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Thread: Quetiapine modified release

  1. #11
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    Re: Quetiapine modified release

    Quote Originally Posted by beautifulfreak77 View Post
    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 donít 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.
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  2. #12
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    Re: Quetiapine modified release

    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 youíre probably thinking itís all psychological and maybe it is. But I can do things once Iíve taken diazepam that I canít do without it. The only other thing that worked but same family was temazepam...I prefer them, but donít get prescribed them very often. Iím hoping the quetiapine will help my anxiety, and yes maybe il try and go without the diazepam, but Iíve tried so many meds for my anxiety itís been a night mare I started in my teens and im now 42. I really feel I canít 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 itís 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 Iím not having a ssri is that it really does send my anxiety through the roof and I canít cope with being more anxious. Thank you for keep replying to me. Itís nice to talk to someone who knows the meds I canít talk to my family about it as they donít understand why I need different medications etc. Or even why I have the problem to be honest.

  3. #13
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    Re: Quetiapine modified release

    Quote Originally Posted by beautifulfreak77 View Post
    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 youíre probably thinking itís all psychological and maybe it is. But I can do things once Iíve taken diazepam that I canít 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 donít 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 Iím not having a ssri is that it really does send my anxiety through the roof and I canít 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.
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  4. #14
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    Re: Quetiapine modified release

    Hi. I know what you mean with the alcohol I know many alcoholics/drug addicts that use the drink/drugs to cover there anxiety, but alcohol doesn’t cover mine it makes it worse while drinking and then the next day it makes me even more anxious,if I only had 2 drink I wouldn’t sleep,I can’t sleep when I have had a couple of drinks , so now I don’t drink it’s just not worth it.. also it makes me depressed now. It used to cheer me up for a bit but when I was having a few drinks I’d think why have you done this. You feel more anxious and depressed than before,now Ul suffer by not sleeping and feel worse tomorrow...
    as for the diazepam I don’t know. Yes maybe it’s doing me harm but I don’t feel anxious after taking them. I don’t feel how I do when I’ve had a few drinks. But yes if I can come off them and just be on the quetiapine and amitriptyline then that would be great. I don’t like taking any tablets. Nothing else has ever worked and I do get dry mouth and that and on some other drugs I’ve been prescribed I’ve had some awful side effects. Ended up in hospital and other meds to take away what that med had done to me. Couldn’t leave my house for over 10 weeks was horrible. Yes once I have settled on a dose of quetiapine if it’s going to be helpful then il start the amitriptyline,just worried about how sedated il be in the morning. Once again thank you for your help and opinions on what I wrote. It’s nice to talk to you again.

  5. #15
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    Re: Quetiapine modified release

    Quote Originally Posted by beautifulfreak77 View Post
    as for the diazepam I donít know. Yes maybe itís doing me harm but I donít feel anxious after taking them. I donít feel how I do when Iíve had a few drinks.
    The difference is alcohol has a half-life of around 4-5 hours so it is mostly out of your system the next day, plus it has other physical effects such as dehydration which can exacerbate anxiety. OTOH, the diazepam half-life is 100-200 hours (incl. active metabolites) so even a single dose takes weeks to be completely eliminated and while the anti anxiety effect is much shorter it does buoy mood for much longer than alcohol typically with a slower decline.

    I donít like taking any tablets.
    You're not alone. Unfortunately, as we age they become an increasing part of life.

    Yes once I have settled on a dose of quetiapine if itís going to be helpful then il start the amitriptyline,just worried about how sedated il be in the morning.
    Meds which sedate via inhibiting histamine H1 receptors are typically most sedating at low doses usually becoming less so as the quetiapine dose increases so it will likely be less of a problem at 400mg/day than it is now, although this isn't an iron-clad guarantee because some do have paradoxical reactions. Amitriptyline can be fairly sedating on its own, but probably won't add much to whatever effect the quetiapine is having, but again, no guarantees.
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  6. #16
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    Re: Quetiapine modified release

    [QUOTE=panic_down_under;1955386]The difference is alcohol has a half-life of around 4-5 hours so it is mostly out of your system the next day, plus it has other physical effects such as dehydration which can exacerbate anxiety. OTOH, the diazepam half-life is 100-200 hours (incl. active metabolites) so even a single dose takes weeks to be completely eliminated and while the anti anxiety effect is much shorter it does buoy mood for much longer than alcohol typically with a slower decline.

    Yes alcohol is just not for me now whether I take diazepam or not. Itís not meant to be taken with it and also quetiapine and amitriptyline say not to drink on them plus you take them at night so Iíd be quite worried to drink then take meds.

    You're not alone. Unfortunately, as we age they become an increasing part of life.
    yes as Iím getting older my list of meds is getting longer.

    Meds which sedate via inhibiting histamine H1 receptors are typically most sedating at low doses usually becoming less so as the quetiapine dose increases so it will likely be less of a problem at 400mg/day than it is now, although this isn't an iron-clad guarantee because some do have paradoxical reactions. Amitriptyline can be fairly sedating on its own, but probably won't add much to whatever effect the quetiapine is having, but again, no guarantees.[/QUOTE
    yes I found that with mirtazepine the lower the dose the more sedating. Yes Iím hoping it doesnít sedate to much but I do have to add in the modafinil too at some point maybe that will wake me up a bit more in the mornings. May I ask how you know so much about meds? Do you work in this area or is it just your own research?

