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Thread: Starting quetiapine

  1. #21
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    I'm assuming alcohol and diazepam isn't likely to be recommended
    No! Not only is their the issue of a additive impact on neurogenesis, but the combination is potentially fatal as both depress brain stem activity. The brain stem takes care of a lot of basic functions, including the breathing and gag reflexes. In large doses the combo can lead to asphyxiation during sleep. Gag reflex suppression increases the risk of choking on vomit, or inhaling it into the lungs.

    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?
    Quetiapine has a short half-life, around 6-7 hours, which makes it a better sleeping pill than mirtazapine because the sedation is less likely to continue into the next day. However, for depression, and especially anxiety, the trick is to maintain plasma levels as even as possible. Taking it in 2-3 split doses usually works well enough, but slow-release formulations are even better and only need to be taken once daily which increases compliance. Humans, being the ornery creatures we are, become progressively less interested in taking a med the more often we have to each day.

  2. #22
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    Re: Starting quetiapine

    I'm so sorry that you are feeling so bad, DS. For what it's worth, I also have a diagnosis of "agitated depression". It's so frustrating when letters take ages to reach the right people which delay things and leave you in the lurch.

    I'd say ring the psych's secretary and find out where that letter to the GP is? I always felt like a zombie on anti psychs-why can't the mirt be continued if it helped with sleep?

  3. #23
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    Re: Starting quetiapine

    Thanks both. I'll try to avoid the booze/diazepam combo then I've had the two together numerous times but not with quetiapine. I will ask about XR next time. I'm a little surprised he didn't prescribe that as he was very keen for my venlafaxine to be XR. Perhaps that explains my mood getting lower as the day goes on.

    I had a call from the psych today who wants me to get up to 100mg quetiapine quickly, and it sounds like he's going to up it further at my next appointment, to 200-300mg. He thinks it should help me sleep but agreed I can stay on mirtazapine too if I need to, so I'll probably drop that to 7.5. He didn't say much about diazepam or lorazepam, just that they're for emergencies and I can take them if I need to. I'm really hoping the letter has got to the GP or I'll run out of quetiapine.

    Ive felt pretty exhausted today and the lovely moments of euphoria I was getting before have gone for now, but I'm not currently feeling quite as awful as I did the last 2 nights so will try to get an earlier night I think.

    Sorry for long rambling post. It helps me to get it out here.

    Pulisa, I'm sorry to hear you go through this too. Can I ask how agitated depression makes you feel? I think he thought the mirt hasn't done much for my mood and that being on too many things at once makes it difficult to know what's working
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  4. #24
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    Re: Starting quetiapine

    I'm probably right at the other end of the "can't get out of bed" spectrum. There's no way I could tolerate a day doing nothing as I need to keep moving no matter how bad I feel. just to try to distract myself and get away from my thoughts.

    I don't take meds but have done in the past. I have some diazepam for the really bad times but take it sparingly. It doesn't do much anyway. I need to function predictably for my family so have worked out my own coping mechanisms which help me get through the day and night.

    I'm glad your psych got back to you and I hope that you can sleep tonight..

  5. #25
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    sounds like he's going to up it further at my next appointment, to 200-300mg
    That is the usual dose range when augmenting an antidepressant. It may look like a lot, but it's a modest dose relative to the maximum 750mg for the immediate release, 800mg for XR formulations.

  6. #26
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    Re: Starting quetiapine

    Thanks guys. I guess I'll see how it goes at 100 when I get there, and brace myself for a further increase. Feeling a bit better today although still cold, and still managed to sleep with 7.5 mirtazapine. The letter has finally got to the GP too, so I should be ok and not run out. I looked up agitated depression and it sounds exactly like what I have sometimes been experiencing, though not all the time. The GP won't give me lorazepam without the psych requesting it, so I suppose I'll stick to diazepam for now. I agree Pulisa, it doesn't do a whole lot, but I think it takes the edge off. It must be very difficult for you trying to look after a family feeling this way, and I admire you enormously.
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  7. #27
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    Re: Starting quetiapine

    Oh don't admire me, DS!! I muddle through the best I can but I'm hardly a good advert for coping with all this!

    I'm glad that your GP has got all the info needed to prescribe. Chasing up letters just adds to all the stress and angst. I hope you feel a bit more stable this weekend and reassured that your new meds regime will be a positive move and that you can get some sleep which always helps so much during the challenging times.

  8. #28
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    Re: Starting quetiapine

    Thank you Pulisa, and I still admire you! It's hard enough dealing with it when you don't have kids to think of, let alone when trying to run a family.

    I increased up to 100mg last night. Had a busy weekend which left me exhausted, but I think was a helpful distraction. I'm going to stick at that dose now until next psych review, alongside 225 Ven and 7.5 mirtazapine. Apart from being tired and cold, I've not noticed any other major side effects. Anxiety ramping up a bit, and I miss the euphoria, but I guess the aim is stability. Definitely more stable than last weekend so hopefully that's a good sign.
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  9. #29
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    Re: Starting quetiapine

    Panic down under, could I ask a quick question? I know you said quetiapine has a short half life of 6-7 hours. I'm just wondering how it can help depression if half of it is out of my system by the time I wake up? Is it supposed to do its job when I'm asleep? Sorry if it's a silly question, and thanks in advance.
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  10. #30
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    Re: Starting quetiapine

    Quote Originally Posted by Dying_Swan View Post
    I know you said quetiapine has a short half life of 6-7 hours. I'm just wondering how it can help depression if half of it is out of my system by the time I wake up? Is it supposed to do its job when I'm asleep? Sorry if it's a silly question,
    The only silly questions are those that are never asked.

    Quetiapine seems to work by enhancing the ability of antidepressants to grow new brain cells (neurogenesis) in the hippocampal regions of the brain. Its active metabolite norquetiapine is also a fairly potent noradrenaline, aka norepinephrine, reuptake inhibitor which may add to its effectiveness at higher doses.

    As for the short half-life, norquetiapine has a similar half-life, but I don't know whether this actually lengthens the time the med remains effective as the NRI antidepressant impact is distinct from the parent drugs neurogenesis affect. I think they probably run in parallel rather than serially. Either way, with daily dosing plasma levels of both quetiapine and norquetiapine reach a *steady-state in about 2 days at which point their plasma levels will remain pretty much constant across 24 hours. But for a good therapeutic outcome immediate-release quetiapine should be taken 2-3 times a day. The XR formulation only needs to be taken once daily, preferably in the evening.

    * as a rule of thumb it takes about 5 half-lives for a med's plasma levels to stabilize to a steady-state with regular dosing

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