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Thread: Starting quetiapine

  1. #1
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    Starting quetiapine

    Hi folks.

    My psychiatrist decided yesterday to switch me from mirtazapine to quetiapine. I'm also on 225mg venlafaxine. I started mirtazapine in June and it has been amazing for sleep, but first dose of quetiapine has kept me up all night. I'm quite concerned by this, and also about weight gain. I put on a couple of pounds on mirtazapine and psych says quetiapine won't be any worse. I'd be grateful for any insight or experiences. I've been on some form of antidepressant since 2005 but antipsychotics are a new one for me and I'm apprehensive.

    Thanks
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  2. #2
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    Re: Starting quetiapine

    Sorry I should add dose of quetiapine - starting on 25mg, to increase to 100mg over 4 weeks
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  3. #3
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    I've been on some form of antidepressant since 2005 but antipsychotics are a new one for me and I'm apprehensive.
    Don't get too hung up on labels, they can be pretty meaningless with some being more about marketing than descriptive.

    There's not that much difference between mirtazapine and quetiapine. They hit the same receptors, though the ratios are a little different and quetiapine is less potent with 50mg quetiapine being roughly equal to 7.5mg mirtazapine.

    Has quetiapine being prescribed to augment venlafaxine because it isn't effective even at 225mg, or to replace mirtazapine for sleep?

  4. #4
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    Re: Starting quetiapine

    Thanks so much for replying, I was hoping you'd see this. I think it's mainly to augment ven but also to help with sleep. I got myself into a bit of a stew and emailed the psych who has come back and said to take it again tonight but with mirtazapine too, though he didn't say how much mirt or for how long. Yesterday he said he didn't want me on all 3 as it would be harder to keep track of what's working, but I guess my panicked email changed his mind
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  5. #5
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    I think it's mainly to augment ven but also to help with sleep.
    I'm guessing it more about augmenting venlafaxine. How effective is it? Close to having you back to 'normal', or falling well short and how long have you been on 225mg/day?

  6. #6
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    Re: Starting quetiapine

    I've been on 225 ven for about 2 months, and just 2 days on 25mg quetiapine. I'm not sure how effective it's been. I felt good after the ven was increased at first and mirtazapine was added, but the initial peak seemed to tail off after a week or so and I started to have some real ups and downs. That was partially stabilised by increasing mirt to 15mg but didn't help enough I guess. Last night I took ven, mirt and quetiapine and finally got a few hours sleep, but was still awake for longer than I'd have liked. Early days but so far, I'm not convinced quetiapine is going to help. Thanks so much for your help.
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  7. #7
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    I've been on 225 ven for about 2 months, and just 2 days on 25mg quetiapine. I'm not sure how effective it's been. I felt good after the ven was increased at first and mirtazapine was added, but the initial peak seemed to tail off after a week or so and I started to have some real ups and downs.
    Then, imho, you and your doctor need to start thinking whether venlafaxine is worth continuing with. I don't see the point in taking a med which isn't effective on its own and then adding more and more drugs in the hope of finding the magic cocktail that will solve all your ills. Maybe if the primary med was 95% of the answer, but not if it's falling well short. The absolute maximum venlafaxine dose is 375mg so upping it a bit is an option, but there are some potential risks and based on what you've been prescribed lately it looks like your doctor doesn't want to go there. Understandable.

    The way I see it you have two options, hang in there for another month in the hope the venlafaxine kicks-in, which is still possible, but becomes less likely with each passing day, or cutting your losses and switching to something else, perhaps just the quetiapine if it makes a significant difference.

  8. #8
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    Re: Starting quetiapine

    Thank you, that's really helpful. He's already said max dose of ven would be 300mg (though I've read 375mg as you say), but I don't get the sense he's keen to increase it any further, as he wanted me to change it entirely to mirtazapine initially (I resisted but agreed a small dose). Can I ask what the risks would be with higher doses of ven? We're now going to have a battle about mirtazapine because I want to stay on it for sleep. Increasing tonight to 50mg quetiapine on advice of mental health service. Thanks so much for all your help. You are so knowledgeable!
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  9. #9
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    Re: Starting quetiapine

    I'm sure you already know but ven is notoriously hard to come off if your psych decides to change to a different drug. I really hope the quetiapine helps you and makes a diffference. Adjusting to different doses and addition of new meds can be very stressful when it's hard to predict what will happen..if anything does of course.

    My son is seeing a psychiatrist on Tuesday-he has been surviving on very little sleep for weeks-so I'll be very interested to hear how you get on with your new regime.

  10. #10
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    Can I ask what the risks would be with higher doses of ven?
    Mild to moderate serotonin toxicity. The rule of thumb is that serotoninergic ADs reach their full potential once 80% of the serotonin transporters are blocked. Venlafaxine usually meets that goal at doses <=150mg, so the only point of taking more is to antagonise the noradrenaline/norepinephrine (NA) transporters which might be worthwhile if venlafaxine became a strong NA transporter blocker, but it is only a weak antagonist even at 300mg. Meanwhile, the extra serotonin activity can lower the seizure threshold and adversely affect the other serotonergic organs. There is also the difficult withdrawal issue pulisa has mentioned which can be more prolonged the higher the dose being weaned off, although may be of less concern if switching to another serotoninergic AD.

    Instead of increasing the venlafaxine dose any further a better option, imho, would be to add a small dose of one of the NE reuptake inhibitors, either desipramine or nortriptyline, but I believe the NHS isn't keen on this and prefer adding mirtazapine, or quetiapine when SSRIs/SNRIs don't work adequately.

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