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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by UgottaHaveHOPE on May 2, 2006, at 19:41:58
Please someone, in laymen's terms, explain to me why Seroquel calms you down, almost making you feel drugged. What does it do in the brain? (I take 300mg)
Posted by vainamoinen on May 2, 2006, at 20:01:43
In reply to How exactly does Seroquel work?, posted by UgottaHaveHOPE on May 2, 2006, at 19:41:58
I think it blocks histamine receptors. So it makes you sleepy just like the active ingredient in Benadryl or over the counter sleep aids, diphenhydramine.
But as far as its antipsychotic properties it is antagonistic to 5HT(2a?) and D2 receptors.
Posted by Phillipa on May 2, 2006, at 22:21:25
In reply to Re: How exactly does Seroquel work?, posted by vainamoinen on May 2, 2006, at 20:01:43
Thanks I didn't know it was anything like benydryl. Love Phillipa
Posted by med_empowered on May 2, 2006, at 22:53:06
In reply to Re: How exactly does Seroquel work? » vainamoinen, posted by Phillipa on May 2, 2006, at 22:21:25
at lower doses, pretty much all seroquel does is act like a way over-priced antihistamine...you can get similar results from Benadryl or Vistaril (hydroxyzine).
At higher doses, Seroquel loosely blocks D2 receptors; this loose blockade may allow for less EPS. It also blocks off some serotonin receptors, which may explain its anti-anxiety properties.
Posted by yxibow on May 3, 2006, at 1:47:57
In reply to How exactly does Seroquel work?, posted by UgottaHaveHOPE on May 2, 2006, at 19:41:58
> Please someone, in laymen's terms, explain to me why Seroquel calms you down, almost making you feel drugged. What does it do in the brain? (I take 300mg)
The drugged feeling is what most all antipsychotics do -- it is called blunting. It is the dullening of emotional affectation. It is an unfortunate side effect but does not really dissappear usually in treatment.
300mg is a clinical dose, its not just an antihistamine (it actually doesn't do anything for my nasal congestion surprisingly unlike Claritin or the similar) -- Seroquel has a wide range of dosing, up to 800mg technically but people have been known to take 1600mg. (I take 1100 currently, though I have been all over the map personally.)
Basically Seroquel blocks the D2 (Dopamine sub 2) receptors like old line antipsychotics but releases them very much quicker than, say Haldol, or Prolixin (fluphenazine) which grab on to the D2 receptors like no tomorrow and cause severe side effects (e.g. akathisia -- feeling like you want to run through a brick wall while standing still), quaintly known as EPS [extra pyramidal syndromes] in the neuroleptic world. It also blocks the D1 receptors somewhat too.
It also, yes, has antihistamine properties which contribute to its drowsiness effects, it is one of the most if not the most drowsy making antipsychotics which has led most clinicians to dose it all at night with a not bad effect considering it only has a 6 hour half life. It also blocks 5HT1a and 5HT2 serotonin receptors, not unlike Remeron at a higher dose (I had similar effects for my disorder with Remeron but Remeron of course is much more weight provoking than Seroquel -- about on the order of Zyprexa or worse).
So basically it calms through the high 5HT2:D2 ratio of receptor binding like all atypicals by antagonizing (blockading) the receptors in the brain.
Posted by Jeroen on May 3, 2006, at 11:29:30
In reply to Re: How exactly does Seroquel work? » vainamoinen, posted by Phillipa on May 2, 2006, at 22:21:25
to philippa, im not well, seroquel
im on 100 AM 100 PM, and i feel drugged, withdrawal, im sick, i wanna stop taking and yes my TD will reappear too badly
Posted by UgottaHaveHOPE on May 3, 2006, at 11:38:05
In reply to Re: How exactly does Seroquel work?, posted by yxibow on May 3, 2006, at 1:47:57
What is the highest dosage you would think someone could take for anxiety? 400mg? 500mg?
Posted by ed_uk on May 3, 2006, at 12:01:24
In reply to Re: Yxibow Q, posted by UgottaHaveHOPE on May 3, 2006, at 11:38:05
Hi
I'm not Yxibow but the highest dose someone should take depends on several factors....
1. Can they afford it?
2. Can they tolerate the side effects?
3. Is a higher dose actually necessary?Ed
Posted by UgottaHaveHOPE on May 3, 2006, at 14:14:11
In reply to Re: Yxibow Q » UgottaHaveHOPE, posted by ed_uk on May 3, 2006, at 12:01:24
Ed, thanks for your reply. I dont know if the higher dose is necessary for anxiety, thats why i was asking. What do you think? Thanks always for your opinion, Michael
Posted by ed_uk on May 3, 2006, at 14:39:43
In reply to Re: Yxibow Q, posted by UgottaHaveHOPE on May 3, 2006, at 14:14:11
Hi
>I dont know if the higher dose is necessary for anxiety, thats why i was asking. What do you think?
