Just increased Seroquel XR to 300 mg

[mjs190]

Hi all - 

Recently I've been going through a rough patch with my mood. Although I take an SSRI, it has never helped with my mood; it does eradicate my Pure-O/obsessive anxiety, however.

 

About a year ago I had a horrible depressive episode with lots of SI, so my doc added Seroquel XR (which I had been off of for about a year, but had previously taken for many, many years at a lower dosage for anxiety). I started at 150 mg and increased to 200 mg shortly after, where I finally found relief. 

 

Due to my recent depressive phase, I have had my Seroquel increased to 300 mg XR. This was originally the intention of my pdoc about a year ago, but when I found relief at 200 mg, we decided to stop there, despite her saying that 300 mg was the true "mood stabilization" dose.

 

It has been two nights of the new 300 mg dose, and I have had some increased anxiety and panicky feelings, fitful sleep, vivid dreams, and just overall feelings of nervousness, anxiousness, and edginess. I'm wondering if this is normal from such a small bump in dosage? I love Seroquel; it has literally saved my life, but these new side effects are bothersome. In the past, I never experienced any side effects except sedation, which obviously faded over time. These new side effects feel very "AAP" to me, if that makes sense? i.e. I have felt them when I trialed other APPs during my time of Seroquel like Risp, Latuda, and Abilfiy.

 

Can anyone speak to changes in how Seroquel "feels" after a dose increase? Has anyone titrated up to the 300 mg range and noticed the med acting differently/causing different side effects? Any feedback appreciated. Just trying to quiet my perpetually anxious and obsessive mind.

[mellifluous]

i've not taken seroquel for mood issues (i've taken for psychosis/schizophrenia and on a separate occasion i recall taking to help fall asleep, for some amount of time, but can't quite flesh out that memory beyond that), so i'm unsure how helpful this will be. in case it might be: when taking as my main antipsychotic, i recall titrating up on seroquel and it made me sleepier at lower dosages (i have no idea what my starting dosage was, though. i could guess/imagine/estimate, but i'm shit with such things and have zero confidence it'd be remotely accurate and i c®apped out, so to speak, at 800 and it wasn't sufficient so didn't last long, if memory serves). it wasn't until the 600-800 range that it both made a dent in things and didn't make me feel at least a little sluggish.

 

though i can't say for certain the mg range at which seroquel ceases to be sedating for most, given that everyone responds differently and in light of what you describe, i think it's conceivable that the switch from 200 to 300 for you was where it stopped being at all sedating OR where it starting giving you (different) side effects. it's known to fairly widely have mild-significant sedation at "lower" dosages that, for many/most reduce as you increase. you increased by 50%, which, depending on the person and medication, could be a "higher" enough dosage for you to find it has a dramatically different effect or could require days/weeks/hopefully not months for you body to adjust. what i mean is that seroquel is kinda the opposite of many medications and makes you sleepier the *lower* the dosage, oftentimes. that change, and here, i'm totally hypothesizing given, as i noted, i've not taken it for mood disturbance (and, so you can consider the source: i also don't have mood disturbance), that 50% increase could make it seem like a totally different medication because, in some sense, it IS, or you could be having different/pronounced side effects as your body adjusts.

 

one other note about *possible* "causes": there's also, among antipsychotics generally, the risk of "paradox effect"; i.e. when it exacerbates (often the exact things) it's supposed to treat. one example is short-acting haldol injections. for a large percentage of people on the majority of occasions, those are "calming", let's say, when having a psychotic break and that's why, in combination with other things, they're so commonly given upon admission. at other times/for other people, the exact same injections can create (sometimes quite severe) agitation, rather than being at all calming. that example hasn't personally happened to me, but i offer it since it's a well documented one. i'm not saying that's what you're experiencing, i'm just throwing out options.

 

at any rate, that you 1. are feeling so different after the increase than before it, and 2. sound distressed and describe experiences that i'm sure you don't want to continue to have or have worsen, i suggest calling your prescribing physician/psych nurse/pharmacist/*someone* professionally overseeing your medical care, who has more expertise and an idea of your medical history, ASAP. i say "ASAP" because it could be a sign that you need to back off the dosage ...it could also be your body adjusting to the increase and that's how that works for you. could portend problems or be likely to resolve...or some third/fourth/fifth option. if you ring, they should be able to give you solutions/options/timeframe for likely resolution/tell you when/what, if not resolving, will indicate you need to make a further adjustment. since things over weekends, for me, "fester", so to speak, and tomorrow's the last weekday, i'm suggesting you ring ASAP and get some answers. 

 

hope that helps and best to you

[MiaB]

I obviously can't diagnose you, but my own experience was that as soon as my pdoc tried to increase my XR dose above 600mg, I developed akathisia and had to go back down again.  Surprisingly, the fact that I'm on an additional relatively small amount of the instant release didn't make a difference - it was specifically the XR increase that caused the symptoms. 

 

The impression I have of this med is that not everyone can tolerate higher doses, and what constitutes "higher" can mean different things for different people.  In your case it may be that 200mg is your limit, or that you need to try a smaller increase, but either way this is something you really must discuss with your pdoc.  She's the one who has the true know-how.  I must also emphasise that you shouldn't force yourself to suffer through this discomfort on the offchance that it'll all suddenly go away.