Quetiapine modified release
Hi all I started my quetiapine modified release last night dose 50mg a night for a week upping every week by 50mg until I get to 400mg. As with other meds I didn’t get tired taking these last night the tiredness hits the next day. So I took them at 10.30pm last night didn’t help me sleep til about 6am I got up at 12 noon. I now feel like a zombie eyes are watering and burry no energy feel drowsy which I expected but my real question is, as they’re modified release should I take them earlier maybe evening and not night time so that hopefully I will find that the tiredness hits when it’s meant to and not like an hour before getting up? Anyone else tried these modified release ones and have any advice? Thanks peeps.
Re: Quetiapine modified release
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Originally Posted by
beautifulfreak77
I didn’t get tired taking these last night the tiredness hits the next day. So I took them at 10.30pm last night didn’t help me sleep til about 6am I got up at 12 noon. I now feel like a zombie eyes are watering and burry no energy feel drowsy which I expected but my real question is, as they’re modified release should I take them earlier maybe evening and not night time so that hopefully I will find that the tiredness hits when it’s meant to and not like an hour before getting up?
The problem with modified/slow/extended release formulations is the dose is released into the bloodstream continually for 24 hours so the time of day they are taken often doesn't really matter much. That said, for quetiapine XR the recommendation to reduce daytime sedation is to take it about 7-8 hours before you normally get up, but this seems not to have worked for you this time. However, a single dose probably isn't a good guide so I'd persevere with taking it at around 9:00 to 10:30 PM for a few more days.
Re: Quetiapine modified release
Hi thanks for replying, I did think does it actually matter what time but psychiatrist said still to take at night. Last night I took at 9.30pm and I was bit drowsy when I got up and that stayed until round about lunch time. So yes I may take at 9pm for few days as some of it is probably just the side effect of the tablet anyway. We have spoken before on here. May I ask your honest opinion of what you think about quetiapine, I have borderline personality disorder, GAD, agoraphobic, depression but I was/am feeling suicidal so been put on these with maybe a antidepressant being added in later. I just wondered what you thought about choice of tablet for my problem mainly the borderline personality being the problem at moment. So up and down. And I know it’s only your opinion... thanks.
Re: Quetiapine modified release
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Originally Posted by
beautifulfreak77
May I ask your honest opinion of what you think about quetiapine, I have borderline personality disorder, GAD, agoraphobic, depression but I was/am feeling suicidal so been put on these with maybe a antidepressant being added in later. I just wondered what you thought about choice of tablet for my problem mainly the borderline personality being the problem at moment.
Quetiapine is relatively benign, especially compared to other meds prescribed for your issues. Only time will tell if it is the right med for you, but it is a good starting point. Sedation is the most common side-effect. It tends to diminish after a while. Sedation might not be a bad thing for you atm. Sleep is a good healer. Just be extra cautious if doing anything potentially hazardous, especially driving.
Re: Quetiapine modified release
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Originally Posted by
panic_down_under
Quetiapine is relatively benign, especially compared to other meds prescribed for your issues. Only time will tell if it is the right med for you, but it is a good starting point. Sedation is the most common side-effect. It tends to diminish after a while. Sedation might not be a bad thing for you atm. Sleep is a good healer. Just be extra cautious if doing anything potentially hazardous, especially driving.
Do you know what would be a better combination for someone with my problems then? Yes I expected to be quite tired and I don’t mind for a while but I have narcolepsy so it’s making me feel worse in that way if you get me. But maybe you’re right and I just need sleep as I don’t sleep that well. It’s just making my daytime sleepiness a lot worse. It’s okay as I have narcolepsy I can’t have a driving license anyway as it’s not under control.
I’m not sure if it’s the quetiapine or just being so tired but my eyes are streaming everyday as if I’m crying but I’m not. Have you ever heard of that being a side effect. Sometimes it’s so bad I can’t see as eyes are so blurry from the water/tears. Thanks for your reply. I hope you’re well.
Re: Quetiapine modified release
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Originally Posted by
beautifulfreak77
Do you know what would be a better combination for someone with my problems then?
I think quetiapine is a good starting point. Only time will tell if it works for you, but there is a good chance it will. As per my previous post, quetiapine is usually fairly benign compared to other antipsychotics.
