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Dr. Bob is Robert Hsiung, MD,
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Posted by Hombre on March 9, 2010, at 20:25:19
In reply to Re: Who's taking Seroquel for (bipolar) depression? » Hombre, posted by Phillipa on March 9, 2010, at 11:59:32
> That's a good question I'd like to follow as took it for a few days and was taken off. Phillipa
From what I hear, many people are put off by the idea if taking higher doses because of the fear of increased sedation and daytime drowsiness. From what I've read, those symptoms may abate at higher doses.For example, my experience with Remeron (at 15mg was that the first night was the worst, but within a few weeks I got used to the sedation. At 30mg a few weeks later I was sleeping soundly but OK during the day. I should note that it was losing its antidepressant punch by then. By the time I went to 45 ~2 months into it, it barely made me drowsy and there weren't any daytime effects as far as I could tell.
I mention Remeron because I believe it affects H1 receptors and antagonizes one or two of the HT receptors. I believe Seroquel has similar actions, but I defer to those with more specific and accurate knowledge.
Posted by Phillipa on March 9, 2010, at 21:26:25
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on March 9, 2010, at 20:25:19
I've heard the same. Sorry I couldn't answer your question better. Phillipa
Posted by Hombre on March 10, 2010, at 3:03:32
In reply to Re: Who's taking Seroquel for (bipolar) depression? » Hombre, posted by Phillipa on March 9, 2010, at 21:26:25
Thanks for responding, though. Maybe people doing well don't frequent the Babble as much.
Posted by mommyron on March 10, 2010, at 12:01:32
In reply to Who's taking Seroquel for (bipolar) depression?, posted by Hombre on March 9, 2010, at 0:25:43
I take Seroquel for bi-polar. I had to come way down on dose though (from 300 to 100) because it caused blood sugar issues, which is quite common. My endocrinologist actually wanted me off it, but my pdoc and I weren't comfortable with that so we took a middle ground and lowered the dose. It does make me sleepy (especially at 200 or 300 mg) so I take it at bedtime. I also take Lamictal, 75 mg.
Posted by bleauberry on March 10, 2010, at 16:50:28
In reply to Who's taking Seroquel for (bipolar) depression?, posted by Hombre on March 9, 2010, at 0:25:43
Well, we are all different and we all repond differently so it is hard to predict anything.
Going simply on trends seen here and at other forums, seroquel doesn't pan out as one of the better performers for bipolar. The real hero in that department is zyprexa.
There are risks with all meds. The antipsychotics have their own risks. I do not believe any single one is less risky than another. That's because prediction of individual response is impossible. Someone in fear of diabetes might expect it from zyprexa but not have a problem, but instead get quite a problem from a med less likely to be at risk such as maybe seroquel. While the risks are known up front, there really is no way to predict.
Who knows, seroquel could be a miracle for you. Or not. Zyprexa has a more impressive track record. I guess if feeling sedated and in desire of long deep sleep, seroquel would get the edge. Not that zyprexa doesn't give good sleep also, but seroquel is much more sedating. If bipolar control on both the depressive spectrum and the manic spectrum are the primary goals, then zyprexa wins hands down. Both carry longterm risks. Most meds do.
Everyone has their own preferences, based on their own experiences and observations. I've been on all the APs and watched the comments of others for many years. Taking all that into account, zyprexa is #1, abilify #2, and seroquel is either #3 or #4, maybe tied with risperdal. Now if we are talking antipsychotics from around the world, not just USA, then amisulpride blows them all in the weeds.
As I see it, remeron and seroquel both share the primary function of being two of the world's most potent antihistamines. Obviously they hit other neurotransmitter systems as well, but histamine much more than anything else. I'm not sure that has much purpose in bipolar, other than sedation and weight gain.
Some people love seroquel. I don't see them very often, but they do exist. The success stories of the other APs seem more numerous.
Posted by Hombre on March 11, 2010, at 8:49:54
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by bleauberry on March 10, 2010, at 16:50:28
Remeron antagonizes the H1, 5-HT2A, 5-HT2B, 5HT2C, 5-HT3, 5-HT7, alpha1, alpha2A, alpha2C, mACh, and inhibits NERT.