  7. #17
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    Re: Quetiapine modified release

    Quote Originally Posted by beautifulfreak77 View Post
    May I ask how you know so much about meds? Do you work in this area or is it just your own research?
    An inquiring mind, lots of listening to folk in support groups like this for over 25 years and discussing issues with some of the leading anxiety and depression researchers.

    I did do a first aid course a very long time ago. Run by an old Greek guy, Hippo something or other. He was big into humours. Didn't understand it at the time, but later I read that the art of doctoring was keeping the patient amused while mother nature healed, so I think that's what he must have meant.
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  8. #18
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    Re: Quetiapine modified release

    Quote Originally Posted by panic_down_under View Post
    An inquiring mind, lots of listening to folk in support groups like this for over 25 years and discussing issues with some of the leading anxiety and depression researchers.

    I did do a first aid course a very long time ago. Run by an old Greek guy, Hippo something or other. He was big into humours. Didn't understand it at the time, but later I read that the art of doctoring was keeping the patient amused while mother nature healed, so I think that's what he must have meant.

    Oh right you must of really took notice and listened a lot and read a lot to know the amount of stuff you know, I like researching stuff myself as I have been like this since my teens and I’m now 43 next week eek. But I do forget things. My short term memory is getting worse,but long term memory is really good. I expect it’s all the meds and what I’ve been on over the years.
    Now I don’t know if you’re humouring me haha with that story but if it’s true,then that’s cool. So laughter really could be the best medicine in some cases?! I don’t know if you’ve ever said but do you suffer with mental health illnesses? Or just interested? If you do have any would you feel comfortable telling me what they are? It’s fine if you don’t,but just interested. I hope you’ve had a good weekend..

  9. #19
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    Re: Quetiapine modified release

    Quote Originally Posted by beautifulfreak77 View Post
    So laughter really could be the best medicine in some cases?!
    Oh, definitely.

    I donít know if youíve ever said but do you suffer with mental health illnesses?
    Yep. Since 12:05 pm, Sunday, 18th January 1987 when the panic attack which propelled me into the 'delights' of panic disorder began, followed the next day by an attack which put me into a potentially dangerous situation that solidified it. These weren't the first attacks, that was on Easter Saturday the year before, but there were plausible explanations for the symptoms that day so I'd dismissed it as not important. That Sunday's wasn't so easy to ignore, Monday's even less so. Fortunately, I responded well to ADs and continue to do so.

    There were extraneous aspects to how/why I developed PD that began my search for answers about these disorders which then lead to studying anxiety disorders in greater detail. Fortunately, I initially had ready access to psychiatrists and psychologists in my job whose brains I could pick, although back in the late 1980s there was much less known about anxiety/depression and quite a bit was plain wrong.
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  10. #20
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    Re: Quetiapine modified release

    Yep. Since 12:05 pm, Sunday, 18th January 1987 when the panic attack which propelled me into the 'delights' of panic disorder began, followed the next day by an attack which put me into a potentially dangerous situation that solidified it. These weren't the first attacks, that was on Easter Saturday the year before, but there were plausible explanations for the symptoms that day so I'd dismissed it as not important. That Sunday's wasn't so easy to ignore, Monday's even less so. Fortunately, I responded well to ADs and continue to do so.

    There were extraneous aspects to how/why I developed PD that began my search for answers about these disorders which then lead to studying anxiety disorders in greater detail. Fortunately, I initially had ready access to psychiatrists and psychologists in my job whose brains I could pick, although back in the late 1980s there was much less known about anxiety/depression and quite a bit was plain wrong.[/QUOTE]

    I see I have panic disorder with agorophobia, I take it you're not agorophobic? Or do you struggle to go out etc. I can now go out locally if someone is with me but it’s getting harder now as kids are grown up and you can’t force them to go with you. I’m sorry to hear that you had it so bad that it put you into a dangerous situation...yes I didn’t tell my doctor for years as I thought I was going mad until one day I went and told him and when I did I fell to the floor where my legs had gone so weak altho I do have narcolepsy and sometimes I do wonder if it’s actually cataplexy but only when I have a very strong emotion, don’t know, probably never will. Yes I can imagine back in the 80s maybe anxiety/depression wasn’t taken so seriously...my auntie had it and yes was put on a high dose of diazepam like a lot of people back then. So you have had quite a long time to research these things but it’s still amazing what you know. You’re better than my psychiatrist,I tell them they’re just textbook as she says she doesn’t suffer herself that she’d not let her self fall into the trap of anxiety or depression which I thought was a bit unfair as none of us asked for this and it can happen to anyone. So as she doesn’t suffer from it she doesn’t know how her patients feel that’s why I call her textbook,cos if I say something that doesn’t fit in with what I’m diagnosed with she gets in a muddle lol. I’m glad you found an AD that suited you and still does. Thank you for sharing with me.

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