How do you fight Seroquel or other medication lethargy?

[TomServo4prez]

Hi this is my first post and of course I am filled with anxiety, I am not a forum posting type of person and don't like talking about my illness but I am desperate. I promise to contribute in the future and not just exploit this for my own needs.

I was diagnosed as bipolar 2 (sometimes 1 you know how they are) and depression when I was 14, I am 31. I think I have rapid cycling but I hate the DSM I explain myself as "I feel every emotion, especially the sad ones, too much." I have been medicated since 16. Whether I wanted to or not, for 15 years I have been drugged and for at least 12 years have been a cocktail of about 400mg Seroquel, 300mg Lamictal, and 200mg of Lithium. I was also diagnosed with hypothyroidism and menieres disease this year, so yeah f*ck 2016!! (BTW: had a terrible tardive dyskinesia experience with Geodon so yeah I wont switch to it, ruined my life.)

So with all these meds, (I know a lot of you probably have higher doses and I hope you do well don't want to seem like a whiner) I guess I have grown to accept it over the years but I want to make some changes that I know will be impossible if I continue the same habits. I know that exercise and healthy diet would help my condition and could make Seroquel lethargy easier to deal with but I cannot find anything online about how to help the drowsiness other than these obvious not so helpful tips. The only thing I found that I think will help me is trying to take it earlier before bed.

This year I have been working towards employment. I hate it but the 2011 death of my Mother destroyed me and after a bunch of new hospitalizations and almost dying from a overdose attempt I was put on SSI for mental illness. After bringing people into my life again and getting married over these last few much better years I feel immense shame and regret about being on disability and want to work again. I have to do better or this cycle of regret, shame and self loathing will keep me depressed with a wasted life forever. *I absolutely don't think there is anything wrong with other people being on disability for mental illness, I am grateful they have that option, I just don't want to do it anymore and know I will feel better about myself once I am doing something again.

This year I started biweekly therapy and have done DBT groups, things I hate, but my biggest barrier I have to fight is my drowsiness and incredible sleep inertia. For instance I set an alarm for noon to give my ferret her ear medicine today, I was very stressed recently thinking she was going to die but just needs monitoring and some ear medicine. I couldn't have a better reason to force me awake. I had twelve hours of sleep, ridiculous I know, but I let that alarm go off over and over until 1:30pm. I spent over an hour in bed with my eyes 1/4 inch open sort of looking at the ceiling, it is exactly like sleep paralysis if you have ever experienced that, screaming inside my mind at my limbs and eyelids to get out of bed for my ferret. I am so ashamed. This same experience ruined my college education and I had to leave during junior year from being late, not bad grades. I can't have that missed opportunity again.

My prescriber will never prescribe anything close to a stimulant, I once had concerta which helped. Before I got sick this year last year I was exercising and eating healthy and I barely felt better. The future success of my marriage and hopeful employment revolve around me trying to improve my life and becoming a normal responsible person. He loves me but it is unfair to him, I have spent 10 months in a rut when my cycling depression usually only happens a couple times a year for a few weeks. This is unfair to him and makes me hate myself. 

I cannot start the Ticket to Work program when I need to sleep 12+ hours a day and cannot wake when I need to. I am working on creating a solid sleep schedule and eating well/exercising again and am going to start volunteering which will create a predictable schedule for my body and tire me out. I have been researching sleep inertia and things about your cycle and the related tips to waking in the morning but I feel like other people who experience drowsiness from these medications might know something that could help me. I don't think I can lower my Seroquel without losing it, I have tried higher and lower I need 400mg. I just want to do the right thing and try to work and feel normal, feel better about myself. I used to draw and paint every day, I am sure my hypothyroidism is contributing to this extra long rut and increased sleepiness and am considering quitting Lithium which exacerbates that disease.

How do you combat lethargy from medication or depression? Do you have both mental illness and hypothyroidism compounding your lethargy?

[notloki]

The best option if amphetamines and ritalin are off the table would be Provigil, it promotes wakefulness without the kind of stimulation a true stimulant does. It is difficult to obtain unless you have sleep apnea, shift work issues,or narcolepsy.Those are its indications. I was able to get it after a fight with insurance for depression and ADD. It is schedule IV.

[mellifluous]

are you taking the bulk of your dosage at night? i divide my clozaril into one smaller morning dose and one larger night dose. it still took a while to adjust, but i would try taking the bulk or even all, if possible, at night.

 

sorry if you mentioned that above...i simply lack the attention span to read for very long right now.xx

[aura]

Have you tried the XR version of seroquel? It doesn't help with my oversleeping problems (Modafinil does, but it sounds like that's off the table for you), but I've heard others around here say that it does.

[dtac]

I never could adjust to the drowsiness from Seroquel. I was late to work recurrently, to the point that it adversely affected my job. That, plus the weight gain, blood sugar elevation, and liver enzyme problems forced me to get off of it. Lithium would make me sleepy too, but just during the day. With those two meds there aren't too many dosing choices, unfortunately. Have you gotten your thyroid levels checked recently? Lithium is known for messing with your thyroid (I'm pretty sure you know this.) 200mg of Lithium is generally too low to be therapeutic, have you had your blood serum level drawn recently?

