pdoc still wont increase my seroquel

[swanny]

been on 400mg of seroquel xr(taken all at night) for schizophrenia for just over a month now. i just saw my pdoc today and i was hoping that he would increase it BUT he said NO. and when i asked him why cant we increase it, he said coz IF we go higher u will get more side effects and plus u seem to managing well. also said "we kept increasing the other antipsychotics uve been on in the past and it didnt do anything"

the side effects ive reported to him so far are: insanely dry mouth, constipation, drowsiness at first but only for the first week and slowed reflexes

he said im "managing well" even though i told him TODAY that i cant leave the house coz im too paranoid and i feel everyone keeps giving me dirty looks, glaring at me and staring at me. basically also told him i still cant concentrate and cant think properly. i mean yes 400mg sounds like a lot but NOT for schizophrenia and ive seen some schizophrenics on much higher doses than that. like 800mg 1200mg 1500mg even 2100mg. so compared to what other schizophrenics have been on 400 is tiny.

do u think my pdoc is right at leaving me on 400mg?

[bpladybug]

You have been complaining about your paranoia, and other symptoms and wanting to increase your Seroquel.

I agree with you, 400 mgs is not a high dose for schizophrenia.

I am on 200 mgs for bipolar, plus lithium and neurontin.

So, I think it is legitimate to feel undermedicated.

I think you need to talk with your doctor again.

Don't you hate it when your tongue is so dry that it literally sticks to the roof of your mouth?

At this point I always, always have water with me. I just bought a purse that will fit a small

bottle of water. Plus chewing gum, everywhere.

If I have to pop into a store I chew gum.

The dry mouth is sort of running my life, because I cannot be without water.

[swanny]

also forgot to mention after the session ended with the pdoc. he straight away said to the other pdoc in the practice "can i talk to u trevor? (name of the other pdoc) could it be possible he was asking trevor for a second opinion about my dose?!?

[swanny]

i mean fair enough suppose i was 1000mg and he didnt want to increase i CAN UNDERSTAND coz thats is already a big dose but come on! 400?

[bpladybug]

oh swanny that could be anything, he could have been asking him to lunch

or about staffing, or the cable internet access

I doubt that was about you

[Velvet Elvis]

Ask if you can take 200 at night and 200 in the morning, or if you can take 25 to 50 mgs as needed during the day.

[swanny]

Ask if you can take 200 at night and 200 in the morning,

really what difference would it make? its still 400mg a day.

or if you can take 25 to 50 mgs as needed during the day.

25mg? ur kidding me! thats the sort of dose ppl with insomnia take. no offence but taking that dose wouldnt touch schizophrenia coz its REALLY tiny

[Velvet Elvis]

Ask if you can take 200 at night and 200 in the morning,

really what difference would it make? its still 400mg a day.

or if you can take 25 to 50 mgs as needed during the day.

25mg? ur kidding me! thats the sort of dose ppl with insomnia take. no offence but taking that dose wouldnt touch schizophrenia coz its REALLY tiny

As a prn during the day it can help since you've already got more on board. Take it like a benzo.

[AnneMarie]

The half life of Seroquel XR is 12 hours. It is longer than immediate release, but it still is short. It means that by the time you wake and are up and moving, half of the medicine you took the night before is out of your system. Continuing with this oversimplification, if you took 400mg at night, you would have 200mg in you in the morning. Half of the 200mg is 100 mg which is what would be in you by the time you are taking the dose again. (This really is an oversimplification!). If instead, you took 200mg at night, you would have 100mg in the morning Plus the additional 200mg you take in the morning. So that's 300mg. At the end of the day before you take your next dose, you'd have about 150mg, or 50mg more than if you took it all at night. The timing difference means you have more in your system during daytime and less in your system at night. Sometimes divided doses optimize efficacy. It depends on the person and whether there are unacceptable side effects during the day.

I would call to ask your doc about split dosing if Seroquel XR does not make you too tired. If it does, then the side effect of daytime sedation would not offset the benefit of more med in your system in the day.

Between now and your next appt, I'd start a log of what you experience that makes you want to increase your dose. Summarize it and bring both to your next appt. Your pdoc may not fully appreciate the symptoms you are having and the effect they have on your life. At the same time, you need to think really hard about whether increases in the side effects you have right now are things you can tolerate long-term. That is what your pdoc is trying to balance. What is the workable compromise between symptoms and side effects?

[LWD]

If your symptoms are not doing well then it's a clear indicator you need to up the dose. The difference between 400mg seroquel and 800mg seroquel was stability. I simply could not manage on 400mg but with 800mg I could get a pdoc who understands this.