the disorders. Since Seroquel (quetiapine fumarate) is the mildest of the atypical antipsychotics, and is the best at helping you sleep, it’s probably the best one in the class to try first for panic / anxiety. Barring any other symptoms that indicate trying one of the others, of course.

Odds of Seroquel working for sleep disorders – dude, if you can’t sleep, ask your doctor about Seroquel (quetiapine fumarate). Seriously. AstraZeneca really needs to be doing some heavy clinical trials for a rebranded version to compete with Ambien as a less messed-up sleep aid for the mentally interesting. Not that they will, it’s just what they should be doing. Seroquel isn’t right for everyone (e.g. people with seizure disorders), but it sure is hell a lot better, and more effective, than other sleep aids for us nut jobs.

Odds of Seroquel working for depression – apparently it’s pretty good for depression, but I can’t tell yet if it’s better for bipolar depression than unipolar depression. It looks like it’s OK for unipolar depression, but better for bipolar, schizoaffective and schizophrenic depression.

Now for the details as to how I arrived at the above odds. Mostly it’s from anecdotal evidence gathered from various online support groups I monitor, user ratings and comments at Remedy Find, experiences people send to me via e-mail and summaries of efficacy from the books in the references at the end of this page. Additionally there are these trials and studies from the PI sheet and that I found through Pub Med:

For schizophrenia efficacy was established in 3 short-term (6 week) controlled trials of well over 1,200 people with schizophrenia. In one trial they used Haldol (haloperidol) as a comparative treatment, but it was inadequate to provide a reliable and valid comparison data. Poor Haldol. I’d really like to know what its inadequacy issues were all about. Anyway, in the three placebo-controlled six-week trials 50, 75, 150, 300, 450, 500, 600, and 750mg a day were tried, usually split over three times a day. Although two and four times a day dosing was tried as well. 50mg a day didn’t do much. 300-500mg a day taken three times a day worked the best. This is where they found that Seroquel (quetiapine) works better on people under 40 than people over 40.

For acute efficacy was established in 3 placebo-controlled trials of a little of 750 bipolar people. These trials included patients with or without psychotic features and excluded patients with rapid cycling and mixed episodes. Two were Seroquel alone, one, lasting all of 3 weeks, was using it along with lithium or Depakote (divalproex sodium). Dosages were 400-800mg a day for all three trials. It doesn’t state in the PI sheet what the optimal dosage was from the trials, just that a enough people got better enough to warrant FDA approval.

Oh, and there was a fourth trial of 200 people. The wonder drug Placebo did better than Seroquel in that one. One of these days I have to buy some stock in the company that makes Placebo.

See the page on a drugs’ efficacy for an explanation of the tests used to evaluate if a medication is any good or not.

As usual, there are no hard numbers in the PI sheet for what is considered “superior” to placebo on these various tests.

As usual with atypical antipsychotics, I’m none too happy with the bipolar trials. Although they had a decent amount of people (300, 299, 170 and 200 people) they were still pretty short (six weeks for monotherapy, three weeks when combined with lithium or Depakote). And only the Young Mania Rating Scale was used. So the people in the experimental group started at 400mg a day (100mg higher than what was shown to be effective for schizophrenia) and got some vague improvement on the Young Mania Rating Scale.
How Seroquel Does Work In Your Brain: Like all Novel / Atypical Antipsychotics, Seroquel (quetiapine fumarate) is a selective antagonist (i.e. it gets in the way of) for key serotonin 5HT1A and 5HT2 (IC50S = 717 & 148 nM respectively), dopamine D1 and D2 (IC50S = 1268 & 329 nM respectively), histamine H1 (IC50 = 30 nM), and adrenergic a1 and a2 receptors (IC50S = 94 & 271 nM, respectively). Quetiapine fumarate has no appreciable affinity at cholinergic muscarinic and benzodiazepine receptors (IC50S >5000 nM). Dr Julien in A Primer of Drug Action also has Seroquel helping to cut back on glutamate reception.
So, what does that mean in English? Well excessive dopamine in certain parts of the brain is one popular hypothesis behind the symptoms of schizophrenia. There’s also evidence that working on the muscarinic receptors makes a big difference as well. But since Seroquel doesn’t do the muscarine thing that’s a good-news / bad-news deal The good-news is that the anticholinergic side effects – dry mouth, nausea, dizziness, aren’t as big a deal and don’t last as long with Seroquel as compared with Zyprexa (olanzapine). The bad news is that Seroquel doesn’t work as well with some some forms (mostly the atypical) of schizophrenia or ultradian rapid cycling bipolar disorder because of not hitting the muscarinic receptors.