Seroquel antagonizes H1, 5-HT1A/2A/2C/7, alpha1/2, and mACh as well as D1/2/3/4.
That's a lot of overlap. I guess I'm thinking that it might work well as an antidepressant and mood stabilizer for those who find Remeron helpful. But that's all on paper, and as you said it's hard to predict.
I'm not sure what the weight gain mechanism of Remeron and Seroquel is. I haven't had much trouble with Remeron in that regard. Stahl seems to think it's a myth that selective blockade of H1 receptors is responsible for weight gain.
http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1916
Anyhow, always nice to hear other people's stories.
Posted by bleauberry on March 11, 2010, at 15:31:49
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on March 11, 2010, at 8:49:54
While you are correct at which receptors these drugs hit, what is missing is the potency at which they hit them. Thep potency on H1 is huge. The others much less, almost insignificant with many of them.
> Remeron antagonizes the H1, 5-HT2A, 5-HT2B, 5HT2C, 5-HT3, 5-HT7, alpha1, alpha2A, alpha2C, mACh, and inhibits NERT.
>
> Seroquel antagonizes H1, 5-HT1A/2A/2C/7, alpha1/2, and mACh as well as D1/2/3/4.
>
> That's a lot of overlap. I guess I'm thinking that it might work well as an antidepressant and mood stabilizer for those who find Remeron helpful. But that's all on paper, and as you said it's hard to predict.
>
> I'm not sure what the weight gain mechanism of Remeron and Seroquel is. I haven't had much trouble with Remeron in that regard. Stahl seems to think it's a myth that selective blockade of H1 receptors is responsible for weight gain.
>
> http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1916
>
> Anyhow, always nice to hear other people's stories.
Posted by morganator on March 12, 2010, at 2:06:07
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by bleauberry on March 10, 2010, at 16:50:28
Just curious, why do you think amulsipride is so much better than all the AP's including zyprexa?
Posted by bleauberry on March 12, 2010, at 19:56:38
In reply to Re: Who's taking Seroquel for (bipolar) depression? » bleauberry, posted by morganator on March 12, 2010, at 2:06:07
> Just curious, why do you think amulsipride is so much better than all the AP's including zyprexa?
Well, if we look at the positive symptoms of schizophrenia, amisulpride does not show a statistical advantage over any of the other APs. If we however look at the negative symptoms of schizophrenia, amisulpride shows a clear statistical advantage in almost every head to head clinical study. It also showed faster onset and more thorough effect on depressive symptoms when compared head to head with ssris. Negative symptoms are very similar to depression, almost indistinguishable.
Amisulpride is also commonly prescribed as monotherapy for major depression, dysthymia, and double depression. I don't know of any other APs that can do that.
But that's all literature stuff from pubmed. In the realworld, I have tried zyprexa, abilify, and seroquel myself. I was on zyprexa for years. So I know APs pretty well. We go way back, you could say. I can only say from my own personal experience, amisulpride is a totally different animal. It stands above them all. It has unique mechanisms that can be changed with dose size. While other APs hit a wide variety of receptors, amisulpride hits D2, D3, and the recent discovery of 5ht7. Based on analgesic effects on rats blocked by antiopiod meds, the assumption is that it also has some interplay with the opioid system. Basically a very clean med.
All I know is, it works! And fast.
Not bad for someone who failed ECT. Gosh, no other APs could do that for me. So how could I NOT speak highly of it.
Mileage varies.
Posted by Hombre on March 22, 2010, at 7:06:51
In reply to Re: Who's taking Seroquel for (bipolar) depression? » morganator, posted by bleauberry on March 12, 2010, at 19:56:38
Well, it looks like I'll be trying Seroquel starting at 50mg. Even at 400mg a day, lithium makes it hard for me to focus and may even be exacerbating my depression and anxiety. If it weren't for a gut feeling I never would have tried not taking the lithium. Not taking it cleared up my head and made it possible to relax more and get some sleep sans zopiclone.
The doc I saw didn't even broach the topic of Depakote. When I asked why, he said it didn't help with the depression side of things.
