Posted by Alan on May 9, 2000, at 7:37:29
In reply to Re: SEROQUEL off label usage anyone?, posted by AndrewB on May 9, 2000, at 6:58:15
> > My pdoc wants to try me on small dosages of Seroquel for my depression/anxiety. This would be to replace the SSRI's Tricyclics and Mood stabilizers that have unacceptable side effects (sexual,early awakening, etc.) Wants to start at 25mg and work up from there. Am curious if any of the other antipsychotics are being used successfully this way...
> >
> > Thanks
> > Alan
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>
> Alan,
>
> Low doses of antipsychotics can be used for anxiety, depression and even fatigue. Cam mentioned that he was aware of low doses of antipsychotics being used as a bridge to help with anxiety and depression until the patient’s antidepressant kicked in. At very low doses an antipsychotic does not act with the pharmacology of an antipsychotic. I’m not sure that such low doses are going to be used in your situation or whether that is what Cam was describing, but let me explain what happens when antipsychotics are used at very low doses.
>
> Antipsychotics at normal doses block the D2 dopamine receptors and are thus able to minimize the positive symptoms of schizophrenia (i.e. hallucinations). However at very low doses the antipsychotics actually do the opposite, they create greater stimulation of these D2 receptors. Some antipsychotics act on the D3 receptors in the same dose dependent manner. The D2 and D3 receptors are involved in mood, anxiety and fatigue. Sulpiride and amisulpride are two examples of such antipsychotics. At normal doses they are used for schizophrenia but at low doses they are very commonly used for depression, dysthymia, anxiety (especially social anxiety) and, less commonly, for fatigue conditions, like Chronic Fatigue Syndrome. Neither of these antipsychotics is marketed in the US though. That may be a shame because, possibly, the antipsychotics available in the US are not as effective in these low dosage applications. I did see one reference in the Tips section to the successful use of very low doses of the antipsychotics Stelazine and Risperdone (sp?) for fatigue conditions where prior trials with stimulants had failed.
>
> I am looking forward to hearing more from you on how the Seroquel works on treating your condition as you learn more.
>
> Best wishes,
>
> AndrewB
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Thanks so much Andrew. I think I understand the mechanics now. I'll talk to my pdoc about the other AP's that you mentioned. Sulpiride and Amisulpiride sound interesting but I wonder why the FDA hasn't approved them....already enough AP's to satisfy the market and therefore not high priority? Or are there problems with them that you know of?
Also Stelazine has definitely been mentioned to me (and I to my pdoc) before. He's had experience enough with it to fear TD and the trembling that goes along with it. That's why he wants to play it safe and try the Seroquel first. Do you know of or have first hand experience with the effectiveness of Sulpiride and Amisulpiride for me to push him in order to get it to try?
Any help would be greatly appreciated...
Thanks.
Alan
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poster:Alan
thread:32846
URL: http://www.dr-bob.org/babble/20000508/msgs/32870.html