If Seroquel Is Mostly An H1 And A1 Antagonist At Low Doses, Then Is It Similar To Alpha Blockers That Do Not Cross The Brain Blood Barrier?

[SirHerpDerp]

I read that at a low dose Seroquel works as mainly an a1 (and h1) antagonist. Does this mean it works similar to Prazosin or Indoramin or something more central acting like Guanethidine or Resperine? Since Seroquel worked so well for some of my symptoms at a low dose, I figure it's the alpha blocking action, and I'm curious if that alpha blocking needs to cross the brain blood barrier or not.

[AnneMarie]

The meds you listed probably work differently than Seroquel otherwise they would be classed as atypical antipsychotics. A lot of drugs touch histimine and alpha receptors. It doesn't mean the receptors are in the brain or that the meds work the same even if the receptors are.

Seroquel works as it does because it crosses the blood brain barrier. Meds that don't aren't going to have significant psych effects.

If you are using low dose Seroquel for sleep and/or anxiety, there are other meds that might work as well. Some might be those you listed. If so, I'd say that there are better choices. Same for anxiety. There are better choices.

[SirHerpDerp]

The meds you listed probably work differently than Seroquel otherwise they would be classed as atypical antipsychotics. A lot of drugs touch histimine and alpha receptors. It doesn't mean the receptors are in the brain or that the meds work the same even if the receptors are.

Seroquel works as it does because it crosses the blood brain barrier. Meds that don't aren't going to have significant psych effects.

If you are using low dose Seroquel for sleep and/or anxiety, there are other meds that might work as well. Some might be those you listed. If so, I'd say that there are better choices. Same for anxiety. There are better choices.

I should have probably explained why I ask and my reasoning: I was using Seroquel for some sort of panic attacks I was having. 50 mg would get rid of it in 10-15 minutes and isn't really much of an antipsychotic until you get up to 500mgs or so. On 600mg's daily they were completely staved off. I went on Saphris and off Seroquel for six days and had an attack. I tried the Seroquel and it no longer worked.

I figured that, if at that dose, Seroquel worked it was either H1 antagonism or a1 antagonism, and since the higher Seroquel dosage the less effect it has on H1, the fact that histamine antagonists no longer make me tired, plus the speed at which it worked, that it may be the alpha blocking action that was helping, not the antipsychotic action. Since alpha blockers are also used for panic attacks I thought maybe there would be a comparable one to how Seroquel's alpha blocking works and nothing else.

My doctor generally gives me a good amount of freedom to suggest medication if I give him a good explanation. These attacks are ruining my life and if they continue I will have to leave school again and am unable to be outside for extended periods of time due to getting them every few days. I am desperate to try alternatives. This is why I ask, because I am thinking about asking for alpha blockers, and am hoping there is an alpha blocker that works comparable to seroquel's alpha blocking actions. Does that mean there's nothing comparable I can try? Or should i just be looking for another antipsychotic, even though it seems unlikely that's the solution?

[AnneMarie]

What is your diagnosis?

What type of doctor are you seeing?

Yes, beta blockers can help with anxiety disorders. This isn't my area, but off-hand I want to say that there are more commonly used ones than those you named. Benzos also can be effective, but are more addictive than beta blockers. I have no idea if this is the route for what ailes you.

Btw, as you take more Seroquel, it does not affect histimine receptors less. It's more like they are filled up so it moves on to the next receptor type that it has the most affinity for. That's the LP's theory, at least IIRC.

I wouldn't over analyze the theories on how meds work. Much is unknown. Instead, I would work on getting a clear diagnosis if you do not have one, looking into what types of meds are typically prescribed for that disorder, and working with your doc letting him or her take the lead.

[Aurochs]

Antipsychotics are not typically prescribed for panic attacks. Neither are alpha-blockers (in fact, I've never heard of an alpha-blocker being prescribed for any kind of anxiety). The drug usually given for those is Xanax, but they respond best to therapy.