For bipolar disorder, anyone who lives in Bipolarland can tell you about getting manic from having their brain soak in serotonin for too long from an SSRI. Or perhaps the same thing happened from too long of a soak in norepinephrine and dopamine from Wellbutrin.

One reason why Seroquel is getting more and more popular for bipolar and schizoaffective disorders is that Seroquel targets your serotonin receptors more than your dopamine receptors (Julien A Primer of Drug Action and Stahl Essential Psychopharmacology of Antipsychotics and Mood Stabilizers).

Since it hits your H1 histamine receptor hard, Seroquel (quetiapine fumarate) is the official antipsychotic of sleepy-bye land.

As is typical in the world of psychopharmacology, no one uses a consistent scale in rating anything (I mean, no one can even agree as to what PI stands for!). The good news is that Seroquel was measured using the IC50 scale, so its effects can be measured against antidepressants. The bad news is you can’t easily measure its potency relative to Risperdal or Zyprexa. Grrrrrr. The consensus in the trenches is that Seroquel is the mildest of the atypical antipsychotics.

Seroquel’s Half-Life: An average of six hours.

Days to Reach a Steady State: About two days.
When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

Side Effects of Seroquel (quetiapine fumarate)
Even though it’s class action lawsuit city with Seroquel (quetiapine fumarate) and other atypical antipsychotics these days because of their side effects, the side effects really aren’t that bad! But if you’re into that sort of thing, we have a page to help you find a lawyer.

For tips on how to cope with these side effects, please see our side effects page. The only proven med-based solution I’ve found to date for Seroquel (quetiapine fumarate) and weight gain is Axid (nizatidine). Everything I have to help lose weight on Seroquel is on the side effects pages.

In addition to the usual short-term side effects for atypical antipsychotics

Seroquel’s Typical Side Effects: Seroquel (quetiapine fumarate) is notorious for two things – making you sleep until next Tuesday, and giving you a hangover when you eventually wake up. For 90% or so of the people who take it, the hangover goes away in two or three days, a week at the outside. And if you’re taking Seroquel as required for sleep, the hangover often goes away eventually. It all depends on how often you take it. Otherwise expect the usual short-term side effects for atypical antipsychotics – headache, nausea, dry mouth, sleepiness or insomnia, diarrhea or constipation, not giving a damn about anything (a.k.a. the zombification effect). Most, if not all of these will go away in a couple of weeks. Except for the excessive sleepiness, which could hang around for as long as you take this med. The other big issue with a lot of people is weight gain. While not as bad as Zyprexa (olanzapine), like that med Seroquel is a potential triple threat when it comes to weight gain, as it could slow your metabolism, may make you want to sleep 10 or more hours a day, and often make you want to eat more. And since it hits the H1 histamine receptor, and hard, (see How Seroquel Works for details) it’s going to make you crave carbohydrates like there’s no tomorrow, so good luck sticking to that Atkins diet. But, hey, at least it’s the goddamn med’s fault and not any lack of willpower on your part.

For tips on how to cope with these side effects, please see our side effects page. Like Zyprexa (olanzapine) the only med-based solution for the weight issue is Axid (nizatidine). Everything I have on that is on the side effects pages.
These aren’t all the side effects possible, just the most popular ones.

