![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by TemporarilyBob on October 26, 2012, at 4:04:22
+ Clonazepam, for full disclosure.
Just interested in people's happy/sad face stories of Seroquel, which is new to me, particularly if you used it along with a TCA.
My new pdoc just put me on it. Mentioned some very positive results on low dosage with amitriptyline in particular, also anti-anxiety benefits tho not approved for such use (FDA does not like the side effect profile for Seroquel as anti-anxiety medication in single med therapy). Pdoc also doesn't like me on clonazepam with me having PTSD since benzo's are pretty much contraindicated in event-induced anxiety disorders like PTSD, but since I was on it before the PTSD event...we'll roll with it for now with thoughts of dropping it completely. That's right -- been on clonazepam longer that the trauma has been with me, but there is some small concern of it doing nothing to making the situation worse now that PTSD is a major driver of anxiety beyond my bipolar disorder.
Posted by SLS on October 26, 2012, at 5:56:41
In reply to New cocktail -- Nortriptyline + Seroquel ..., posted by TemporarilyBob on October 26, 2012, at 4:04:22
I have bipolar disorder and did not like the way I felt when I first added Seroquel to imipramine. It made me agitated. Perhaps if I had stuck with it for more than a week, this effect would have dissipated.
My idiosyncratic reaction aside, I see nothing wrong with the combination. I don't think the antidepressant properties of Seroquel have been adequately elucidated, but they do seem to exist. The major metabolite of Seroquel (norquetiapine) acts to inhibit the reuptake of norepineprhine as does nortriptyline. Both Seroquel and nortriptyline block serotonin 5-HT2a receptors, so there is some overlap. Compared to other neuroleptic antipsychotics, Seroquel has a reduced risk of EPS. This might also include tardive dyskinisia (TD). However, we don't yet have people taking this drug for 20 years to confirm this.
- Scott
Posted by Phillipa on October 26, 2012, at 10:08:57
In reply to Re: New cocktail -- Nortriptyline + Seroquel ... » TemporarilyBob, posted by SLS on October 26, 2012, at 5:56:41
I thought prazosin was used for PTSD? A female I know was taking it for nightmares related to PTSD. I know my Son at one time was given zoloft for Desert Storm PTSD but he chose to discontinue it. Eventually the PTSD went away. But seriously does one being bipolar make it different in treatments? Phillipa
Posted by schleprock on October 26, 2012, at 15:49:00
In reply to New cocktail -- Nortriptyline + Seroquel ..., posted by TemporarilyBob on October 26, 2012, at 4:04:22
> + Clonazepam, for full disclosure.
>
> Just interested in people's happy/sad face stories of Seroquel, which is new to me, particularly if you used it along with a TCA.
>
> My new pdoc just put me on it. Mentioned some very positive results on low dosage with amitriptyline in particular, also anti-anxiety benefits tho not approved for such use (FDA does not like the side effect profile for Seroquel as anti-anxiety medication in single med therapy). Pdoc also doesn't like me on clonazepam with me having PTSD since benzo's are pretty much contraindicated in event-induced anxiety disorders like PTSD, but since I was on it before the PTSD event...we'll roll with it for now with thoughts of dropping it completely. That's right -- been on clonazepam longer that the trauma has been with me, but there is some small concern of it doing nothing to making the situation worse now that PTSD is a major driver of anxiety beyond my bipolar disorder.Did your Pdoc give any reasons why he chose Seroquel in particular over other antipsychotics (risperdone, abilify, etc.)? I've heard that seroquel is the most sedating.
By the way, what is it we're treating here exactly?
Posted by Phil on October 26, 2012, at 17:11:49
In reply to New cocktail -- Nortriptyline + Seroquel ..., posted by TemporarilyBob on October 26, 2012, at 4:04:22
Seroquel at 300 mg has worked. But if you have a particular gene variant(sorry no ideal what that means)you'll be buying new clothes so fast you won't keep up, some people gain no weight. It doesn't sedate me during(sorry, dozed off) during the day. Maybe Adderall may have something to do with that.
And, google Pisa Syndrome. I've got that too. But I'm staying on it for now.