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Yes I expected to be quite tired and I don’t mind for a while but I have narcolepsy so it’s making me feel worse in that way if you get me. But maybe you’re right and I just need sleep as I don’t sleep that well. It’s just making my daytime sleepiness a lot worse. It’s okay as I have narcolepsy I can’t have a driving license anyway as it’s not under control.
The sedation may ease as the dose increases and will diminish further as your body adjusts, but it is going to take a while.
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I’m not sure if it’s the quetiapine or just being so tired but my eyes are streaming everyday as if I’m crying but I’m not. Have you ever heard of that being a side effect. Sometimes it’s so bad I can’t see as eyes are so blurry from the water/tears.
Quetiapine is a mild antihistamine so dry eyes (also dryness of the mouth and other mucus membrane areas) is the more common side-effect, but paradoxical reactions do occur and symptoms similar to seasonal allergy are relatively common. Having experienced dry eyes and mouth with previous ADs, I'd much prefer the reaction you're having. It may be short-lived, but if it continues mention it to your GP as there may be ways of reducing the tears.
Are you on any other medication, or supplement?
Re: Quetiapine modified release
Quetiapine is a mild antihistamine so dry eyes (also dryness of the mouth and other mucus membrane areas) is the more common side-effect, but paradoxical reactions do occur and symptoms similar to seasonal allergy are relatively common. Having experienced dry eyes and mouth with previous ADs, I'd much prefer the reaction you're having. It may be short-lived, but if it continues mention it to your GP as there may be ways of reducing the tears.
Are you on any other medication, or supplement?
i went to the chemist and they said dry eyes can cause watering eyes as your body is trying to make up for them being dry,she gave me some drops but to be honest there’s no difference yet. I’m still tired and drowsy the next day for quite a while , it’s just annoying due to being tired anyway from having narcolepsy, Altho I’m meant to start modafinil for that,I’m just scared to whilst getting used to the quetiapine I thought it best to get to my dose on quetiapine then add in the modafinil incase I got any side effects I wouldn’t know which one was causing it. As for other medication. I take cocodamol 30/500mg, diazepam 5mg 3 times a day, bisoprolol, questran, omeprazole...
Re: Quetiapine modified release
Quote:
Originally Posted by
beautifulfreak77
I’m still tired and drowsy the next day for quite a while , it’s just annoying due to being tired anyway from having narcolepsy, Altho I’m meant to start modafinil for that,I’m just scared to whilst getting used to the quetiapine I thought it best to get to my dose on quetiapine then add in the modafinil incase I got any side effects I wouldn’t know which one was causing it.
Being unable to pin down which med is responsible for a side-effect is definitely a potential problem when starting more than one med at a time. But you need to balance this against delaying getting the narcolepsy under control. It comes down to how much the narcolepsy is effective your life. If a serious issue does arise you can always stop the modafinil. It has a fairly short half-life, 12-15 hours, so stopping it should alleviate an side-effect/s within a day.
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As for other medication. I take cocodamol 30/500mg, diazepam 5mg 3 times a day, bisoprolol, questran, omeprazole...
That is a highish diazepam dose and may be contributing to the sedation. How long have you been taking it?
Re: Quetiapine modified release
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Originally Posted by
panic_down_under
Being unable to pin down which med is responsible for a side-effect is definitely a potential problem when starting more than one med at a time. But you need to balance this against delaying getting the narcolepsy under control. It comes down to how much the narcolepsy is effective your life. If a serious issue does arise you can always stop the modafinil. It has a fairly short half-life, 12-15 hours, so stopping it should alleviate an side-effect/s within a day.
yes the narcolepsy is quite bad and it’s taken years to get the proper diagnosis and medication so I wanted to try it pretty quick but as I’ve just started the quetiapine I thought it best to start one med at a time as I said as I wouldn’t know which one was causing any side effects. Do you think as the quetiapine is modified release it would Interfere with how the modafinil works? Do you think I should add the modafinil now? As I’ve heard sometimes it’s quite helpful with depression and that so maybe I wouldn’t need a higher dose on the quetiapine, or do you think I should get on a good dose of quetiapine and then start?
