Seroquel long-term (and other) side effects at a low dose

[YogaAbbaFriend]

Hi, 

I have been on a trial of Abilify for the past few months for the treatment of PTSD. My main issues are sleep, flashbacks, irritability, and mood instability (but not bipolar). I found Abilify helpful, but it turns out to be too activating -- in the end, it made my anxiety worse. 

I also take Trileptal, which helps with sleep and mood. However, I am unable to increase it to a level that might help more with depression and anxiety -- if I go beyond the sweet spot, it makes me irritable. I also suspect that it may have worsened the side effects of some other meds I've tried (e.g., I think it caused me to have more spaciness when I tried Wellbutrin).

My new pdoc recommends that I discontinue the Abilify and start a low dose of Seroquel with an eye towards having that replace the Trileptal eventually.

I am extremely sensitive to medications and so will probably start at 12.5 mg (approximately, because it's hard to cut a pill into quarters). Given my sensitivity, I'm guessing that, if it is useful, I'll end up around 50-100 mg. For me, the name of the game here will be avoiding too much sedation during waking hours. Sedating medications make my depression much worse. I was unable to tolerate Lithium for this reason (it actually made me a bit suicidal, which is not a typical symptom for me). 

I have seen it stated in some places that the antihistamine properties of Seroquel make it more sedating at lower doses. This made me think of Mirtazipine, where increasing from 3.5 to 15 mg makes it less and less sedating. However, from the article cited in one of the stickies in this forum (https://thelastpsychiatrist.com/2007/07/the_most_important_article_on.html), I understand that in fact the sedative effect would increase in a linear way with dosage to a certain point, but then further increases would not make it _more_ sedating: 

Quote

Going from 25mg to 50mg is a big jump in sedation (level 1), but going from 400mg (level 3) to 800mg is not felt to be an increase in sedation. It's the same amount of sedation, because by the time you hit 400mg, you were all full up.

If I understand this correctly, it does make sense for me to start very low and go up from there in order to avoid excessive sedation. 

Otherwise, the one potential side effect that scares me is Tardive Diskenesia, which can be permanent after long-term use of even second generation antispychotics. (I suppose I should have asked about this before starting Abilify :-)  According to this article, however, the risk would be lower at low doses and may be mitigated by taking vitamin E: https://www.quora.com/What-is-the-risk-of-tardive-dyskinesia-in-low-doses-of-an-atypical-antipsychotic-1mg.

Any comments or further information about either of these topics would helpful. 

Thanks for your input. 
--YAF 

Edited October 22, 2017 by YogaAbbaFriend

[Juniper29]

Is there a reason you're taking the AAPs on their own instead of with an SSRI? Just wondering, I don't know your history. I also wonder about long term, low dose effects.

12.5 mg of Seroquel knocked me out better than Ativan, definitely take before bed.

[YogaAbbaFriend]

1 hour ago, Juniper29 said:

Is there a reason you're taking the AAPs on their own instead of with an SSRI? Just wondering, 

 

Oh, yeah, good question. I've tried a few and they had intolerable side effects. However, I suspect the side effects were caused by interaction with the Trileptal. So, my thought process is that if I can get off the Trileptal, then I'll try an antidepressant again. That said, as I understand it, seroquel on its own does have some antidepressant effect and for some folks that alone is enough. We'll see. 

 

1 hour ago, Juniper29 said:

12.5 mg of Seroquel knocked me out better than Ativan, definitely take before bed.

 Ah, that's useful to know. Do you use Seroquel PRN, or is there some reason you don't take it regularly? 

[Juniper29]

33 minutes ago, YogaAbbaFriend said:

 

 Ah, that's useful to know. Do you use Seroquel PRN, or is there some reason you don't take it regularly? 

I tried it briefly, but had trouble breathing. It's probable that the sedation wears off after a few days, but I couldn't tolerate it long enough to find out.

[browri]

Based on what I've read from other people's experiences (I've never personally taken Seroquel) as well as some reading of Stephen Stahl (one of the greatest psychopharmacological minds of our time) it seems that the threshold when Seroquel starts to become stimulating is around 200mg. Meaning, it will be sedating and continue to get more sedating as you go up from 50mg to 200mg and then the norepinephrine reuptake inhibition should start to make it stimulating during the day. But YMMV and some people can never get past the sedation even at 300mg or 400mg.

The XR seems to help with the sedation as well as the weight gain for some people.

[Iceberg]

For me it was sedating 25-400 then got less sedating at 800 (combo of 400ir and 400 Xr) The problem with XR is the lowest dose is 50 and u can't usually cut XR so u might have to start with ir by default. Definetly take it at night and for me if I took it a little before bed as opposed to right at bed there was less morning "hangover" 

[tryp]

I went as high as 600 mg on Seroquel and the sedation never got better.  I was totally zonked at all times and sleeping 12+ hours per night.  XR was not substantially better than IR for overall sleepiness, except that the XR didn't have that "hit you like a ton of bricks/immediate unconsciousness" that the IR had for me.

It was pretty good for my PTSD though.  I still take it as a PRN - my brain loves it.  Way better than benzos for me.  Just had to come off due to side effects (predominantly weight gain)

Edited November 7, 2017 by tryp

[Iceberg]

Many people have good luck with PRN  even at 12.5 ...I didn't but YMMV