EDIT: Also, H₁ antagonism does have an anxiolytic effect. Hydroxyzine (Vistaril), an antihistamine, is sometimes used to treat anxiety. However, I am not aware of any anxiolytic effect from alpha blockers. Beta blockers are used to treat performance anxiety, but they're not the least bit useful for panic disorder.

[Aurochs]

Also, A₁ is an adenosine receptor, not an alpha-adrenergic receptor. Caffeine would be an A₁ antagonist. The abbreviation you're looking for is α₁, with the Greek letter alpha. This is a pain to type, so you can just write out alpha.

[SirHerpDerp]

What is your diagnosis?

I have bipolar disorder, schizophrenia, and GAD. I'm not sure if I'm having "panic attacks" they are more like "paranoia attacks," intense periods of paranoia/derealization that go away within a few hours or if I take a nap.

What type of doctor are you seeing?

A psychiatrist

Yes, beta blockers can help with anxiety disorders. This isn't my area, but off-hand I want to say that there are more commonly used ones than those you named. Benzos also can be effective, but are more addictive than beta blockers. I have no idea if this is the route for what ailes you.

Btw, as you take more Seroquel, it does not affect histimine receptors less. It's more like they are filled up so it moves on to the next receptor type that it has the most affinity for. That's the LP's theory, at least IIRC.

I wouldn't over analyze the theories on how meds work. Much is unknown. Instead, I would work on getting a clear diagnosis if you do not have one, looking into what types of meds are typically prescribed for that disorder, and working with your doc letting him or her take the lead.

I hope he can actually take the lead, he wasn't my psych when I was having this symptoms and I have a hard time explaining them. These symptoms were controlled when I started seeing him. Last time I tried to describe them to he didn't really get it so I'm going to try and write it down.

Antipsychotics are not typically prescribed for panic attacks. Neither are alpha-blockers (in fact, I've never heard of an alpha-blocker being prescribed for any kind of anxiety). The drug usually given for those is Xanax, but they respond best to therapy.

EDIT: Also, H₁ antagonism does have an anxiolytic effect. Hydroxyzine (Vistaril), an antihistamine, is sometimes used to treat anxiety. However, I am not aware of any anxiolytic effect from alpha blockers. Beta blockers are used to treat performance anxiety, but they're not the least bit useful for panic disorder.

I have ativan but my doctor will not prescribe more as he is against benzos, on top of it not really working.

I have hydrozyzine, it was first prescribed for my anxiety, and does nothing.

If Seroquel worked to prevent panic attacks for you at any dose, it may be worth looking into again. Having one panic attack on it doesn't mean it's now completely useless.

Once again, not sure if I'm having panic attacks or some sort of "paranoia" attack. There's nothing therapy can do for these, I have tried, the nature of them don't respond to it. I have looked back into Seroquel. It used to work within 10 minutes at 50-100mg when I had an attack coming on. On 600mg a day I was no longer having any attacks. I switched to Saphris and went off Seroquel for a week. The attacks came back but when I tried using seroquel it no longer worked. I tried it more than once for the next panic attacks and eventually tried going back on 600mg a day. It no longer works. It is now completely useless, no matter how many times I've tried using it again.

Also, please keep in mind that we sort of know what these drugs do in the brain, but not enough to start drawing direct comparisons between unrelated drug classes. People get a little too caught up with the pharmacology of these drugs looking for clinical effect when the truth is that we're not really sure where the clinical effects are coming from.

Good point, hadn't thought of it that way.

In all, if seems like I may be having some sort of unnamed "paranoia" attack that was helped by a medication it no longer responds to, and am now completely fucked and disabled and going to lose everything again. I've already as of today had to withdraw from school (again) and I don't seem my doctor for a week or so. Great.

[AnneMarie]

Spending some time writing out what you mean by attacks is probably the smartest thing you can do between now and your doc appt. What you are describing sounds like a panic attack, but depending on what you mean by "paranoia attack," it might not be. That is important info for you and your doc to suss out.

I'm curious. Have you tried other antipsychotics? Or SSRIs?

