Quetiapine modified release

[beautifulfreak77]

Hi all I started my quetiapine modified release last night dose 50mg a night for a week upping every week by 50mg until I get to 400mg. As with other meds I didn’t get tired taking these last night the tiredness hits the next day. So I took them at 10.30pm last night didn’t help me sleep til about 6am I got up at 12 noon. I now feel like a zombie eyes are watering and burry no energy feel drowsy which I expected but my real question is, as they’re modified release should I take them earlier maybe evening and not night time so that hopefully I will find that the tiredness hits when it’s meant to and not like an hour before getting up? Anyone else tried these modified release ones and have any advice? Thanks peeps.

[panic_down_under]

I didn’t get tired taking these last night the tiredness hits the next day. So I took them at 10.30pm last night didn’t help me sleep til about 6am I got up at 12 noon. I now feel like a zombie eyes are watering and burry no energy feel drowsy which I expected but my real question is, as they’re modified release should I take them earlier maybe evening and not night time so that hopefully I will find that the tiredness hits when it’s meant to and not like an hour before getting up?

The problem with modified/slow/extended release formulations is the dose is released into the bloodstream continually for 24 hours so the time of day they are taken often doesn't really matter much. That said, for quetiapine XR the recommendation to reduce daytime sedation is to take it about 7-8 hours before you normally get up, but this seems not to have worked for you this time. However, a single dose probably isn't a good guide so I'd persevere with taking it at around 9:00 to 10:30 PM for a few more days.

[beautifulfreak77]

Hi thanks for replying, I did think does it actually matter what time but psychiatrist said still to take at night. Last night I took at 9.30pm and I was bit drowsy when I got up and that stayed until round about lunch time. So yes I may take at 9pm for few days as some of it is probably just the side effect of the tablet anyway. We have spoken before on here. May I ask your honest opinion of what you think about quetiapine, I have borderline personality disorder, GAD, agoraphobic, depression but I was/am feeling suicidal so been put on these with maybe a antidepressant being added in later. I just wondered what you thought about choice of tablet for my problem mainly the borderline personality being the problem at moment. So up and down. And I know it’s only your opinion... thanks.

[panic_down_under]

May I ask your honest opinion of what you think about quetiapine, I have borderline personality disorder, GAD, agoraphobic, depression but I was/am feeling suicidal so been put on these with maybe a antidepressant being added in later. I just wondered what you thought about choice of tablet for my problem mainly the borderline personality being the problem at moment.

Quetiapine is relatively benign, especially compared to other meds prescribed for your issues. Only time will tell if it is the right med for you, but it is a good starting point. Sedation is the most common side-effect. It tends to diminish after a while. Sedation might not be a bad thing for you atm. Sleep is a good healer. Just be extra cautious if doing anything potentially hazardous, especially driving.

[beautifulfreak77]

Quetiapine is relatively benign, especially compared to other meds prescribed for your issues. Only time will tell if it is the right med for you, but it is a good starting point. Sedation is the most common side-effect. It tends to diminish after a while. Sedation might not be a bad thing for you atm. Sleep is a good healer. Just be extra cautious if doing anything potentially hazardous, especially driving.

Do you know what would be a better combination for someone with my problems then? Yes I expected to be quite tired and I don’t mind for a while but I have narcolepsy so it’s making me feel worse in that way if you get me. But maybe you’re right and I just need sleep as I don’t sleep that well. It’s just making my daytime sleepiness a lot worse. It’s okay as I have narcolepsy I can’t have a driving license anyway as it’s not under control.
I’m not sure if it’s the quetiapine or just being so tired but my eyes are streaming everyday as if I’m crying but I’m not. Have you ever heard of that being a side effect. Sometimes it’s so bad I can’t see as eyes are so blurry from the water/tears. Thanks for your reply. I hope you’re well.

[panic_down_under]

Do you know what would be a better combination for someone with my problems then?

I think quetiapine is a good starting point. Only time will tell if it works for you, but there is a good chance it will. As per my previous post, quetiapine is usually fairly benign compared to other antipsychotics.

Yes I expected to be quite tired and I don’t mind for a while but I have narcolepsy so it’s making me feel worse in that way if you get me. But maybe you’re right and I just need sleep as I don’t sleep that well. It’s just making my daytime sleepiness a lot worse. It’s okay as I have narcolepsy I can’t have a driving license anyway as it’s not under control.

The sedation may ease as the dose increases and will diminish further as your body adjusts, but it is going to take a while.

I’m not sure if it’s the quetiapine or just being so tired but my eyes are streaming everyday as if I’m crying but I’m not. Have you ever heard of that being a side effect. Sometimes it’s so bad I can’t see as eyes are so blurry from the water/tears.

Quetiapine is a mild antihistamine so dry eyes (also dryness of the mouth and other mucus membrane areas) is the more common side-effect, but paradoxical reactions do occur and symptoms similar to seasonal allergy are relatively common. Having experienced dry eyes and mouth with previous ADs, I'd much prefer the reaction you're having. It may be short-lived, but if it continues mention it to your GP as there may be ways of reducing the tears.

Are you on any other medication, or supplement?

[beautifulfreak77]

Quetiapine is a mild antihistamine so dry eyes (also dryness of the mouth and other mucus membrane areas) is the more common side-effect, but paradoxical reactions do occur and symptoms similar to seasonal allergy are relatively common. Having experienced dry eyes and mouth with previous ADs, I'd much prefer the reaction you're having. It may be short-lived, but if it continues mention it to your GP as there may be ways of reducing the tears.

