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I just can't seem to quit Seroquel


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After going IP in April, starting lithium for the first time, and literally being able to come off every single other med I was taking, the one med I just can't get rid of is Seroquel. I went from 600 mg of XR in April to 400 XR by the start of summer, 150 mg IR by the end of summer, and recently this month 50 mg IR. But now my anxiety is completely off the rails, night time is especially bad. It feels like I was inches from the finish line, and now I¬†gotta back track on to a dose that gets this anxiety and panic under control. Anyone else feel this way in some regard? Is there anything else out there to fight anxiety symptoms for us bipolar folks? I was really aiming for monotherapy with lithium...ūü§¶‚Äć‚ôāÔłŹ

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@mjs190, is your goal to get off of antipsychotics completely? If you're still up for taking an antipsychotic, I personally had great results with Saphris (asenapine) for anxiety and insomnia. Right now I'm on Seroquel IR 100 mg for insomnia, but I plan on asking about Saphris again next time I see my pdoc because it's more weight-neutral for me. Despite its high affinity for the 5-HT2C and H1 receptors, it tends to be a weight-neutral AAP for most people, which is pretty surprising. The only downside of Saphris for me was the taste of the tablets: they're sublingual and taste pretty awful ("black cherry" flavor is a suggestion for the imagination! lol)

If you're up for trying something out of the box and you think your pdoc might prescribe it for you, trifluoperazine (Stelazine) works wonders for my anxiety. My pdoc doesn't like me to take it what with it being a typical AP and the associated risk of TD though. I take it periodically when my anxiety gets out of control. It helps my anxiety like no other anxiolytic medication does... It's not sedating (at least in low doses), and can actually be somewhat stimulating/energizing (not in a bad way), especially in low doses (2-4 mg/day). When I was on 6 mg/day, it did get a little sedating at 6 mg/day after a while of being on it though. It also tends to be weight-neutral.

As for other agents that aren't antipsychotics, have you ever tried hydroxyzine (either Vistaril or Atarax)? It works well for some, but mostly just sedates people from what I have heard of it... It doesn't really do much of anything for me unless I take it with a benzo. The absolute best control I ever had over my anxiety was when I was on a combination of Stelazine, Vistaril, and Serax (oxazepam).

Speaking of oxazepam, I don't know if you are trying to stay away from benzos or not, but I really like oxazepam quite a lot. When alprazolam stopped working for me a while back (tolerance), oxazepam worked when no other benzo would work. I'm back on alprazolam now, and oddly enough, oxazepam doesn't really do anything for me anymore. Diazepam (Valium) worked well for me too, even in super low doses (4-6 mg/day).

I see you've tried quite a lot of antidepressants to no avail. Do they just not help or do you have a tendency to become hypomanic with antidepressants? I ask because I didn't see mirtazapine (Remeron) on your list of past meds. I know it does have a huge risk of weight gain and metabolic issues, but it was just the only thing I could think of. Imipramine (Tofranil) is great for anxiety and insomnia, but being a TCA, it has a higher risk of causing mood cycling/switches.

Also, @argh's suggestions of Lyrica and gabapentin are always good too. Gabapentin, as I'm sure you know already, is even a second-line mood stabilizer for bipolar disorder (I personally don't believe it works as a mood stabilizer, but I'm not an expert either... lol). I didn't really get relief of any kind from gabapentin, even at 1,200 mg (I suppose I could've tried higher, but my pdoc didn't want me to). One of my best friends, however, was able to get significant relief (albeit for a limited time) on just 100 mg TID. He had to go up to 300 mg TID, which actually relaxed him too much... lol. I've never tried Lyrica, but have been curious about it. The weight gain risk deters me though.

I almost forgot about phenelzine (Nardil). I know it's an MAOI, but I've read that it helps immensely with people with severe anxiety.

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5 hours ago, argh said:

gabapentin acted as a mood stabilizer for me. Didn't provide full coverage but it definitely did work. Then again i'm on the softer side of BP2, practically not even BP at all,  so it might not help you.

In case I came off as discounting gabapentin's efficacy for anyone, I wanted to say I didn't intend my post to come across that way at all. :) 

Edited by mikl_pls
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On 10/17/2019 at 2:29 AM, argh said:

Lyrica? Gabapentin?

I've tried gabapentin very briefly and I really didn't notice much benefit I guess. Never tried Lyrica, though.