ETA: I'm sorry you had to drop school. That sucks. I hope all this works out soon.

[SirHerpDerp]

Spending some time writing out what you mean by attacks is probably the smartest thing you can do between now and your doc appt. What you are describing sounds like a panic attack, but depending on what you mean by paranoia attack, it might not be. That is important info for you and your doc to suss out.I'm curious. Have you tried other antipsychotics? Or SSRIs?

I have tried other antipsychotics, a first generation and most second generation, since I began having auditory hallucinations in late 2007, but for the attacks, which started in late 2009, Seroquel is the only medication I used for it and it worked.  I've also used SSRIs in the past but none during the period I've had these "attacks". So, when it comes to these "attacks", I've tried nothing but Seroquel, though I'm on Saphris and lamotrigine now and those do not seem to help.  The doctor I saw the other day had me increase my Saphris but there hasn't been much difference. I'm also trying propranolol and ativan.  I took them earlier today before an attack and the attack seemed less intense but the paranoia was still bad.  Not sure if it's related so will try to take the propranolol when an attack starts and then the next attack try taking the ativan.

ETA: I'm sorry you had to drop school. That sucks. I hope all this works out soon.

  

Yeah, having to withdraw from school for the fifth or sixth time sucks.  I was finally getting back on my feet.

[Velvet Elvis]

At 50 or 100 mgs seroquel should not be expected to do anything for psychotic symptoms.

[SirHerpDerp]

At 50 or 100 mgs seroquel should not be expected to do anything for psychotic symptoms.

That's why I was perplexed as to why it worked in 10 minutes for my "paranoia attacks".  I mean, worked almost immediately.  Since it doesn't seem to be the antipsychotic aspect, and my doctor gives me a good deal of freedom to suggest meds, I had thought it might be the alpha antagonism.  Seroquel has stopped working and I need to try new medications for these "attacks".  I was hoping the low dose of seroquel's action would be a clue as to what I should try next.

[Velvet Elvis]

At 50 or 100 mgs seroquel should not be expected to do anything for psychotic symptoms.

That's why I was perplexed as to why it worked in 10 minutes for my "paranoia attacks".  I mean, worked almost immediately.  Since it doesn't seem to be the antipsychotic aspect, and my doctor gives me a good deal of freedom to suggest meds, I had thought it might be the alpha antagonism.  Seroquel has stopped working and I need to try new medications for these "attacks".  I was hoping the low dose of seroquel's action would be a clue as to what I should try next.

Well, first you need to more clearly define if these attacks are the products of an anxiety disorder or a thought disorder. All engines are stop until you do that.

Are there physical symptoms? Increased heart rate or palpitations? Shortness of breath or hyperventilation? Those would usually be present with panic attacks.

SSRIs are commonly used for their prophylactic effect against panic. Xanax will break a panic attack better than anything else most of the time and is the only medication on the market specifically developed to treat panic disorder.

If it's not panic disorder, you need to look at taking an an anti-psychotic at the full dose indicated for for psychotic conditions.

Beta blockers as well as related hypertension meds such as clonidine can also help.

[SirHerpDerp]

At 50 or 100 mgs seroquel should not be expected to do anything for psychotic symptoms.

That's why I was perplexed as to why it worked in 10 minutes for my "paranoia attacks". I mean, worked almost immediately. Since it doesn't seem to be the antipsychotic aspect, and my doctor gives me a good deal of freedom to suggest meds, I had thought it might be the alpha antagonism. Seroquel has stopped working and I need to try new medications for these "attacks". I was hoping the low dose of seroquel's action would be a clue as to what I should try next.

Well, first you need to more clearly define if these attacks are the products of an anxiety disorder or a thought disorder. All engines are stop until you do that.