Are you on any other medication, or supplement?

i went to the chemist and they said dry eyes can cause watering eyes as your body is trying to make up for them being dry,she gave me some drops but to be honest there’s no difference yet. I’m still tired and drowsy the next day for quite a while , it’s just annoying due to being tired anyway from having narcolepsy, Altho I’m meant to start modafinil for that,I’m just scared to whilst getting used to the quetiapine I thought it best to get to my dose on quetiapine then add in the modafinil incase I got any side effects I wouldn’t know which one was causing it. As for other medication. I take cocodamol 30/500mg, diazepam 5mg 3 times a day, bisoprolol, questran, omeprazole...

[panic_down_under]

I know that is classed as highish dose now but when I started many years ago I was on 50mg of diazepam...

It was a high dose even back in the 1960-70s.

The irony is there is now good evidence BZDs actually produce the same brain atrophy that causes anxiety and depression as the initial trigger, high stress hormone levels in the brain.

I came off that and a few years ago was put on 20mg I said to psychiatrist I can manage with it just 3 times a day. But I have an agreement with my psychiatrist I don’t have to take 3 a day.

I think you should seriously consider talking to your psychiatrist about weaning off diazepam. It is likely doing more harm than good. You may not need anything else once the quetiapine kicks-in, but if needed an AD would be a better option than diazepam.

[beautifulfreak77]

I think you should seriously consider talking to your psychiatrist about weaning off diazepam. It is likely doing more harm than good. You may not need anything else once the quetiapine kicks-in, but if needed an AD would be a better option than diazepam.[/QUOTE]

The thing is diazepam has always helped my anxiety and is the only thing that has helped it. And i know you’re probably thinking it’s all psychological and maybe it is. But I can do things once I’ve taken diazepam that I can’t do without it. The only other thing that worked but same family was temazepam...I prefer them, but don’t get prescribed them very often. I’m hoping the quetiapine will help my anxiety, and yes maybe il try and go without the diazepam, but I’ve tried so many meds for my anxiety it’s been a night mare I started in my teens and im now 42. I really feel I can’t live much longer feeling the way I do with the anxiety and the personality disorder. I hate the way it makes me feel and act it’s embarrassing at times. So I really want this quetiapine to work and when I start the modafinil, also the other antidepressant that they may want to add is amitriptyline, do you think that is a good choice? I tried mirtazapine before quetiapine but made my irregular heartbeat even worse. The reason I’m not having a ssri is that it really does send my anxiety through the roof and I can’t cope with being more anxious. Thank you for keep replying to me. It’s nice to talk to someone who knows the meds I can’t talk to my family about it as they don’t understand why I need different medications etc. Or even why I have the problem to be honest.

[panic_down_under]

I think you should seriously consider talking to your psychiatrist about weaning off diazepam. It is likely doing more harm than good. You may not need anything else once the quetiapine kicks-in, but if needed an AD would be a better option than diazepam.

The thing is diazepam has always helped my anxiety and is the only thing that has helped it. And i know you’re probably thinking it’s all psychological and maybe it is. But I can do things once I’ve taken diazepam that I can’t do without it.

Yes, and that's the trap. The most prescribed 'med' for anxiety (and depression) isn't an antidepressant, or benzodiazepine, but alcohol. There are far more people self-prescribing it than taking ADs and BZDs and they will tell you it works great, and it does...while they on it. But it is also quietly worsening the brain deficit that produces anxiety and depression. The BZDs do the same.

Anxiety and depression are the emotional symptoms of atrophy of parts of the two hippocampal regions of the brain caused by high brain stress hormone levels, mostly of cortisol (PDF). It kills hippocampal brain cells and inhibits the growth of new ones. Antidepressants work by stimulating the growth of replacement cells (neurogenesis), as do the psychotherapies. It is the new cells and the connections they form which produces the therapeutic response, not the ADs directly. This is why it takes so long for ADs to 'kick-in.' It takes about 7 weeks for neurons to go from the precursor stage to full maturity, however, improvement often begins a week or two earlier.

Alcohol has the same affect on hippocampal neurogenesis as cortisol. Even moderate drinking can reduce hippocampus neurogenesis by nearly half (see also: Morris SA, 2010; Crews FT, 2003)

There is now good evidence that BZDs have the same effect as alcohol and cortisol and consequently significantly reduce the effectiveness of antidepressants (see: Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).

The only other thing that worked but same family was temazepam...I prefer them, but don’t get prescribed them very often.

You're getting it anyway. Temazepam is one of the 2 primary active metabolites of diazepam and does much of the heavy lifting, both directly and through its metabolite oxazepam.

antidepressant that they may want to add is amitriptyline, do you think that is a good choice?

...The reason I’m not having a ssri is that it really does send my anxiety through the roof and I can’t cope with being more anxious.

Yes, it could be a good choices, though the only way to know is by trying it. The advantage of the TCAs is that they come in low dose tablets relative to their therapeutic dose range which makes it much easier to begin on small doses and to titrate up by the same small amount to limit the severity of any initial side-effects. The TCAs tend to produce less side-effects at the beginning anyway (and less withdrawal symptoms when quitting), however, they tend to have more ongoing ones, mostly nuisances such as dry-mouth and constipation which can usually be managed fairly easily.