Seroquel’s Not So Common Side Effects: Diabetes. Manic reaction (Hey, the evidence is mounting that it’s a fairly decent antidepressant amongst the bipolar and schizoaffective, so you’ve got to expect this sort of thing.) Muscle aches and pains. Getting all sweaty for no good reason. Tremor. Irregular heart beat and prolonged QT interval (whatever the hell that means, ask your doctor). While the sexual dysfunctions aren’t as bad as Risperdal (risperidone) or Zyprexa (olanzapine), they can still happen. Like any antipsychotic there is a slight, but real risk for extrapyramidal symptoms (EPS), tardive dyskenesia, and neuroleptic malignant syndrome (NMS). Please see the page on these risks. Seroquel (quetiapine fumarate) tests as having one of the lowest risks for EPS and TD and has been used to treat people with TD.
These may or may not happen to you don’t, so don’t be surprised one way or the other.

Seroquel’s Freaky Rare Side Effects: Infanticide (Tragic case of a mother having a psychotic episode and using her Seroquel in a really nasty way.) Completely eating someone’s blood. Priapism (i.e. the never-ending hard-on) from an overdose. Kids, don’t try this at home as a Cialis substitute The PI sheet also lists “bone pain” and “abnormal ejaculation” so I’d be especially careful about taking too much to stay hard.

Seroquel’s Suicide Risk: The use of Seroquel (quetiapine fumarate) has had a few documented suicide attempts, notably with adolescents. This is spelled out in the PI sheet. But all psychiatric and neurological meds have a potential suicide risk. It’s prevented far more suicides than encouraged such attempts, and in that respect its use far outweighs any suicide risk.

Interesting Stuff Your Doctor Probably Won’t Tell You: Seroquel (quetiapine fumarate) is marginally better absorbed with food. So if you feel you need just a little boost in the dosage, try taking it with dinner or a late night snack.

Like most drugs older people don’t clear it out of their systems as well, too the point that they may need a lower dosage (or would do better with the generic version when such comes on the market). That’s not particularly interesting. What is interesting is that Seroquel (quetiapine fumarate) seems to work better for people under 40 than over 40.
Comments: The weakest of the atypical antipsychotics, but the most sedating. Seroquel (quetiapine fumarate) is frequently prescribed in low dosages (25-100mg a night) just to combat insomnia. Seroquel (quetiapine fumarate) antagonizes a lot of histamine receptors and doesn’t do much in the dopamine department, and that’s the best guess as to why it is so sedating. Unfortunately it didn’t help Mouse sleep, and was one of those cases where the antipsychotic made her psychotic, by causing her to hear voices. While Seroquel doesn’t have the weight-gain reputation that Zyprexa does, mainly because the effect doesn’t happen quite nearly as often, when it does happen it can be just as dramatic as Zyprexa, again thanks to that histamine antagonism.

Seroquel (quetiapine fumarate) is the least likely of the atypical antipsychotics to mess with your prolactin or to cause EPS and TD. So if any of those have been issues of yours or are major concerns, then Seroquel is your first best choice in an antipsychotic. Because of that it’s also being studied up the wazoo to treat various symptoms of Parkinson’s.

So is Seroquel (quetiapine fumarate) a good long-term med for you? That depends. Obviously if nothing else works and Seroquel does, it’s the best long-term med for you and you just have to find a way to deal with the weight gain and potential threat of diabetes. Regular testing for diabetes and doing what you can in the way of exercise and other tips I have on the weight-gain side effects page is all you can do for now. Plus eat lots of cinnamon. I’ll have more on this on a page specific for the diabetes threat, but it looks like a quarter teaspoon a day of cinnamon can help regulate blood sugar and cholesterol levels.

You can always try another novel/atypical antipsychotic whose side effects don’t suck as much. Abilify (aripiprazole) and Geodon (ziprasidone HCl) are the two usually tried in place of Seroquel (quetiapine fumarate) as they rarely, if ever, cause weight gain and it’s a coin-toss about Geodon (ziprasidone HCl) and sedation. Just don’t go begging your doctor for another med because of lack of specific side effects, as that is a sucker’s game. Every med has some side effect that sucks a lot of ass. In any event, if some other med doesn’t work out for you, you can always come back to Seroquel. Like most of the atypical antipsychotics, it’s very forgiving that way.

Generally, though, people are happy with Seroquel in the long-term to treat their symptoms. See How Seroquel Works & Compares with Other Meds for some one, two and three-year long studies on treating bipolar disorder and schizophrenia.

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