Starting quetiapine

[Dying_Swan]

It often significantly lowers heart rates (Bradycardia) which might be more responsible for the dizziness when getting up quickly than the low BP.

Methylpred? Thank you for that. I'm really hoping I'll not need it for much longer, and I'm using a bit of trial and error with the dosage. My BP seems to be sitting around 90/50, but I'm not sure whether to be worried about fainting or whether that'll be ok. I might start reducing my propranolol if it continues. Only on 40mg/day but I might bring it down a bit. I think tomorrow I might try 100mg quetiapine in the morning and 300 at night (currently 200 am and pm). If I'm going to have low BP I'd rather it's at night

[panic_down_under]

Methylpred?

Yes, on lower bpm.

I think tomorrow I might try 100mg quetiapine in the morning and 300 at night (currently 200 am and pm). If I'm going to have low BP I'd rather it's at night

I'm not sure about that as the lower AM dose might be inadequate for its intended purpose.

That aside, interestingly, very recent advice for those taking BP meds is to take them at night, rather than in the morning as probably most do. Doing so significantly reduces the risk of heart attacks and ischaemic stroke, apparently.

[Dying_Swan]

Thank you PDU. I hope I can stop the steroids soon, maybe even today. If not I'm going to try quartering the tablet to take the lowest dose possible. I'm wondering if they are also affecting my mood. Last night I was feeling awful, then I worry I'm "immune" to antidepressants and sedatives and that nothing will ever help. I was taking the whole 400mg quetiapine at night but my GP suggested splitting it to twice daily due to the low BP. I think though, it's just making it drop during the day too, so I was thinking to go back to the original 400 at night. As long as I'm asleep when it kicks in, it's fine, but if not I know all about it.

Interesting about BP meds. I'm not on propranolol for BP but assume it has an impact. A GP told me years ago not to take it at night as he said it keeps you awake, though it sounds like it's better to take it at night.

[panic_down_under]

I think though, it's just making it drop during the day too, so I was thinking to go back to the original 400 at night. As long as I'm asleep when it kicks in

In slow-release form there shouldn't be a specific kick-in, just a pretty much level continuation, however, because the rate people metabolise meds can vary significantly there may be some who notice a drop off in apparent effectiveness before the next dose is due. The only certainty about psych meds is that there is no certainty. Everyone responds to them in their own unique way and even that can change from time to time. They are all very much 'interesting' meds in the Chinese sense of that word.

I'm not on propranolol for BP but assume it has an impact. A GP told me years ago not to take it at night as he said it keeps you awake, though it sounds like it's better to take it at night.

Seems so, though I don't know if beta-blockers (B-B) were part of the study which made the discovery. I think these days they aren't prescribed much for lowering blood pressure. Plus I'm not sure the GP was right. The B-Bs are generally tiring meds, not sedating in the way antihistamines are, but physically tiring, because of their impact on adrenaline. At least that was my experience when I was on one for a while years ago. Some afternoons I felt like I'd swum the Olympics 1,500 metres through a pool of treacle and felt exhausted. However, keeping the earlier caveat in mind, YMMV.

[Dying_Swan]

Thank you PDU. I like what you said about there being no certainty. That's reassuring when I feel like I should be on cloud 9 with all this lot, but am absolutely not. Perhaps I will ask again about slow release. Last time I asked I was told there was no need as I wasn't having problems, but I think the BP and inner restlessness issues started for me at 300mg. I tried 100 yesterday morning and didn't feel dizzy thankfully, but I fell asleep last night without taking the 300, so not too hot today. I'm off the steroids now. My mood has been very low and I wonder if they were responsible.

Interesting that you found beta blockers tiring. I've been on them years, initially for hormone headaches and then increased due to venlafaxine-induced pounding heart/tachycardia. They have been very effective for both issues but I might try a reduction (slowly).

PDU - I want to thank you so much. You really are a huge help on these boards and I hope you know how much you are appreciated.

[panic_down_under]

I'm off the steroids now. My mood has been very low and I wonder if they were responsible.

Very likely. Glucocorticoid steroids such as methylprednisolone frequently trigger depression and other psych disorders when taken for extended periods. They have much the same damaging affect on the hippocampus as cortisol and alcohol. Fortunately, this tends to resolve fairly quickly once the steroids are stopped. ADs can be protective, or at least the SNRIs and SNRIs are, but for some reason the TCAs can sometimes make things worse. Not sure why.

Interesting that you found beta blockers tiring.

I wasn't on them long enough to find out whether tolerance can develop to this. I suspect not, but apparently some are worse than others. I don't recall which one I was on.

I want to thank you so much. You really are a huge help on these boards and I hope you know how much you are appreciated.

You're most welcome. I only know the little I do because others having been willing to share their knowledge and experiences over the years.

[Dying_Swan]

Well, you know an awful lot! Scary about the steroids. I was only on them 3 days but perhaps that was enough to upset things. I've knocked alcohol on the head for now, but have taken a couple of doses of lorazepam over the past week in a desperate attempt to lift my mood. I'm considering raising my quetiapine dose. I tried emailing the psych for an appointment but heard nothing back, so feel a bit like I'm on my own with it now. I realise that's probably not advised and wouldn't recommend it to anyone else. Thank you PDU for making me feel a bit less alone with this.

[panic_down_under]

I've knocked alcohol on the head for now, but have taken a couple of doses of lorazepam over the past week in a desperate attempt to lift my mood.

Total prohibition isn't required. The occasional drink or BZD dose won't matter. The problems start when occasional become most days. Also alcohol and psych meds can be a tricky as their combined affect may be unpredictable. Some days you might be able to easily drink a herd of alcoholic elephants under the table, on others half a pint could turn legs to rubber. Whatever you do don't drink and drive.

[Dying_Swan]

I wouldn't drink and drive, no worries there. The problem I have with alcohol is once I start, I can't stop, and it has led to some hairy moments, especially when I'd taken diazepam too and scared myself a bit (lesson learnt). My impulse control isn't good at the moment. I've taken a double dose of lorazepam tonight, might have some more yet (within safe limits), but I'm not sure whether to up the quetiapine too. I've also found that having a drink after taking quetiapine means I can't stand up for feeling faint, so I assume it knocks my BP down further. Hopefully the benzos won't matter too much.

[panic_down_under]

Hopefully the benzos won't matter too much.

Taking them for 2-3 days probably won't make difference, but 2-3 weeks is problematic. There are no hard and fast rules on this. It's all a trade off. Letting anxiety run unchecked can be just as bad. You do what you must to get through today so you can renew the battle tomorrow.