Zyprexa put me in the hospital for 6 days. Seroquel has me real close to Type II you know what. You may get better if it doesn't kill you first. YMMV Good to see you.
Posted by phidippus on October 26, 2012, at 19:33:57
In reply to New cocktail -- Nortriptyline + Seroquel ..., posted by TemporarilyBob on October 26, 2012, at 4:04:22
Seroquel plus nortryptaline equals a lot of norepenephrine.
Have you tried Prazzosin for your PTSD?
Eric
Posted by TemporarilyBob on October 27, 2012, at 9:45:10
In reply to Re: New cocktail -- Nortriptyline + Seroquel ... » TemporarilyBob, posted by phidippus on October 26, 2012, at 19:33:57
Trying to respond to three different posts here.
Being treated for what might eventually solidify as a dx of bipolar III. Atypical responses to traditional ADs, with SSRIs being particularly toxic. Substance-induced mania. Positive responses to mood stabilizers. A few other things I'm sure I don't know about but having a pdoc from a research university hospital has him looking at the bleeding edge stuff.
Why seroquel? Abilify is about $600/mo. Seroquel is free to people with my level of income. Plus, there's a solid base of research showing TCA/seroquel cocktails as being extremely effective with people in my situation and there's a strong hope of it helping me get off a benzo for my anxiety.
Yeah, I know about zyprexa. Was on it for about three weeks, till a blood test came back with my triglycerides over 900 -- basically, too high to be measured reliably. Type II was screaming at me louder than the doc running the blood tests. So I got off that quick as possible.
Have not had anything prescribed specifically for the PTSD other than acupuncture, which worked amazingly well. Was done by my NYC pcp who was a very traditional, scientific Western med doc who also just happened to train in acupuncture at one of the top Chinese institutes and is one of the few US practitioners licensed to teach it. I wish I was still in NYC -- effects of the treatment were beginning to last longer each cycle of sessions and showed a glimmer of hope for a long-term "cure" but my economics wouldn't have it. As for now, my pdoc wants to straighten out the mess that was my cocktail into something with as few meds as possible for my bipolar. What I was treated with in the past -- benzos -- appear to be contraindicated for PTSD now rather strongly, so we're waiting to see what nortrip/seroquel can do before adding anything else.
Posted by Phil on October 27, 2012, at 11:05:05
In reply to Re: New cocktail -- Nortriptyline + Seroquel ..., posted by TemporarilyBob on October 27, 2012, at 9:45:10
Good luck with that, Bob. With disability and no insurance Costco saved me with their pricing on Seroquel and others. I have a friend that takes acupuncture for PTSD and likes the results.
You've been through a lot. Hopefully this will do the trick.
Posted by TemporarilyBob on October 29, 2012, at 1:26:15
In reply to Re: New cocktail -- Nortriptyline + Seroquel ... » TemporarilyBob, posted by Phil on October 27, 2012, at 11:05:05
> Good luck with that, Bob. With disability and no insurance Costco saved me with their pricing on Seroquel and others. I have a friend that takes acupuncture for PTSD and likes the results.
> You've been through a lot. Hopefully this will do the trick.Man oh man, I wish I was still in NYC getting acupuncture from my PCP. I am needle-phobic, I never could understand how I could let him poke me with 15 or more needles at a time (not all the time), maybe it was because he'd been my family doc for so long and he was so good about it I trusted him implicitly. But it felt like acupuncture was slowly rewiring my nervous system in a very therapeutic way. He'd give me about ten sessions, usually 3x per week, then lay off a month, to "let my system readjust" he'd say. Each time, by the time it came around to starting up again it felt clearly as is I had "backslid" less and less -- that what good it was doing was becoming more permanent. Man, I miss getting stuck by all those needles...particularly that "third eye" chakra spot; that one really blew me away.
BTW for anyone out there (I'm betting Scott knows the answer off the top of his head): how long should it take for seroquel to reach its "therapeutic" level. I know for benzos it's hours, for traditional ADs it's weeks to a couple months -- so any idea when I should think things have settled in? Also, any yo-yoing on this? Going from too good to nothing or worse and eventually settling into a pattern of useful or not?
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.