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First few days on Quetiapine (Seroquel). What to expect?

HLon99

HLon99

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Joined
Apr 15, 2020
Messages
924
Location
London, UK
Dear all,

Just had an appointment with my psychiatrist and we decided to switch my Aripiprazole (Abilify) 5mg to Quetiapine (Seroquel) XR 200mg. I'm looking forward to it, because my Aripiprazole hasn't been working great and Quetiapine has been known to be a very effective mood stabiliser . However, I am aware that it does come with some side effects.

Sedation is my primary concern. I'm not too worried about it during the night, as my sleep isn't that good anyway, but does it still linger on into the day? Does the sedation effect pass/become more tolerable after a couple of weeks or does it stay?

Next, weight gain. I know it has the potential to cause weight gain, less so than other drugs like Olanzapine or Risperidal, but more than my current Aripiprazole. I have been loosing weight already before and sticking to a strict diet and exercise regiment; would this be suffice to keep the weight gain under control?

Finally, regarding dosage. Normal indications for Bipolar are usually 300mg and upwards. I'll be on 200mg. Has anyone had any luck with slightly lower doses of Quetiapine? Will it provide me with adequate protection against mania and depression?

Anything else I should be aware of? Any tips would be greatly appreciated.
 
U

Underdog21

Well-known member
Joined
Mar 26, 2021
Messages
115
Location
Oxford
Dear all,

Just had an appointment with my psychiatrist and we decided to switch my Aripiprazole (Abilify) 5mg to Quetiapine (Seroquel) XR 200mg. I'm looking forward to it, because my Aripiprazole hasn't been working great and Quetiapine has been known to be a very effective mood stabiliser . However, I am aware that it does come with some side effects.

Sedation is my primary concern. I'm not too worried about it during the night, as my sleep isn't that good anyway, but does it still linger on into the day? Does the sedation effect pass/become more tolerable after a couple of weeks or does it stay?

Next, weight gain. I know it has the potential to cause weight gain, less so than other drugs like Olanzapine or Risperidal, but more than my current Aripiprazole. I have been loosing weight already before and sticking to a strict diet and exercise regiment; would this be suffice to keep the weight gain under control?

Finally, regarding dosage. Normal indications for Bipolar are usually 300mg and upwards. I'll be on 200mg. Has anyone had any luck with slightly lower doses of Quetiapine? Will it provide me with adequate protection against mania and depression?

Anything else I should be aware of? Any tips would be greatly appreciated.
I was prescribed Seroquel for psychosis, don't remember the dose. All I can tell you is that it knocked me out to the point that I was sleeping throughout the day and the short time I was awake during the day I was eating lots of food. I couldn't live like this so they changed to Risperidone. I was on it for a short while so maybe long term these side effects will subside. It did practically make me feel like a sleepy hungry zombie. Maybe you will tolerate it differently.
 
E

emmaleemochizuki

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Apr 13, 2020
Messages
237
Location
London
It worked really well for me but initially I was a zombie.

It really worked to stabilise my mood. both mania and depression. and it helped my psychosis too.

the tiredness would subside just give it time. and yes there's weight gain. I was so hungry.
 
HLon99

HLon99

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Joined
Apr 15, 2020
Messages
924
Location
London, UK
It worked really well for me but initially I was a zombie.

It really worked to stabilise my mood. both mania and depression. and it helped my psychosis too.

the tiredness would subside just give it time. and yes there's weight gain. I was so hungry.
How long did it take the tiredness to subside?

I keep a pretty strict diet so hopefully I can control the weight gain.
 
E

emmaleemochizuki

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Apr 13, 2020
Messages
237
Location
London
several months. but my dose got increased to max so that's probably why
 
HLon99

HLon99

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Messages
924
Location
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several months. but my dose got increased to max so that's probably why
Ah ok, and in between dosage increases, did you feel that the sedation effect would subside at all after a few weeks? And in the mornings did you feel groggy at all?
 