Sounds like it may be time to explore other med options that aren't as sedating (Abilify comes to mind) if the sedation is the biggest factor. I know I've fought it with nearly every med I've been on, it's just taken the right balance to get it under control.

[melissaw72]

Do you think your dose of Seroquel could be too high?

[Alien Navel Cord]

What other AAP's have you tried beside the Slurroquel? I'm on Abilify and have had very minimal side effects (maybe just weight gain) and no sleepiness on it whatsoever. (I get sleepy from my klonipin and gabapentin but not Abilify). I hear ya on the Geodon, that stuff was the WORST - it made me euphoric manic which felt great, but it also caused the worst akasthesia and weight gain and caused me to actually rapid cycle (I think that is when my rapid cycling started). 

If I were you, I'd see about taking a different AAP if you haven't tried already. Or, like someone said above, break up the dose - in the morning take one, and at night take the other half and see if that works. Still taking the same amount but just not as likely to make you sleepy.

Interestingly enough, I was on slurrroquel for a while and it didn't have any effect on me whatsoever, good or bad. It didn't help my bipolar mania, and it never made me sleepy or tired. On any dose I tried. I highly recommend the Abilify if that's an option for you.

[cloudmonger]

On 12/30/2016 at 4:23 PM, dtac said:

I never could adjust to the drowsiness from Seroquel. I was late to work recurrently, to the point that it adversely affected my job. That, plus the weight gain, blood sugar elevation, and liver enzyme problems forced me to get off of it. Lithium would make me sleepy too, but just during the day. With those two meds there aren't too many dosing choices, unfortunately. Have you gotten your thyroid levels checked recently? Lithium is known for messing with your thyroid (I'm pretty sure you know this.) 200mg of Lithium is generally too low to be therapeutic, have you had your blood serum level drawn recently?

Sounds like it may be time to explore other med options that aren't as sedating (Abilify comes to mind) if the sedation is the biggest factor. I know I've fought it with nearly every med I've been on, it's just taken the right balance to get it under control.

I totally agree with dtac - Seroquel (and most A/P's) were all super super sedating for me. In fact, I was prescribed them for insomnia (and acute psychosis years ago) would never go on them again.

Your Lithium dose (200mg) seems low - perhaps you could go up on that and then taper down very slowly on the Seroquel? I would also suggest maybe giving a newer A/P (like Abilify) a try. Many people say that it can increase energy in certain doses. i also agree with getting Thyroid levels and Iron levels checked (both contribute to fatigue if they are off).

[melissaw72]

39 minutes ago, cloudmonger said:

i also agree with getting Thyroid levels and Iron levels checked (both contribute to fatigue if they are off).

I agree.  I have had low iron levels and I was running out of breath very fast, even with walking around, which made me tired, etc.  And the tired part ... I was very tired.

And definitely the thyroid level being checked too.

[Alien Navel Cord]

Don't want to hijack the thread but quick question: When on lithium, how do you know if your thyroid is hypo? Do you feel certain side effects or is it only detectable in the blood tests? And then the docs put you on meds for that? Is it reversable? 

[melissaw72]

3 hours ago, Alien Navel Cord said:

Don't want to hijack the thread but quick question: When on lithium, how do you know if your thyroid is hypo? Do you feel certain side effects or is it only detectable in the blood tests? And then the docs put you on meds for that? Is it reversable? 

I didn't feel anything ... a DR I had back then noticed my thyroid was enlarged.  She had me get lab work done, and it said I had hyperthyroidism (not hypo).  I don't remember feeling side effects, but that is NOT to say there aren't with other people.  I am almost positive that others feel some sort of (something) ... or have an unexplainable  fast weight gain, or something that is really out of wack that it is questionable.  Yes, I was put on meds for it.  Idk anyone who has a thyroid problem under control without meds.  Yes the thyroid problems were reversible for me ... it took over 10 years for my thyroid to go back to completely normal.  There is absolutely nothing wrong with my thyroid now. 

[confused]

I have lots of problems with fatigue. I have tried with my pdoc, changing dosage and scheduling with a little benefit. But, I recently had a sleep study and found i have sleep apnea. For years, I have been blaming my fatigue all on meds, I am sure they are part of it, but there is more. I have hypothyroid but I take medication and it is in control. I also take 50mg seroquel at night.

I am working part time on my ticket to work. I am hoping once i adjust to the cpap I will have more energy and be able to be more productive.

[Strangelove]

TomServo, 

first of all, let me say that I am SO sorry about your Meniere's diagnosis!! I have Meniere's disease as well, and learning to live with Meniere's plus Bipolar Disorder is a crapfest. Not to mention that the meds can often increase your chances of having a relapse of vertigo! 

Mad far as Seroquel sedation -- what has helped me is taking my dosage in the evening between 6 and 7 pm. Yes, I wind up in bed a lot earlier, but I can still drag myself out of bed by 6 am. You learn to deal with the fatigue and become accustomed to it as you spend more time on Seroquel. As a BD I, GAD insomniac, Seroquel has really helped me. I hope you are able to find a way to work around its SE's.