It depends whether the lower dose is working for you. Do you need more relief?
Ed
Posted by UgottaHaveHOPE on May 3, 2006, at 16:30:22
In reply to Re: Yxibow Q » UgottaHaveHOPE, posted by ed_uk on May 3, 2006, at 14:39:43
Yes, I need more relief. I was wondering if there were others who take Seroquel to treat thier anxiety and how high of a dosage were the able to go up to.
Posted by Jeroen on May 3, 2006, at 16:42:00
In reply to Re: Yxibow Q, posted by UgottaHaveHOPE on May 3, 2006, at 16:30:22
:(
Posted by Phillipa on May 3, 2006, at 18:51:31
In reply to Re: How exactly does Seroquel work?, posted by Jeroen on May 3, 2006, at 11:29:30
Jeroen I'm sorry I'm on so late our service is down. Long story. How come you didn't ask for Ed on the Seroquel as he is the one who knows most of the meds? I usually support you. Maybe he will be on later. Write a response to this thread addressed to Ed and he will get it. Jeroen honestly I don't know the answer. I just want to see you well and happy. Love Phillipa. And I have your E-mail.
Posted by yxibow on May 4, 2006, at 0:05:38
In reply to Re: Yxibow Q » UgottaHaveHOPE, posted by ed_uk on May 3, 2006, at 12:01:24
> Hi
>
> I'm not Yxibow but the highest dose someone should take depends on several factors....
>
> 1. Can they afford it?
> 2. Can they tolerate the side effects?
> 3. Is a higher dose actually necessary?
>
> EdWell I'm not going to disclose my insurance policy although it happens to be a certain PPO. It doesn't matter how many pills of Seroquel you take, the copayment is exactly the same.
The side effects of drowsiness I will agree are a problem I am trying to mitigate at the moment.
Is the higher dose necessary? If anxiety relief is being provided at a modest dose, then no. I am a firm believer in the lowest dose that provides the most benefit and as low as possible of EPS and other side effects of any, new, or old generation antipsychotic.
Do I think Seroquel should be used for pure anxiety? Not really necessarily -- controlled and monitored use of a moderate dose of something like Valium could be just as affective for GAD. Or Luvox or Paxil. But there may be some reason why the person's doctor prefers to use Seroquel or thinks the treatment is better.
I take it for an awfully complex somatiform disorder, but only because I need to suppress the type of dopamine that Seroquel provides because I have about the rarest disorder on the planet that makes my vision brighter and damn annoying. And I suppose the serotonergic profile of Seroquel might do something for me also. I take a high (1100 at the moment) dose of it although I've been on other doses at other times. But I'm on polypharmacy anyway, its rather complicated.
I think that Ed is hedging on the study that came out not that long ago, CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness ). But not all of the reports are out yet. Furthermore, although for some people with Schizophreniform disorders may benefit in terms of drug effectiveness just as well on old line antipsychotics, is their quality of life really the same? I think there was a cursory glance over things which lead people to think, oh, perphenazine works just as well as the more expensive Seroquel, why bother with the cost. And I think that's a dangerous view towards things -- yes, it is true we do not know the full possibilities of TD with the newest atypical antipsychotics but we certainly know the likelihood with old generation ones and they're not good. There was a fairly large study of Zyprexa a while back in the British Journal of Psychiatry which concluded at best 1/2% per year give or take. One can probably interpret that even less for Seroquel. And Haldol, perphenazine, Prolixin -- as much as 30% in some studies.That's the quality of life issues that are missing from the study that I find cursory -- that you can just dose up with old line drugs and mask all the akathisia with Cogentin and its just the same. Sure, Zyprexa carries a non zero risk of Type II Diabetes, and I continue to be monitored on Seroquel (which has a less problematic lipid profile than Zyprexa) although I am on a fairly rigorous exercise program now and my cholesterol dropped 64 points. But the EPS and lifetime side effects are so much lower. Cost is an issue, I agree -- it costs over $2 billion to treat Schizophrenia in this country alone. But I think its money well worth spent if it gives even a small number of those patients a greater outlook on life and maybe even a return to some productivity.
-- Jay
Posted by ed_uk on May 4, 2006, at 13:41:41
In reply to Re: Yxibow Q, posted by yxibow on May 4, 2006, at 0:05:38
>I think that Ed is hedging on the study that came out not that long ago....
J, what do you mean? I never said anything about perphenazine.
Ed
Posted by ed_uk on May 4, 2006, at 14:55:19
In reply to Re: Yxibow Q, posted by UgottaHaveHOPE on May 3, 2006, at 16:30:22
>Yes, I need more relief
In that case, trying a higher dose seems logical, at least temporarily.
Ed
Posted by yxibow on May 6, 2006, at 2:44:46
In reply to Re: Yxibow Q » yxibow, posted by ed_uk on May 4, 2006, at 13:41:41
> >I think that Ed is hedging on the study that came out not that long ago....
