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When/how do you decide a med is not working? Seroquel XR

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Hi, I'm new here. Sorry if this is a question that was asked and answered 873 times before. I did a forum search, without much luck.


I was diagnosed as bipolar about six months ago, after spending a year on antidepressants (citalopram) that were pretty much making me crazy. Even though I was just diagnosed, I'm in my mid-30s and I've been having mood issues for 20+ years. Unmedicated, I naturally tend more towards depressions or mixed episodes with anxiety, agitation, and irritability, rather than classic depressive or manic states.


I got in to a pdoc's office (my first pdoc) at the end of December, while I was quite manic, and they took one look at me and handed me a prescription for Seroquel XR. For the first couple of months, it was wonderful. The first few weeks were rough, as I titrated the Seroquel up to 400 mg and the citalopram down to nothing, but afterwards I felt normal and stable up until March. As time goes on, though, I am finding that it seems to provides less and less control over my moods. I called my doc after I had several weeks of a hypomanic episode that went crashing into depression, and he increased my dose to 600. I've been on that since, um, April I think? 


My anxiety has been creeping back, to the point that I take alprazolam (currently only .25mg in the morning, plus more if I need it later in the day) on a daily basis, just in order to be able to do things like leave the house or go to the supermarket.


And I am having more and more mood episodes that basically start out with me going hypomanic, feeling great, talking way too loud and way too fast, staying up all night cleaning the entire house, watching 15 episodes of a television show in a row, getting 2.5 hours of sleep, but then within a few days go crashing right down into depression and, even worse, mixed states that are freakin' unbearably awful. Also, and this is more subjective, I don't recognize my mood states all the time anymore. Before I was medicated, I understood how a hypomanic or a depressive episode would proceed. Now that I'm on meds, it changes the pattern of my moods and I just... don't understand them now. So I can't say, "I'm feeling bad right now but if I do XYandZ it'll make me feel better," or something along those lines.


It seems to me that the Seroquel just isn't working as well anymore. I asked my pdoc about it, and he said, "Well, do you have more good days than bad days? Then it's working. You're still going to have mood episodes." Which, I guess I have more good days than bad? But the bad ones kind of suck? And they seem to be joining forces with each other, so that there are more and more of them together at one time? Pretty much the end of May and the entire month of June thus far has been a big ugly emotional mess for me.


I feel like my pdoc wants quantifiable, scientific answers to his questions, and my more subjective responses frustrate him. In return, I am frustrated because I feel like he isn't listening to what I'm saying.


How long do I have to give a drug or a dosage before I can say, "This is just not working for me?" I mean, it seems to me this med at this dose is not doing what I would like it to do, but I've never been treated for bipolar before; I don't even know what I'm supposed to expect out of it.


How do you know when you've failed on a drug, or a drug has failed you?

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If your illness is not under control then its not working (as well, might still be partially working). Sadly this happens a lot ot some people, so you might have to stop taking it until its out of your body then wait a bit to start taking it again to have a full effect. Fortunately seroquels half life is so low its pretty easy to do, or you can just take something else meanwhile.

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