HLon99

HLon99

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Joined
Apr 15, 2020
Messages
924
Location
London, UK
I was prescribed Seroquel for psychosis, don't remember the dose. All I can tell you is that it knocked me out to the point that I was sleeping throughout the day and the short time I was awake during the day I was eating lots of food. I couldn't live like this so they changed to Risperidone. I was on it for a short while so maybe long term these side effects will subside. It did practically make me feel like a sleepy hungry zombie. Maybe you will tolerate it differently.
How long were you on it for?
 
E

emmaleemochizuki

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Joined
Apr 13, 2020
Messages
237
Location
London
Ah ok, and in between dosage increases, did you feel that the sedation effect would subside at all after a few weeks? And in the mornings did you feel groggy at all?
yes it did subside after probably couple weeks.

I also found modified release actually was less sedating at the same dose and it worked better for me.
 
E

emmaleemochizuki

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Messages
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London
immediate release tablets just knock me out, I couldn't keep my eyes open.
 
HLon99

HLon99

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Joined
Apr 15, 2020
Messages
924
Location
London, UK
yes it did subside after probably couple weeks.

I also found modified release actually was less sedating at the same dose and it worked better for me.
Perfect. I can bite the bullet for a few weeks. I doubt I'll need a higher dose, I'm typically very responsive to medication. Also, I will be using the extended release
 
K

keith74

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Joined
Sep 14, 2020
Messages
540
Location
Canada
Dear all,

Just had an appointment with my psychiatrist and we decided to switch my Aripiprazole (Abilify) 5mg to Quetiapine (Seroquel) XR 200mg. I'm looking forward to it, because my Aripiprazole hasn't been working great and Quetiapine has been known to be a very effective mood stabiliser . However, I am aware that it does come with some side effects.

Sedation is my primary concern. I'm not too worried about it during the night, as my sleep isn't that good anyway, but does it still linger on into the day? Does the sedation effect pass/become more tolerable after a couple of weeks or does it stay?

Next, weight gain. I know it has the potential to cause weight gain, less so than other drugs like Olanzapine or Risperidal, but more than my current Aripiprazole. I have been loosing weight already before and sticking to a strict diet and exercise regiment; would this be suffice to keep the weight gain under control?

Finally, regarding dosage. Normal indications for Bipolar are usually 300mg and upwards. I'll be on 200mg. Has anyone had any luck with slightly lower doses of Quetiapine? Will it provide me with adequate protection against mania and depression?

Anything else I should be aware of? Any tips would be greatly appreciated.
Hi H,
Hope you are doing well. What I have heard is that if you are worried about feeling sedated the next day, IR may be better than XR, and to take the IR anywhere from 10-12 hours before you want to wake up the next morning. The issue with XR is that due to the slow sustained release, it can be in your system for awhile, long into the next day. The IR hits you all at once and knocks you out but most of the sedative effects are out by 10-12 hours. Of course everyone is different. But this seems to be the case for my wife with IR. A bit groggy in the morning but after that passes, she's good. However, XR could be good if you have some side effects like shaking leg after taking the IR. The XR helps with stuff like that (and also so you don't get super sleepy).

As for weight gain, my wife has more carb cravings (especially at night). Not as bad a Olanzapine but still noticeable. After a bit of weight gain (5-10 lbs), she has it under control by sticking to her healthy diet, and not keeping (a lot of) junk food and other carbs in the house (this includes bread). She also sticks to her exercise routine. She says that if she keeps her mind occupied, the cravings are not there as much. If you commit to sticking to your healthy diet and keep your exercise routine, you should be good. Again, everyone is different. But this is what works for my wife.

As for dosage, my wife is still on 300mg. Yeah I have heard that for quetiapine, 400mg is the dose that starts to effectively handle everything (depression, mania, psychosis). But I have seen many people on lower doses who say it works for them. Again, everyone is different. I think as a mood stabilizer for stability/maintenance, lower doses can be fine (my wife used to take lower doses (100mg) for mood stabilization and anxiety). But if something happens and you hit a mood swing, you need the higher doses to really get you out of (or avoid) the acute state (300+ for depression, 400+ for the rest). When my wife was hospitalized for acute mania lats year, she was being resistant to taking her meds. I talked to the doctor at the time and he said the she refuses to take more than 100mg and that dose is just too low to have much effect on her acute mania other than to help her sleep.