So now:
venlafaxine 75mg
mirtazapine 30mg
quetiapine 50mg
lorazepam .5mg PRN
Posted by Hombre on March 24, 2010, at 1:58:01
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on March 22, 2010, at 7:06:51
Day 1:
Had hay fever type symptoms for the first time in several years. Left nostril leaking like a bad faucet. Headache from sinus issues. Tired, unmotivated, slightly depressed. Didn't want to eat much. Went jogging and felt temporarily better. Out like a light ~1 hr afer taking Remeron 30mg + Seroquel 50mg.
Day 2:Woke up bright and early after 6.5 hours relatively uninterrupted sleep. Needed caffeine to get going, but otherwise awake esp. after taking (generic) effexor XR 75mg. Still rather unmotivated, however, but vastly better than yesterday. Reminds me of starting Remeron - if I'd have judged it from day 1 I would have dropped it, but side effects did diminish with time and patience. No anxiety as of afternoon.
Posted by SLS on March 24, 2010, at 6:00:40
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on March 24, 2010, at 1:58:01
> Day 2:
>
> Still rather unmotivated, however, but vastly better than yesterday. Reminds me of starting Remeron - if I'd have judged it from day 1 I would have dropped it, but side effects did diminish with time and patience. No anxiety as of afternoon.I hope things keep moving in a positive direction. Thanks for the updates.
- Scott
Posted by Hombre on March 26, 2010, at 1:03:40
In reply to Re: Who's taking Seroquel for (bipolar) depression? » Hombre, posted by SLS on March 24, 2010, at 6:00:40
> I hope things keep moving in a positive direction. Thanks for the updates.
>
>
> - ScottI really appreciate the encouragement, Scott. I also hope the best for your treatment.
***
Day 3:
Still waking up a bit early in the morning, but for the most part sound asleep for the most part. Life stresses are high right now, but I think even .5mg Ativan is subtly adds to tiredness and even depression, so I will avoid taking it unless absolutely necessary.
Day 4:
Last night was horrible for personal reasons, but I think the ADs + Seroquel are keeping things in check. I don't automatically feel hopeless in response to stressors. Exercise is of paramount importance as well.
Posted by Hombre on March 28, 2010, at 7:45:44
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on March 26, 2010, at 1:03:40
Days 5 & 6:
No problems falling asleep. No daytime anxiety, either. I am still waking up too early, maybe 4:30-5:30am with fitful sleep, sweating, weird body sensations, and sometimes nightmares. It seems to go away once I take my morning generic Effexor 75mg around 8am. I think there is a good chance that I am experiencing mini-withdrawal every morning. Will need to talk to the doc about splitting the dose a.m./p.m. or adding a little in the evening.
So until I get that sorted out I don't think I can make a fair judgement of how sedating Seroquel is during the day. It doesn't seem to be. As for appetite, it's pretty normal. Since I am able to exercise I think I will actually shed the extra kgs I put on from lithium.
Posted by Hombre on March 30, 2010, at 20:07:56
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on March 28, 2010, at 7:45:44
Days 7 & 8:
I realize that the last week or so has also been a process of getting lithium out of my body. Symptoms include dizziness, constipation, varying levels of energy. My skin is clearing up (who gets pimples on their shins?). Weight is steady if not decreasing.
Seroquel is still knocking me out every night, but I still find myself waking up after 3-6 hours. Not quite enough sleep. I've been taking .5mg lorazepam when I wake up in the middle of the night. I am able to get a few more hours of rest that way.
I did not take my multivitamin with B-complex for a few days. Energy level dropped and I even felt a bit depressed. Yesterday I took it again and felt better. Went for a run/walk. It's humbling how unfit I am after years of smoking and other sorts of abuse and lethargy.
Posted by Hombre on April 2, 2010, at 20:14:08
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on March 30, 2010, at 20:07:56
Days 9 - 12:
Although falling asleep is not a problem, staying asleep still is. The cumulative lack of sleep was starting to make me feel a bit flat, depressed, and, of course, tired. I called my doctor and until I see her on Monday she suggested just taking lorazepam and/or zoplicone at night so I can just get a decent night's rest.