>
> J, what do you mean? I never said anything about perphenazine.
>
> Edthe "1. Can they afford it?" part.
I was talking in general about the possible increasing trend here of some doctors or institutions using the CATIE study out of context and possibly doing dangerous cutting costs from it. That's all. It's a topic of late among the medical community. No company has tried to pursue claims that their novel antipsychotic is better in effectiveness than old line ones -- just that they might have lower EPS and better quality of life as a result. Except perhaps for Clozaril, but that's a special category in itself.
cheers
-- Jay
Posted by ed_uk on May 6, 2006, at 12:17:30
In reply to Re: Yxibow Q » ed_uk, posted by yxibow on May 6, 2006, at 2:44:46
Hi Yxi
>Can they afford it?" part
I was just thinking that high doses of Seroquel are more expensive than lower doses. I wasn't thinking of perphenazine.
Ed
Posted by yxibow on May 6, 2006, at 13:10:44
In reply to Re: Yxibow Q » yxibow, posted by ed_uk on May 6, 2006, at 12:17:30
> Hi Yxi
>
> >Can they afford it?" part
>
> I was just thinking that high doses of Seroquel are more expensive than lower doses. I wasn't thinking of perphenazine.
>
> EdFor some reason or other, PPO insurance X, and I will not reveal it, charges the same copay, which is in the low three figures, for any dose of Seroquel so far prescribed. They do so for any drug not in their primary formulary and not "expensive". For those in their second tier, it can be like $75, and things like Valium can be as low as $25-$50. We have to hold on to these insurance cards for dear life here, Ed. We're talking about $900 to $1,200 "worth" of medication (only to the manufacturer -- the actual wholesale prices are negotiated with pharmacies and haggled with every insurance company on the planet here).
Posted by ed_uk on May 6, 2006, at 16:23:31
In reply to Re: Yxibow Q » ed_uk, posted by yxibow on May 6, 2006, at 13:10:44
Hi Yxi
But don't some people have to pay more for higher doses of Seroquel? I don't really know how it works in the US.
Ed
Posted by Phillipa on May 6, 2006, at 20:08:54
In reply to Re: How exactly does Seroquel work?, posted by Jeroen on May 3, 2006, at 11:29:30
I feel you are both not answering poor Jeron's question about how much Seroquel he sound take to keep his TD and blinking eyes away. Please one of you answer him he's in Finland. And he needs someone's advise that is familiar with this med. Love Phillipa
Posted by Jeroen on May 6, 2006, at 20:38:36
In reply to Re: Yxibow Q » yxibow, posted by ed_uk on May 6, 2006, at 16:23:31
JOKE :)
i feel better on 100 mg twice a dayand im in belgium not finland, drunk :)
Posted by yxibow on May 6, 2006, at 21:49:40
In reply to Re: Yxibow Q » yxibow, posted by ed_uk on May 6, 2006, at 16:23:31
> Hi Yxi
>
> But don't some people have to pay more for higher doses of Seroquel? I don't really know how it works in the US.
>
> EdUndoubtedly. Every insurance company here, whether profit (most) or nonprofit (some) has set copays and their own structures.
HMOs are cheaper, but you have to go through hoops and triages to get a referral to a specialist who will actually do something for you.
PPOs are more expensive, have higher copays and deductibles, but you don't have to go through hoops particularly and you can go to any specialist you want, provide you and they are willing to pay their contracted rate.
All insurances have "lifetime" caps, some pathetically low. Insurances that dont have 1-6 million dollar lifetime caps are doing a gross disservice to their customers. On the rare case that you have been run over by one of our enormous SUVs here, you could be looking at months in the hospital if you survive, at up to $1500 a day plus nursing and ICU expenses, drugs, etc. These "last ditch" caps are necessary for those very reasons. Or if you got some rare form of cancer and needed chemotherapy at $2000 a pill plus another $50 a pill to keep you from throwing up, and possible surgery, etc. All last scenario events.
Not to mention the exclusion from policies of things that havent been litigated to not be excluded like HIV status, so your insurance card is basically a piece of burnt toast if you have disease x,y, or z that they wish to minimize their costs and maximize their profits.
-end highhorse-
tidings
-- Jay
Posted by Phillipa on May 6, 2006, at 22:29:36
In reply to Re: Yxibow Q, posted by yxibow on May 6, 2006, at 21:49:40
Jeroen poor memory. But I've been in Belgium and I loved it. Was beautiful. I'll never forget how we had to wait while the cows crossed the street. And I don't drink can water make you drunk? Love Phillipa
Posted by Phillipa on May 6, 2006, at 22:31:22
In reply to Re: How exactly does Seroquel work?, posted by Phillipa on May 6, 2006, at 20:08:54
Okay I got the Country straight now answer Jeroens question about seroquel. I will spank both of you. Love Phillipa
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Dr. Bob is Robert Hsiung, MD,
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