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I'm currently on a couple hundred mgs of Seroquel instant release at night as an antidepressant augmentor. Is it true that over the long term seroquel has a very low rate of TD almost as low as clozapine? (When compared to other antipsychotics)

Edited by OCDme
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55 minutes ago, OCDme said:

I'm currently on a couple hundred mgs of Seroquel instant release at night as an antidepressant augmentor. Is it true that over the long term seroquel has a very low rate of TD almost as low as clozapine? (When compared to other antipsychotics)

I don’t think it’s that straightforward 

https://pubmed.ncbi.nlm.nih.gov/20156410/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109728/
 

here are two studies that have quetiapine higher, but I don’t think it’s that set in stone or easy to predict. There are lots of factors and different studies of comparison TD rates often differ. However, most consistently suggest that second gens have lower incidence than 1st gen 

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On 8/21/2022 at 8:34 PM, OCDme said:

I'm currently on a couple hundred mgs of Seroquel instant release at night as an antidepressant augmentor. Is it true that over the long term seroquel has a very low rate of TD almost as low as clozapine? (When compared to other antipsychotics)

I pretty much agree with @Iceberg----Second generation APs like Seroquel, in general, have a lower risk of TD when compared to first generation APs such as Haldol.

https://www.psychiatrictimes.com/view/tardive-dyskinesia-facts-and-figures

Also, there are now a couple of medications out there that are FDA-approved to treat TD: Ingrezza and Austedo.

Edited by CrazyRedhead
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  • 3 months later...

This is something that is easy to get confused. Clozapine, quetiapine, and olanzapine all have generally very low rates of akathisia and other EPS. This is owe to their intermediate binding profile at dopamine receptors. They bind and quickly dissociate from the receptor. This effect at pre-synaptic dopamine auto-receptors triggers the release of more dopamine and this tends to off-set the akathisia+EPS caused by dopamine antagonism at post-synaptic receptors.

However, olanzapine generally causes less akathisia because it's a potent anticholinergic, which generally masks the onset and progression of TD but doesn't prevent it from happening. Clozapine's TD risk is possibly lower because most of its effect is mediated via some glutamatergic mechanism and not dopamine receptors. However, all three of these second generation antipsychotics still carry a significant risk of TD mostly because pdocs and patients don't realize it's developing right under their noses until they try to get off the medications and the symptoms become apparent. In other words, it's probably more insidious with the "-pines" if it does develop.

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