Took Z Thursday night, which was a bit better, not great. Took Z + loraz. last night, and while I woke up in the middle of the night to pee (never used to do that) I made it through to 6am ok. After taking the morning's venlafaxine I do feel somewhat better.
Right now I'm not sure how Remeron and Seroquel are interacting with Effexor. Before Seroquel I tried dropping Remeron to 15mg and felt a slow but steady drop in mood. At least on paper, Seroquel does a lot of what Remeron does, and so along with venlafaxine may complete the (New Wave) California Rocket Fuel combo that seems to have lifted me out of the depression. The only problem is getting a good night's rest.
Posted by SLS on April 3, 2010, at 6:06:32
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on April 2, 2010, at 20:14:08
Hi.
I'm glad that you are getting some sleep. I'll be interested to know what your doctor prescribes to improve the quality of your sleep.
> Right now I'm not sure how Remeron and Seroquel are interacting with Effexor. Before Seroquel I tried dropping Remeron to 15mg and felt a slow but steady drop in mood. At least on paper, Seroquel does a lot of what Remeron does, and so along with venlafaxine may complete the (New Wave) California Rocket Fuel combo that seems to have lifted me out of the depression. The only problem is getting a good night's rest.
Seroquel does not antagonize NE alpha2 receptors as does Remeron. I don't think there is enough overlap between the two drugs so as to call them equivalent in the California Rocket Fuel regime.
- Scott
Posted by Hombre on April 5, 2010, at 0:46:45
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by SLS on April 3, 2010, at 6:06:32
> Hi.
>
> I'm glad that you are getting some sleep. I'll be interested to know what your doctor prescribes to improve the quality of your sleep.Hi Scott. Good to hear from you. Getting more rest is certainly helping. We are going to try 1mg lorazepam to see if that will take care of the mid-sleep anxiety. No zopliclone. Here I was thinking that the less benzos and hypnotics the better. It's weird how I feel more "guilty" taking a benzo or sleeping pill whereas I don't flinch at taking a handful of other meds.
>
> > Right now I'm not sure how Remeron and Seroquel are interacting with Effexor. Before Seroquel I tried dropping Remeron to 15mg and felt a slow but steady drop in mood. At least on paper, Seroquel does a lot of what Remeron does, and so along with venlafaxine may complete the (New Wave) California Rocket Fuel combo that seems to have lifted me out of the depression. The only problem is getting a good night's rest.
>
> Seroquel does not antagonize NE alpha2 receptors as does Remeron. I don't think there is enough overlap between the two drugs so as to call them equivalent in the California Rocket Fuel regime.
>
>
> - ScottI thought Seroquel antagonized alpha 1 and alpha 2 adrenergic receptors. Maybe not to the same extent as Remeron or at a clinically significant level.
In any case, we're going to try 150mg Effexor and drop down to 15mg Remeron with the goal of eliminating it.
The Great Experiment continues...
150mg venlafaxine XR
15mg mirtazapine
50mg quetiapine
1mg lorazepamBest of luck to all in their own pursuit.
Posted by SLS on April 5, 2010, at 7:18:53
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on April 5, 2010, at 0:46:45
> > > Right now I'm not sure how Remeron and Seroquel are interacting with Effexor. Before Seroquel I tried dropping Remeron to 15mg and felt a slow but steady drop in mood. At least on paper, Seroquel does a lot of what Remeron does, and so along with venlafaxine may complete the (New Wave) California Rocket Fuel combo that seems to have lifted me out of the depression. The only problem is getting a good night's rest.
> > Seroquel does not antagonize NE alpha2 receptors as does Remeron. I don't think there is enough overlap between the two drugs so as to call them equivalent in the California Rocket Fuel regime.
> I thought Seroquel antagonized alpha 1 and alpha 2 adrenergic receptors. Maybe not to the same extent as Remeron or at a clinically significant level.
> In any case, we're going to try 150mg Effexor and drop down to 15mg Remeron with the goal of eliminating it.
>
> The Great Experiment continues...
