Low, Infrequent Seroquel Titration

[A208B]

I swear I've read everything I can get my hands on about Seroquel but I still don't have the slightest clue what the hell my doctor is doing, and when I try to get a straight answer out of him, all I seem to get is "Let's just see what it does" and "The fewer medications, the better," and I just feel like: Okay, but what is it supposed to do, how is it supposed to help me; I mean, does he think I'm a junkie and just want some Susie Q on rave nights? I'm so frustrated I could cry (read: have been) and I was hoping you guys could help me understand, because I'm at a total loss.

I was on 25mg of Seroquel for 23 days "to see if it would help with the depression," then bumped up to 50mg for a week, 100mg for a week, and 150 for a week. At no point did I have any intolerable side effects, but neither has the medication really done anything. So after ~40 days of taking a sub-200mg dose, I begged my pdoc today to give me something more, something to actually fucking help, and he relented and gave me a 200mg prescription of the stuff to take once a day for the next three weeks.

I told him I'm scared of breakthrough mania, that I'm starting to have severe irritability and that I'm having to watch my behavior closely, that if I don't do something soon I'm probably going to have an episode no matter how well I'm coping, and he said: "But you aren't manic right now, right?" And no, I don't think I am? Not, like, full-blown manic. But what, do I have jump couches like fucking Tom Cruise before he'll give me a dosage of Seroquel that isn't bafflingly low? I want to PREVENT that type of mania from happening to me ever again. It's frightening and dangerous and I don't like it an ounce and I'm getting real fucking tired of being "treated" in such a way that it feels as though I'm not being treated at all.

Full disclosure: I'm also taking 1mg of Klonopin PRN for manic symptoms, and it helps some, some of the time.

Has it taken anyone else this long to experiment with a single medication? Is there a reason I'm being kept on a rat's worth of Seroquel that doc just won't tell me? I'm so upset. I've been a good girl--I'm going to my therapy sessions, I'm staying med compliant, I'm not drinking alcohol or doing drugs and I'm taking care of my health the best I can. I want to get better. I'm trying my damnedest. Does anyone have any idea what might be going on, here...?

I'm so sorry for ranting. Thank you so much for reading.

[bpladybug]

This is the link to the astrazeneca prescribing information for Seroquel.  For Bipolar Mania it is 400 - 800.  For Bipolar depression it is 300 mgs.  

 

I am Bipolar 1 and I take 400 mgs.  My husband is Bipolar 2 and he takes 800 mgs.  We have different doctors.  Now I did take a long time to work up to my 400 mgs dose.  But that was my trepidation.  My doctor would have done it faster.  As you must know Seroquel hits receptors in the brain in different ways - so a low dose of 25 mgs hits the histamine receptors which is why it makes you so sleepy.  You need to get to a high dose to hit the other receptors such as dopamine.  Then it has anti manic properties.

 

I would bring your doctor the dosing information from Astra Zeneca.  I would show him the facts.  

 

http://www1.astrazeneca-us.com/pi/Seroquel.pdf

 

Personally, in terms of irritability and other hypomanic symptoms, I try and treat it BEFORE I get really bad.  I want to prevent damaging manic episodes.  NOT treat them after I am in a full blown episode.  I don't agree with his logic.

 

However, as you also know it is a serious medication with bad metabolic side effects and ideally we should take only as much as we need.  Who knows, your doctor might have had a patient who became diabetic on a higher dose or gained a lot of weight..  But ultimately you want to manage your bipolar.  If you are not in alignment together than perhaps you need to get a second opinion.  

[larkspur]

One of the beautiful things about Seroquel is that it allows for the dose to be titrated upward very rapidly, and going super-slow isn't required at all. When I took it, I went from zero to 300mg within a week, going up by 50mg each night. After I was at 300mg for a while (maybe 4 weeks or so), I saw pronounced antidepressant effects. Now, granted, my pdoc is crazy and foreign and does things differently from a lot of other doctors, but what you're describing just sounds stupid to me, quite honestly. There is no reason that you should have had to suffer so long. I would maybe consider getting a second opinion if this pdoc isn't listening to you. 

 

From http://www.moodletter.com/MedNewsSeroquelBipolar.htm

 

Doctors want to raise the dose as quickly as is tolerable to the target dose, avoiding daytime sedation the following day. That increase may take as little as four days or as long as several weeks. 

For bipolar disorder depression, Seroquel should be taken once daily at bedtime to reach 300 mg/day by day four.

For bipolar mania, Seroquel is usually started at 100 mg/day, and increased in increments of up to 100 mg/day to 400 mg/day on day 4. Further adjustments up to 800 mg/day by day 6 should be in increments of no greater than 200 mg/day. The majority of patients respond to dosages between 400 to 800 mg/day.

 

From http://bipolar-disorder.emedtv.com/seroquel/seroquel-dosage.html

Generally, your healthcare provider will increase your dose quickly within a few days, up to Seroquel 800 mg (taken in two or three smaller doses per day), if needed.

 

All emphasis mine. What your pdoc is doing is silly. To each their own, and maybe his clinical experience is that patients respond to low doses...but really, all the evidence points to you needing to be at 300mg or more to really see mood stabilization effects, and that getting there quickly is ideal, to reduce the amount of next-day sedation/hangover. 

[A208B]

Thank you both so much for your responses. I feel validated now; I was wondering whether I was just paranoid--after all, Doc knows best! But it just seemed wrong to keep me at such a low dose for such a long time without any particular reason. Thank you, thank you, thank you. I'm going to try my best to be more aggressive with my pdoc the next time I see him about getting medicated more quickly--maybe I'll call? I don't have hope that I would get referred to another pdoc. The one I've got is literally the top rung of the ladder where we're stationed.

It's just so frustrating. I've been in the behavioral health system here since November, and it feels like I'm making zero progress.  

Again, so many thanks, for the support as well as for both of your sources.