Good luck!
 
HLon99

HLon99

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Joined
Apr 15, 2020
Messages
924
Location
London, UK
Hi H,
Hope you are doing well. What I have heard is that if you are worried about feeling sedated the next day, IR may be better than XR, and to take the IR anywhere from 10-12 hours before you want to wake up the next morning. The issue with XR is that due to the slow sustained release, it can be in your system for awhile, long into the next day. The IR hits you all at once and knocks you out but most of the sedative effects are out by 10-12 hours. Of course everyone is different. But this seems to be the case for my wife with IR. A bit groggy in the morning but after that passes, she's good. However, XR could be good if you have some side effects like shaking leg after taking the IR. The XR helps with stuff like that (and also so you don't get super sleepy).

As for weight gain, my wife has more carb cravings (especially at night). Not as bad a Olanzapine but still noticeable. After a bit of weight gain (5-10 lbs), she has it under control by sticking to her healthy diet, and not keeping (a lot of) junk food and other carbs in the house (this includes bread). She also sticks to her exercise routine. She says that if she keeps her mind occupied, the cravings are not there as much. If you commit to sticking to your healthy diet and keep your exercise routine, you should be good. Again, everyone is different. But this is what works for my wife.

As for dosage, my wife is still on 300mg. Yeah I have heard that for quetiapine, 400mg is the dose that starts to effectively handle everything (depression, mania, psychosis). But I have seen many people on lower doses who say it works for them. Again, everyone is different. I think as a mood stabilizer for stability/maintenance, lower doses can be fine (my wife used to take lower doses (100mg) for mood stabilization and anxiety). But if something happens and you hit a mood swing, you need the higher doses to really get you out of (or avoid) the acute state (300+ for depression, 400+ for the rest). When my wife was hospitalized for acute mania lats year, she was being resistant to taking her meds. I talked to the doctor at the time and he said the she refuses to take more than 100mg and that dose is just too low to have much effect on her acute mania other than to help her sleep.

Good luck!
Thanks Keith, much appreciated!

I've heard the opposite about sedation that net-net effect is better for XR because its less intense and blows you less of your feet. If I took the IR, I would have to take it twice daily to prevent Mania; once in the morning, once at night; therefore the morning dose would just kill me. I know your wife uses it for depression, which is why once daily IR is suffice, but for mania prevention it has to be twice, which is why XR does seem like the better option.

Thanks for the tips about weight gain. I will definitely bear those in mind. Its a lot easier to avoid temptation when those foods aren't simply in your house. Since Feb, I lost around 7-9kg already and hopefully I can maintain that with exercise and diet on Quetiapine. Weight gain can be a problem with this drug, but definitely not as bad as things like Olanzapine.

Dosage is a tricky one. I have to say, when my psychiatrist told me he was putting me on 200mg I was a little concerned that this would not be enough to prevent me from going manic. He even considered starting me out on 100mg but luckily I talked him out of it. Officially, you're absolutely right 300mg+ for depression; 400mg+ for Mania. However, anecdotally some people respond to sub optimal doses of medication just as well. I previously responded to only half the normally required dose of Aripiprazole really well. However, Quetiapine has a totally different pharmacological profile, so really its kinda a grey area. Gotta just hope for the best I guess.
 
G

Ginger Kitten

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Oct 2, 2020
Messages
287
Location
Surrey, Uk
Hi HLon99. I've been on Q about 9 years now, at varying doses, but I do remember the initial sedation. I was very groggy first thing and felt exhausted and sleepy most of the day. However, it only lasted a few weeks then I adjusted to it. It's used for maintenance now in my case and I'm on a relatively low dose of 250mg, so I can't comment on its use as an anti-manic in your case. I think most people find they adjust to it after a while, so I don't think you'll be permanently drowsy. Good luck with this meds change, I know it's not easy for you. KR, Ginger.
 
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