Starting quetiapine

[panic_down_under]

I am not sleeping so well and while I know quetiapine is meant to be sedative, I'm wondering if it's possible for it to do the opposite? I'm still on mirtazapine but it's not making me sleep like it used to.

Both quetiapine and mirtazapine affect much the same receptors to about the same degree which might be the issue as these meds are usually at their most sedating at the low end of their dose range, becoming less so as the dose increases.

I spoke to GP on the phone and will have bloods next week, but I'm not sure how much of a risk it is, or whether I'm overreacting, or whether to cancel the bloods if it improves?

Leucopenia and neutropenia are relatively common quetiapine side-effects affecting up to 10%, however, given you're only on a low dose your symptoms are more likely to stem from the cold. Even if you're feeling well next week the blood test would still be worth having, imho, even if only for peace of mind.

I never knock back any medical test doctors suggest even ones I'm sure are a waste of time because twice they have picked up other things which might not have been found until it was too late. Those of us with anxiety/depression tend to live longer than 'normies' and the main reason seems to be we see doctors more often and so are more likely to have problems discovered at an earlier, more easily treated stage. Being nutz can sometimes be an advantage.

[Dying_Swan]

Thank you so, so much. Can't tell you how much it helps to have your advice. I don't know what I'll do about sleep, but that makes sense. Do you think trazodone would help? I don't know if that also acts on the same receptors?

I am relieved that you think it's more likely the cold and not neutropenia, but I'll go for the bloods just in case. My immune system has gone a bit up the creek this year, simultaneously letting me down whilst also attacking me, and I don't know how neutropenia etc would impact on all that. You're right that peace of mind is a good idea. Thank you again. You're a total star.

[panic_down_under]

Do you think trazodone would help? I don't know if that also acts on the same receptors?

Mirtazapine and quetiapine mostly rely on blocking histamine H1 receptors to induce sleep. Trazodone is a much weaker H1 inhibitor and seems to rely mostly on serotonin 5-HT2a and alpha 1a receptors so it would definitely be worth a shot. Its use for sedation is well covered in Settimo L, Taylor D., 2017 (PDF) beginning toward the end of article page 99, the fourth page of the PDF.

[Dying_Swan]

Thank you so much. I'll have a read and ask the psych again about it.

[Dying_Swan]

Another psych review. Increasing to 300mg quetiapine, which I expected, but surprisingly reducing venlafaxine as he doesn't think it's helped. I said I can't tolerate once daily XR ven, so would take 75mg twice a day, but am thinking now I might try just the 150 in the morning. I'm a little worried as felt rubbish on 150 before, but maybe the quetiapine will take care of that. We agreed I'll go straight up to 300 and not do increments, as each increase seems to cause agitation. Also got the ok to try trazodone instead of mirtazapine for sleep. 50mg trazodone, which according to that article seems to be ok. I just have to wait for the letter to get to the GP to get them.

[pulisa]

Do you feel satisfied with the review, DS? is there a plan to replace the ven?

[Dying_Swan]

I think so, I get the impression he knows what he's doing, it's just frustrating that I don't seem to be improving as quickly as I'd like. I think the idea is that the extra quetiapine will replace the reduction in ven. Very much hoping I won't have withdrawal. Hope you are doing ok?

[pulisa]

It must be a tough job being a psychiatrist (although certainly a lucrative one!) because individual response to drugs isn't predictable and it's all a bit trial and error.

It's good that you're happy with him and with his decisions because that all helps. I've seen some psychiatrists and have thought they have more issues than i have!!

[Dying_Swan]

You're right about lucrative, especially when NHS mental health care is so underfunded and lacking and people are so desperate. I bet it's an interesting job, quite unlike other branches of medicine. So far I've survived 24 hours of 150mg venlafaxine and 300mg quetiapine, and like clockwork, heeeeeere's agitation! At least it's just the one increase this time. In a strange turn of events, I accidentally ate half a nitrofurantoin (antibiotic) capsule tonight, and am hoping there's no interaction. Think it's ok. I could ring 111 to check but fear I'd burst out laughing, or possibly crying.

A question. I take omeprazole and propranolol alongside venlafaxine for side effects, but if I'm taking it once a day I figure I don't need these twice a day. I've cut the omeprazole to once daily (20mg) but I have a feeling you have to be more careful with reducing propranolol. I have been on 20mg twice daily (40mg/day) and wondering if I can cut the evening 20mg? So that would be just 20mg in the morning. Or I could reduce and take 10mg PM. Sorry, I know I'm waffling again. Trying to keep calm and not doing a very good job

[panic_down_under]

A question. I take omeprazole and propranolol alongside venlafaxine for side effects, but if I'm taking it once a day I figure I don't need these twice a day.

But venlafaxine XR is being released into your blood stream continually for ~24 hours. Omeprazole has a very short 1 hour half-life, though it's effect lasts longer than this and propranolol's is only 3-4 hours with its metabolite extending its effects by several more hours.

I've cut the omeprazole to once daily (20mg) but I have a feeling you have to be more careful with reducing propranolol. I have been on 20mg twice daily (40mg/day) and wondering if I can cut the evening 20mg? So that would be just 20mg in the morning. Or I could reduce and take 10mg PM.

I think you should discuss this with your GP first and definitely don't cut the propranolol PM dose completely until you've done so.