And therein lies the rub. It seems somewhere in between but I'm not sure. I do get horrible anxiety on a regular basis but the attacks don't seem to come directly from it because I can be completely fine when they happen. I've been recording what is happening during the attacks and the symptoms are mostly non-somatic: initial derealization, fear, anxiety, but most prominently paranoia, which is where the fear and anxiety seem to come from and change in breathing. Breathing deep helps, taking a nap completely gets rid of it, and it generally lasts a few hours. So it can go either way.

Are there physical symptoms? Increased heart rate or palpitations? Shortness of breath or hyperventilation? Those would usually be present with panic attacks.

None of those, other than shallow breathing.

SSRIs are commonly used for their prophylactic effect against panic. Xanax will break a panic attack better than anything else most of the time and is the only medication on the market specifically developed to treat panic disorder.

My doctor hates benzos, but I have a script for ativan and propranolol. I used them for an "attack" yesterday and it did not supside, though I also used them earlier in the day and the attack was less severe perhaps due to that. I plan on giving each a separate trial when my next attacks hit.

If it's not panic disorder, you need to look at taking an an anti-psychotic at the full dose indicated for for psychotic conditions.

I've been on Saphris for almost three months and it's worked great for auditory hallucinations (the ones unrelated to attacks) and have been on most AAPs and APs but these attacks only started in 2009 after I had been on a trial of most of those.

Beta blockers as well as related hypertension meds such as clonidine can also help.

Probably trying an alpha (Prazosin)/beta (propranolol) blocker and clonidine at some point with my doc. But since Seroquel's main affinity at those dosages are for H1 and alpha 1, I'm also looking at antipsychotics with those affinities, even though I know that pharmacology is kind of a shot in the dark when it comes to how these drugs actually work out.

I still find it strange that Seroquel would work at such a low dose, since it doesn't have much antipsychotic activity there, and so quickly, and hope that those two facts point towards something else that may work. The whole thing is complicated and it's hard to even tell if I'm having panic attacks or some kind of paranoia attacks, because I'm finding online that other people get these paranoia attacks and they're considered panic attacks especially with the derealization aspect, something that only happens during the attacks. Also the fact that sleeping makes it go away, that it only started in 2009, two years after my illness started. If The Last Psychiatrist post is true, even though effectiveness does not follow from pharmacology, I might as well look at other antipsychotics that hit that alpha 1 receptor, since it's the most prominent detail.

I really don't know, just grasping for straws at this point.

[AnneMarie]

IIR, propranolol is not an immediate release drug. Does your prescriptions say to take it once or twice a day? If so, that is what you should do.

[SirHerpDerp]

IIR, propranolol is not an immediate release drug. Does your prescriptions say to take it once or twice a day? If so, that is what you should do.

If that's true, then I'll have to wait until I have another attack without taking any meds. Then I'll have to start taking the propranolol daily and see if there is a change. This is because I took the propranolol [and ativan] in the morning yesterday and my attack was less physical, even though I still got clammy hands, but I don't know if it was due to those meds or not.

I have old bottles of it from when I would get akathisia from other antipsychotics and would take it immediately and it would go away within an hour.

The doctor gave me no specific instructions because I told the doctor I saw last (He wasn't my regular GP and not my or a psych, though he called my psych, but I saw him via instructions from the emergency room [i went there last week related to these attack]) that I would try propranolol so he said okay and put it on my instructions. Like I said, my doctors generally let me try what I want since I relieved my negative symptoms through research, they trust me as long as the risks are justified. So I have no actual directions for it, just a go ahead to try it.

If it's true that it isn't insta release, I guess I'll have to wait for after another attack again to get a better idea of baseline before trying it daily.

[AnneMarie]

Why don't you just take it in the evening after dinner. I don't understand the need to wait.

[Guest]

I take propranolol for tremors and it generally lasts about 10 hours before they start to come back. I only take one dose though just to cover me during the day, if I needed to do something fine at night I would take a second dose.

I'm also taking 40mg btw.

[SirHerpDerp]

Why don't you just take it in the evening after dinner. I don't understand the need to wait.

I need to measure my attacks at baseline before I start using it to see if it has any effect so I know if it's something I need to be taking or not.