>
> 150mg venlafaxine XR
> 15mg mirtazapine
> 50mg quetiapine
> 1mg lorazepam
Hi.Good luck with your new treatment regime. As an aside, the major metabolite of Seroquel does inhibit the reuptake of NE. Interesting combo.
- Scott
Posted by Hombre on April 7, 2010, at 1:13:52
In reply to Re: Who's taking Seroquel for (bipolar) depression? » Hombre, posted by SLS on April 5, 2010, at 7:18:53
Thanks again, Scott. I think the really interesting part will be when I try to decrease Remeron. That didn't work before, but I was on 400mg lithium, which may have been bringing me down and exacerbating anxiety.
Days 13-16:
Still getting to sleep, but still waking up after about 5-6 hours. I'm not sure if lorazepam is adequate. With Venlafaxine XR at 150mg (morning/afternoon) I definitely get more energy, which from experience will die down a bit after 3-4 days. Tonight I only take 15mg Remeron.
(sidebar - not a redirect to alternative)
I am also religiously taking lots of B vitamins incl. 5mg extra folic acid and 2-3g of vitamin C. I will also add niacin in large doses to try to improve my lipid profile. I want to add magnesium too, but it is a little harder for me to source reasonably affordable supplements where I currently live. In any case, while the meds are definitely necessary, I think exploration of supplementation is filling in some of the gaps.
Posted by Hombre on April 10, 2010, at 6:44:43
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on April 7, 2010, at 1:13:52
Days 17-19
Increased venlafaxine 75->150mg and kept mirtazapine at 30mg for two days. Felt a lot of energy and clear headed. Dropped mirtazapine down to 15mg and immediately felt worse-less energy, flat mood, anxiety. Am going back on 30mg because I have not had such a bad day since starting venlafaxine since the last time when I tried to decrease mirtazapine.
Still having issues sleeping, so I'm taking 1mg lorazepam + 7.5mg zopiclone and I am getting fractured but mostly restful sleep. I realize now that a lot of my depression symptoms are directly linked to my sleep or lack thereof. Just started "Insomniac" by Gayle Greene, which looks to be the bible of the sleepless.
I wonder if I need to increase Seroquel from 50 to 100mg.
Posted by Hombre on April 13, 2010, at 4:27:57
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on April 10, 2010, at 6:44:43
Days 20-22:
All this tweaking of medications, especially the antidepressants, is really undermining the stability that I really need to have in order to feel confident enough to deal with all the psychological/social fallout from such a long period of depression.
The doctor and I have agreed that this is for certain:
30mg Remeron
150mg Effexor XRand this is under trial:
100mg Seroquel (from 50mg)
to help with sleep. I feel rather out of it, and I know this is to be expected, but it sucks. I've become hypersensitive to any sort of dip in mood or motivation. It's like I've used up all my guilt-free days and every day that I'm on the bench only serves to remind me that something is wrong with me.
Posted by SLS on April 13, 2010, at 6:47:44
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on April 13, 2010, at 4:27:57
> I've become hypersensitive to any sort of dip in good or motivation. It's like I've used up all my guilt-free days and every day that I'm on the bench only serves to remind me that something is wrong with me.
I completely understand. However, you are no less permitted to be sick now than you were before. Don't beat yourself up too much over something you have little control over. I hope you achieve the stability that you are looking for. You are doing everything right.
- Scott
Posted by Hombre on April 13, 2010, at 21:42:15
In reply to Re: Who's taking Seroquel for (bipolar) depression? » Hombre, posted by SLS on April 13, 2010, at 6:47:44
I try not to bring too much negative energy to this place, but as you know the battle is often tiring.
I thank you so much for your kindness and compassion.
Posted by Hombre on April 18, 2010, at 7:57:22
In reply to Re: Who's taking Seroquel for (bipolar) depression?, posted by Hombre on April 13, 2010, at 21:42:15
Days 23 - 27:
Doing well at 100mg Seroquel. Trying relatively large doses Niacin while trying to adjust to the higher does of Seroquel was silly, but a lesson learned. The difference between 50mg and 100mg is subtle, but my mood is consistently good and there is no anxiety. Sleep is a bit fractured, but not interfering with waking life too much.
This is the end of the thread.
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