On 10/17/2019 at 3:50 PM, mikl_pls said:

@mjs190, is your goal to get off of antipsychotics completely? If you're still up for taking an antipsychotic, I personally had great results with Saphris (asenapine) for anxiety and insomnia. Right now I'm on Seroquel IR 100 mg for insomnia, but I plan on asking about Saphris again next time I see my pdoc because it's more weight-neutral for me.

As for other agents that aren't antipsychotics, have you ever tried hydroxyzine (either Vistaril or Atarax)? It works well for some, but mostly just sedates people from what I have heard of it... It doesn't really do much of anything for me unless I take it with a benzo. The absolute best control I ever had over my anxiety was when I was on a combination of Stelazine, Vistaril, and Serax (oxazepam).

I see you've tried quite a lot of antidepressants to no avail. Do they just not help or do you have a tendency to become hypomanic with antidepressants? I ask because I didn't see mirtazapine (Remeron) on your list of past meds.

Ideally I would like to stay on 25-50 mg for sleep, because if I don't sleep well, its reflected in my moods. I tend to spiral pretty quickly without at least 7-8 hours of sleep or more, which is almost impossible without Seroquel. One thing I've noticed is that Seroquel IR could potentially be causing me some anxiety. I don't know what it is about the IR form, but once it starts to kick in, I get anxious as hell. XR doesn't do this, so I may have to consider switching forms as someone else mentioned.

Vistaril never worked for me, I think maybe because I've always tried it while I was on Seroquel, and MOA-wise they're kinda the same.

I tried anti-depressants years ago while I wasn't on a solid mood stabilizer and I think they tended to cause me to cycle a bit faster IIRC. Cymbalta outright almost landed me in the hospital. I'd be interested in trying an SSRI now that I'm on a healthy dose of Lithium, but I'm not sure how my doctor will feel. I've read they can help anxiety if there's a mood stabilizer on board first.

I've also read Depakote can help with anxiety to some extent, so I might ask about that, too. Depakote always treated me well in the past.

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9 hours ago, mjs190 said:

Ideally I would like to stay on 25-50 mg for sleep, because if I don't sleep well, its reflected in my moods. I tend to spiral pretty quickly without at least 7-8 hours of sleep or more, which is almost impossible without Seroquel. One thing I've noticed is that Seroquel IR could potentially be causing me some anxiety. I don't know what it is about the IR form, but once it starts to kick in, I get anxious as hell. XR doesn't do this, so I may have to consider switching forms as someone else mentioned.

I'm sure you know this, but Seroquel, at 25-50 mg, is basically a glorified antihistamine with very little D2/5-HT2A antagonism (especially the IR version). Supposedly the XR version promotes more stable levels of norquetiapine, thereby increasing NET occupancy and increases the amount of time the NET is occupied. This theoretically could cause anxiety, but with all the other MOA's of Seroquel, one might think it would have more anxiolytic properties than anxiogenic properties.

Something like Saphris might be a good alternative to Seroquel that would have more mood-stabilizing properties as well as sleep-promoting properties, even at low doses. It might be worth discussing it with your pdoc.

9 hours ago, mjs190 said:

I tried anti-depressants years ago while I wasn't on a solid mood stabilizer and I think they tended to cause me to cycle a bit faster IIRC. Cymbalta outright almost landed me in the hospital. I'd be interested in trying an SSRI now that I'm on a healthy dose of Lithium, but I'm not sure how my doctor will feel. I've read they can help anxiety if there's a mood stabilizer on board first.

So SNRIs are out... lol. Have you tried Luvox or Paxil for anxiety? 

9 hours ago, mjs190 said:

I've also read Depakote can help with anxiety to some extent, so I might ask about that, too. Depakote always treated me well in the past.

I've read the same thing, but it can definitely impact cognition (or at least it did in my case...).

 

Another possibility is, if you aren't experiencing hypotension or bradycardia from the Inderal LA, you could have whomever prescribed it increase the dose to 80-120 mg.

Edited by mikl_pls
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  • 2 weeks later...

This is a well known effect if you take antihistamines or anything with antihistamine activity for a long time. You body gets used to having a reduced response to allergens. Take away the antihistamine and your body will be more sensitive to allergens for a while. A taper down of the antihistamine is indicated or just get used to scratching and itching. This doesn't happen to everybody, I take 2 strong antihistamines a day and if I miss them I don't itch. Could be an effect of the allergy desentization I had performed. It happened to a friend who was taking amitriptyline for sleep; when he quit he itched for a few weeks. Benadryl and, doxepin, almost all the TCA's, and some antipsychotics can do this and are commonly used for sleep. 

 

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