That is a highish diazepam dose and may be contributing to the sedation. How long have you been taking it?
I know that is classed as highish dose now but when I started many years ago I was on 50mg of diazepam... I came off that and a few years ago was put on 20mg I said to psychiatrist I can manage with it just 3 times a day. But I have an agreement with my psychiatrist I don’t have to take 3 a day. As I’m agoraphobic sometimes I need to go on further journeys and so if some days I’ve only taken 1 or diazepam then I have some left over and use them for if I have a stressful day or a journey far from home. I did come off diazepam and cocodamol to see in my sleep studies if it was sedating me and it’s not. Also when I have sedation at hospital like when I had an endoscopy I don’t get sedated I go the opposite same with the diazepam if I take a few at a time I go hyper as if I have taken a drug like amphetamine type drug,I even had a double dose of sedation into vein and my 3 diazepam and I was up chatting and doing thing for hours after it didn’t sedate me at all I remember everything in the room having the endoscopies and I’ve had a few now n happens each time.
Re: Quetiapine modified release
Sorry half my answer is in the quote bit of what you said some how. I’m not very good at using the right things on here nothing seems to come out right. So yes the modafinil bit is in with your bit of writing ����*♀️
Re: Quetiapine modified release
Quote:
Originally Posted by
beautifulfreak77
I know that is classed as highish dose now but when I started many years ago I was on 50mg of diazepam...
It was a high dose even back in the 1960-70s.
The irony is there is now good evidence BZDs actually produce the same brain atrophy that causes anxiety and depression as the initial trigger, high stress hormone levels in the brain. :ohmy:
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I came off that and a few years ago was put on 20mg I said to psychiatrist I can manage with it just 3 times a day. But I have an agreement with my psychiatrist I don’t have to take 3 a day.
I think you should seriously consider talking to your psychiatrist about weaning off diazepam. It is likely doing more harm than good. You may not need anything else once the quetiapine kicks-in, but if needed an AD would be a better option than diazepam.
Re: Quetiapine modified release
I think you should seriously consider talking to your psychiatrist about weaning off diazepam. It is likely doing more harm than good. You may not need anything else once the quetiapine kicks-in, but if needed an AD would be a better option than diazepam.[/QUOTE]
The thing is diazepam has always helped my anxiety and is the only thing that has helped it. And i know you’re probably thinking it’s all psychological and maybe it is. But I can do things once I’ve taken diazepam that I can’t do without it. The only other thing that worked but same family was temazepam...I prefer them, but don’t get prescribed them very often. I’m hoping the quetiapine will help my anxiety, and yes maybe il try and go without the diazepam, but I’ve tried so many meds for my anxiety it’s been a night mare I started in my teens and im now 42. I really feel I can’t live much longer feeling the way I do with the anxiety and the personality disorder. I hate the way it makes me feel and act it’s embarrassing at times. So I really want this quetiapine to work and when I start the modafinil, also the other antidepressant that they may want to add is amitriptyline, do you think that is a good choice? I tried mirtazapine before quetiapine but made my irregular heartbeat even worse. The reason I’m not having a ssri is that it really does send my anxiety through the roof and I can’t cope with being more anxious. Thank you for keep replying to me. It’s nice to talk to someone who knows the meds I can’t talk to my family about it as they don’t understand why I need different medications etc. Or even why I have the problem to be honest.
Re: Quetiapine modified release
Quote:
Originally Posted by
beautifulfreak77
I think you should seriously consider talking to your psychiatrist about weaning off diazepam. It is likely doing more harm than good. You may not need anything else once the quetiapine kicks-in, but if needed an AD would be a better option than diazepam.
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The thing is diazepam has always helped my anxiety and is the only thing that has helped it. And i know you’re probably thinking it’s all psychological and maybe it is. But I can do things once I’ve taken diazepam that I can’t do without it.
Yes, and that's the trap. The most prescribed 'med' for anxiety (and depression) isn't an antidepressant, or benzodiazepine, but alcohol. There are far more people self-prescribing it than taking ADs and BZDs and they will tell you it works great, and it does...while they on it. But it is also quietly worsening the brain deficit that produces anxiety and depression. The BZDs do the same.
