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Thread: Starting quetiapine

  1. #11
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    Re: Starting quetiapine

    Thank you both for your replies. Really helpful to know. I've been worrying mildly about serotonin levels with this current regime but hopefully it's ok. The thought of coming off ven terrifies me and I have heard its not nice. I'm not really keen to increase it further. Today has been ok, I've just felt very tired which I guess is to be expected. I've emailed the psych to say basically I don't want to stop mirt, but haven't heard back yet. I might drop it to 7.5mg but I'm not willing to stop it yet. Pulisa - would mirtazapine be an option for your son? I have found it amazing for sleep. I'll definitely keep you posted. Not too sure when I'll increase the quetiapine again, I might leave it a bit longer. Thank you again, and PDU, I will ask him about those drugs if this regime doesn't work out. I asked about trazodone a while ago after you mentioned it but at the time he preferred for me to have mirt, don't know why.
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  2. #12
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    I asked about trazodone a while ago after you mentioned it but at the time he preferred for me to have mirt, don't know why.
    In the U.S. and Australia trazodone is the preferred med for SSRI/SNRI induced insomnia, but mirtazapine seems to be the NHS choice. Imho, trazodone is the better of the two simply because it has a much shorter half-life which lessens any sedation carry over into the next day. It is also a pretty good antidepressant at high doses, however, it is only a very weak serotonin reuptake inhibitor so won't help with venlafaxine withdrawal.

  3. #13
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    Re: Starting quetiapine

    Thanks PDU. He said he uses trazodone often but for whatever reason preferred mirtazapine for me. The whole combo totally knocked me out last night and I slept for about 14 hours feeling rough today - nauseous, cold, light headed. Feels a bit like I've had half a bottle of vodka, though I haven't. Speaking of which, I'm not sure what to do about alcohol. The box says no alcohol at all, the psych just pointed out its a depressant but didn't exactly say none at all. I'm not planning on heavy drinking or anything but what would your thoughts be? It also says no grapefruit juice, but I can't see that being a problem! I'm not feeling enthusiastic about the next increase if this is how it makes you feel. The mental health people want me to take diazepam as needed but I'm feeling pretty wary of adding another CNS depressant into the cocktail. Sorry for waffling, I wasn't expecting to feel so yucky.
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  4. #14
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    Re: Starting quetiapine

    Just had a callback from duty GP, who won't get involved in psych meds whilst there's a psychiatrist involved
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  5. #15
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    Speaking of which, I'm not sure what to do about alcohol. The box says no alcohol at all, the psych just pointed out its a depressant but didn't exactly say none at all. I'm not planning on heavy drinking or anything but what would your thoughts be?
    Alcohol is problematic for two reasons. Firstly, it blocks the hippocampi neurogenesis mechanism by which ADs work. Even moderate drinking can reduce hippocampus neurogenesis by nearly half (see also: Morris SA, 2010; Crews FT, 2003.

    The second problem is that ADs and psych drugs can affect the impact alcohol has. Some days you might be able to drink a herd of alcoholic elephants under the table without raising a sweat, at other times half a pint of light ale may turn legs to rubber. One or two drinks *occasionally probably won't hurt, but be careful until you work out how the meds/alcohol combo affects you and don't drive even if you think you're okay.

    * note: "occasionally" does not mean on every day which ends in a 'y'!

  6. #16
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    Re: Starting quetiapine

    Thank you, that is helpful info. I guess it sounds like alcohol isn't going to be a great idea, though at some stage I might test out a small amount. Usually I find it hard to stop once I start so I should probably avoid it for a while. I'm also meant to be taking diazepam, possibly changing to lorazepam, though I'm nervous about the number of CNS depressants here. The psych isn't keen on benzos but the MHT are - although they were only very briefly involved. I've just emailed psych again as don't really know what I'm doing anymore. Really worried about hassling him but as the GP won't advise, I don't have much choice. I'm incredibly thankful to have your advice here. I definitely wouldn't drive with alcohol, don't worry.
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  7. #17
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    Re: Starting quetiapine

    Mixed messages are so unhelpful and confusing. Can't the psych manage your care without additional "help" from the MHT? Just so you have one point of contact re prescribing?

  8. #18
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    Re: Starting quetiapine

    Thank Pulisa. He mainly is but I had a big meltdown at the weekend and they got involved, albeit briefly. The psych is private, and although I emailed him with their recommendations, I didn't hear back. I guess I'm one of many patients. Turns out the GPs haven't had his letter so won't prescribe anything without it. I'm stressed out about that and that once they do get it, they'll stop mirtazapine. I don't know if it's normal to feel worse when starting quetiapine but I sure as hell ain't feeling better. Sorry to be so gloomy. I'm so tired of it all.
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  9. #19
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    I'm also meant to be taking diazepam, possibly changing to lorazepam, though I'm nervous about the number of CNS depressants here. The psych isn't keen on benzos but the MHT are
    Taking a benzodiazepine occasionally is probably okay, but they become counter productive when taken often because they also inhibit hippocampal neurogenesis, i.e. it's the same issue as alcohol, but maybe worse.

    I don't know if it's normal to feel worse when starting quetiapine but I sure as hell ain't feeling better.
    Unfortunately, most psych meds make things worse at the beginning. It's almost a feature, not a bug. So don't read too much into how you're feeling atm, it probably isn't telling you anything useful about the med in the longer term.

  10. #20
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    Re: Starting quetiapine

    Thank you so much. I really do hope this is temporary, and your post is reassuring. I once heard the term "agitated depression" and think this might be it. I think diazepam is kicking in now which helps a little bit. I'm assuming alcohol and diazepam isn't likely to be recommended I have also noticed I have immediate release quetiapine and everything I've read says it should be XR for adjunctive treatment of depression. Do you think that matters?
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