Anxiety and depression are the emotional symptoms of atrophy of parts of the two hippocampal regions of the brain caused by high brain stress hormone levels, mostly of cortisol (PDF). It kills hippocampal brain cells and inhibits the growth of new ones. Antidepressants work by stimulating the growth of replacement cells (neurogenesis), as do the psychotherapies. It is the new cells and the connections they form which produces the therapeutic response, not the ADs directly. This is why it takes so long for ADs to 'kick-in.' It takes about 7 weeks for neurons to go from the precursor stage to full maturity, however, improvement often begins a week or two earlier.
Alcohol has the same affect on hippocampal neurogenesis as cortisol. Even moderate drinking can reduce hippocampus neurogenesis by nearly half (see also: Morris SA, 2010; Crews FT, 2003)
There is now good evidence that BZDs have the same effect as alcohol and cortisol and consequently significantly reduce the effectiveness of antidepressants (see: Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).
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The only other thing that worked but same family was temazepam...I prefer them, but don’t get prescribed them very often.
You're getting it anyway. Temazepam is one of the 2 primary active metabolites of diazepam and does much of the heavy lifting, both directly and through its metabolite oxazepam.
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antidepressant that they may want to add is amitriptyline, do you think that is a good choice?
...The reason I’m not having a ssri is that it really does send my anxiety through the roof and I can’t cope with being more anxious.
Yes, it could be a good choices, though the only way to know is by trying it. The advantage of the TCAs is that they come in low dose tablets relative to their therapeutic dose range which makes it much easier to begin on small doses and to titrate up by the same small amount to limit the severity of any initial side-effects. The TCAs tend to produce less side-effects at the beginning anyway (and less withdrawal symptoms when quitting), however, they tend to have more ongoing ones, mostly nuisances such as dry-mouth and constipation which can usually be managed fairly easily.
Re: Quetiapine modified release
Hi. I know what you mean with the alcohol I know many alcoholics/drug addicts that use the drink/drugs to cover there anxiety, but alcohol doesn’t cover mine it makes it worse while drinking and then the next day it makes me even more anxious,if I only had 2 drink I wouldn’t sleep,I can’t sleep when I have had a couple of drinks , so now I don’t drink it’s just not worth it.. also it makes me depressed now. It used to cheer me up for a bit but when I was having a few drinks I’d think why have you done this. You feel more anxious and depressed than before,now Ul suffer by not sleeping and feel worse tomorrow...
as for the diazepam I don’t know. Yes maybe it’s doing me harm but I don’t feel anxious after taking them. I don’t feel how I do when I’ve had a few drinks. But yes if I can come off them and just be on the quetiapine and amitriptyline then that would be great. I don’t like taking any tablets. Nothing else has ever worked and I do get dry mouth and that and on some other drugs I’ve been prescribed I’ve had some awful side effects. Ended up in hospital and other meds to take away what that med had done to me. Couldn’t leave my house for over 10 weeks was horrible. Yes once I have settled on a dose of quetiapine if it’s going to be helpful then il start the amitriptyline,just worried about how sedated il be in the morning. Once again thank you for your help and opinions on what I wrote. It’s nice to talk to you again.
Re: Quetiapine modified release
Quote:
Originally Posted by
beautifulfreak77
as for the diazepam I don’t know. Yes maybe it’s doing me harm but I don’t feel anxious after taking them. I don’t feel how I do when I’ve had a few drinks.
The difference is alcohol has a half-life of around 4-5 hours so it is mostly out of your system the next day, plus it has other physical effects such as dehydration which can exacerbate anxiety. OTOH, the diazepam half-life is 100-200 hours (incl. active metabolites) so even a single dose takes weeks to be completely eliminated and while the anti anxiety effect is much shorter it does buoy mood for much longer than alcohol typically with a slower decline.
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I don’t like taking any tablets.
You're not alone. Unfortunately, as we age they become an increasing part of life. :sad:
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Yes once I have settled on a dose of quetiapine if it’s going to be helpful then il start the amitriptyline,just worried about how sedated il be in the morning.
Meds which sedate via inhibiting histamine H1 receptors are typically most sedating at low doses usually becoming less so as the quetiapine dose increases so it will likely be less of a problem at 400mg/day than it is now, although this isn't an iron-clad guarantee because some do have paradoxical reactions. Amitriptyline can be fairly sedating on its own, but probably won't add much to whatever effect the quetiapine is having, but again, no guarantees.
Re: Quetiapine modified release
[QUOTE=panic_down_under;1955386]The difference is alcohol has a half-life of around 4-5 hours so it is mostly out of your system the next day, plus it has other physical effects such as dehydration which can exacerbate anxiety. OTOH, the diazepam half-life is 100-200 hours (incl. active metabolites) so even a single dose takes weeks to be completely eliminated and while the anti anxiety effect is much shorter it does buoy mood for much longer than alcohol typically with a slower decline.
Yes alcohol is just not for me now whether I take diazepam or not. It’s not meant to be taken with it and also quetiapine and amitriptyline say not to drink on them plus you take them at night so I’d be quite worried to drink then take meds.
You're not alone. Unfortunately, as we age they become an increasing part of life.
yes as I’m getting older my list of meds is getting longer.
Meds which sedate via inhibiting histamine H1 receptors are typically most sedating at low doses usually becoming less so as the quetiapine dose increases so it will likely be less of a problem at 400mg/day than it is now, although this isn't an iron-clad guarantee because some do have paradoxical reactions. Amitriptyline can be fairly sedating on its own, but probably won't add much to whatever effect the quetiapine is having, but again, no guarantees.[/QUOTE
yes I found that with mirtazepine the lower the dose the more sedating. Yes I’m hoping it doesn’t sedate to much but I do have to add in the modafinil too at some point maybe that will wake me up a bit more in the mornings. May I ask how you know so much about meds? Do you work in this area or is it just your own research?
Re: Quetiapine modified release
Quote:
Originally Posted by
beautifulfreak77
May I ask how you know so much about meds? Do you work in this area or is it just your own research?
An inquiring mind, lots of listening to folk in support groups like this for over 25 years and discussing issues with some of the leading anxiety and depression researchers.
I did do a first aid course a very long time ago. Run by an old Greek guy, Hippo something or other. He was big into humours. Didn't understand it at the time, but later I read that the art of doctoring was keeping the patient amused while mother nature healed, so I think that's what he must have meant. :D
Re: Quetiapine modified release
Quote:
Originally Posted by
panic_down_under
An inquiring mind, lots of listening to folk in support groups like this for over 25 years and discussing issues with some of the leading anxiety and depression researchers.
I did do a first aid course a very long time ago. Run by an old Greek guy, Hippo something or other. He was big into humours. Didn't understand it at the time, but later I read that the art of doctoring was keeping the patient amused while mother nature healed, so I think that's what he must have meant. :D
Oh right you must of really took notice and listened a lot and read a lot to know the amount of stuff you know, I like researching stuff myself as I have been like this since my teens and I’m now 43 next week eek. But I do forget things. My short term memory is getting worse,but long term memory is really good. I expect it’s all the meds and what I’ve been on over the years.
Now I don’t know if you’re humouring me haha with that story but if it’s true,then that’s cool. So laughter really could be the best medicine in some cases?! I don’t know if you’ve ever said but do you suffer with mental health illnesses? Or just interested? If you do have any would you feel comfortable telling me what they are? It’s fine if you don’t,but just interested. I hope you’ve had a good weekend..
Re: Quetiapine modified release
Quote:
Originally Posted by
beautifulfreak77
So laughter really could be the best medicine in some cases?!
Oh, definitely.
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I don’t know if you’ve ever said but do you suffer with mental health illnesses?
Yep. Since 12:05 pm, Sunday, 18th January 1987 when the panic attack which propelled me into the 'delights' of panic disorder began, followed the next day by an attack which put me into a potentially dangerous situation that solidified it. These weren't the first attacks, that was on Easter Saturday the year before, but there were plausible explanations for the symptoms that day so I'd dismissed it as not important. That Sunday's wasn't so easy to ignore, Monday's even less so. Fortunately, I responded well to ADs and continue to do so.
There were extraneous aspects to how/why I developed PD that began my search for answers about these disorders which then lead to studying anxiety disorders in greater detail. Fortunately, I initially had ready access to psychiatrists and psychologists in my job whose brains I could pick, although back in the late 1980s there was much less known about anxiety/depression and quite a bit was plain wrong.
Re: Quetiapine modified release
Yep. Since 12:05 pm, Sunday, 18th January 1987 when the panic attack which propelled me into the 'delights' of panic disorder began, followed the next day by an attack which put me into a potentially dangerous situation that solidified it. These weren't the first attacks, that was on Easter Saturday the year before, but there were plausible explanations for the symptoms that day so I'd dismissed it as not important. That Sunday's wasn't so easy to ignore, Monday's even less so. Fortunately, I responded well to ADs and continue to do so.
There were extraneous aspects to how/why I developed PD that began my search for answers about these disorders which then lead to studying anxiety disorders in greater detail. Fortunately, I initially had ready access to psychiatrists and psychologists in my job whose brains I could pick, although back in the late 1980s there was much less known about anxiety/depression and quite a bit was plain wrong.[/QUOTE]
I see I have panic disorder with agorophobia, I take it you're not agorophobic? Or do you struggle to go out etc. I can now go out locally if someone is with me but it’s getting harder now as kids are grown up and you can’t force them to go with you. I’m sorry to hear that you had it so bad that it put you into a dangerous situation...yes I didn’t tell my doctor for years as I thought I was going mad until one day I went and told him and when I did I fell to the floor where my legs had gone so weak altho I do have narcolepsy and sometimes I do wonder if it’s actually cataplexy but only when I have a very strong emotion, don’t know, probably never will. Yes I can imagine back in the 80s maybe anxiety/depression wasn’t taken so seriously...my auntie had it and yes was put on a high dose of diazepam like a lot of people back then. So you have had quite a long time to research these things but it’s still amazing what you know. You’re better than my psychiatrist,I tell them they’re just textbook as she says she doesn’t suffer herself that she’d not let her self fall into the trap of anxiety or depression which I thought was a bit unfair as none of us asked for this and it can happen to anyone. So as she doesn’t suffer from it she doesn’t know how her patients feel that’s why I call her textbook,cos if I say something that doesn’t fit in with what I’m diagnosed with she gets in a muddle lol. I’m glad you found an AD that suited you and still does. Thank you for sharing with me.
Re: Quetiapine modified release
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Originally Posted by
beautifulfreak77
I see I have panic disorder with agorophobia, I take it you're not agorophobic? Or do you struggle to go out etc.
I do when not medicated. There have been times when I literally couldn't set foot outside the front door of the house to check the mail. But with meds I can/have travelled the world. Drove the length of Tasmania and back today, around 500 miles.
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I can now go out locally if someone is with me but it’s getting harder now as kids are grown up and you can’t force them to go with you.
Gradual exposure can help. Walk from home until you begin to feel a little uncomfortable and stop there until the anxiety eases, then walk back home. Repeat it until you no longer feel any anxiety when you get to the same spot and then walk further until you again begin to feel a little uncomfortable and keep rinsing and repeating until you're comfortable going anywhere. The important bit is the word 'little.' The mistake many make is by pushing too hard and becoming overly anxious which reinforces the agoraphobia instead of diminishing it.
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she says she doesn’t suffer herself that she’d not let her self fall into the trap of anxiety or depression which I thought was a bit unfair as none of us asked for this and it can happen to anyone.
Exactly!! Anxiety/depression aren't a choice, any more than type 1 diabetes, or arthritis are. They are all caused by auto-immune reactions.
Some doctors have all the empathy of a house brick and the bedside manner of Ghengis Khan!! :mad: The problem is university selections for medicine are almost exclusively based on test results these days. It wasn't always the case in the past when empathy/bedside manner was also considered. There are still the odd med school holding the line, but not many. Plus, as a former GP of mine was fond of saying, these days GPs know less and less about more and more as knowledge expands exponentially , whereas specialities are going in the opposite direction, splitting into more and more sub specialities where they know more and more about less and less. It is almost at the point where the guy you see about a problem with a big toe can't help with little toe issues! :ohmy:
