Benefits Of Seroquel For Anxiety
There are potential benefits associated with utilizing quetiapine for the treatment of anxiety to consider. Arguably the most significant benefit is that quetiapine can be an effective anxiolytic for a subset of persons with refractory or treatment-resistant anxiety disorders. Another substantial benefit is that quetiapine monotherapy can treat anxiety, plus neuropsychiatric comorbidities such as: schizophrenia, bipolar disorder, and major depression. Moreover, the fact that quetiapine is manufactured in multiple formats , has a unique mechanism of anxiolytic action, and is substantiated by RCTs as an acute and long-term intervention for anxiety, might make it appealing to some.
What Other Treatments Can Help Manage Anxiety
Medications for anxiety are safe and effective and are good options for many people. But some people want to avoid medication, and some want to combine medication with other treatments. You can try:
- Psychotherapy. Cognitive behavioral therapy is a first-line treatment for anxiety, and phobias can respond to biofeedback and exposure therapy.
- Stress management techniques. You can learn breathing techniques and progressive muscle relaxation to reduce anxiety.
- Lifestyle modifications. Getting enough quality sleep, exercising, and avoiding alcohol, illicit drugs and excessive caffeine can help reduce anxiety.
- Support groups. Connecting with people who share your experiences can be valuable.
Studies In Mood And Psychotic Disorders
Guidelines from the American Academy of Sleep Medicine and others agree that off-label use of antipsychotics should be avoided, although quetiapine may be useful for insomnia in patients with psychiatric disorders.
In 2009, Wine et al reviewed 10 controlled studies and case reports assessing the effects of immediate-release quetiapine on sleep in patients with bipolar disorder, schizophrenia, history of trauma, or depression. Their analysis suggested that quetiapine improved total sleep time, efficiency, and subjective sleep within a dose range of 12.5 mg to 800 mg however, decreased rapid-eye-movement sleep was noted in some populations. Notable adverse events included akathisia, metabolic changes, and periodic leg movements.
In 2014, Anderson and Vande Griend analyzed studies investigating quetiapine for insomnia, including a review of the 2010 EMBOLDEN II trial, which found that quetiapine improved sleep in patients with bipolar depression over 8 weeks. Despite this, Anderson and Vande Griend argued that given the insufficient evidence of efficacy for treating insomnia and potential risks associated with the drug, they did not recommend quetiapine for insomnia even in patients with psychiatric disorders.
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How Should I Take Seroquel
Never take Seroquel in larger amounts, or for longer than recommended by your doctor. Follow all directions on your prescription label. High doses or long-term use of quetiapine can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include tremors or other uncontrollable muscle movements.
Take this medicine with a full glass of water. You may take immediate-release Seroquel with or without food. It is suggested that Seroquel XR be administered without food or with a light meal , preferably in the evening.
Do not crush, chew, or break an extended-release tablet. Swallow it whole.
Seroquel may cause you to have high blood sugar . If you are diabetic, check your blood sugar levels on a regular basis while you are taking Seroquel.
You should not stop using Seroquel suddenly. Stopping suddenly may make your condition worse.
Blood pressure may need to be checked often in a child or teenager taking Seroquel.
Quetiapine can cause you to have a false positive drug screening test. If you provide a urine sample for drug screening, tell the laboratory staff that you are taking Seroquel.
Store at room temperature away from moisture and heat.
Pharmacokinetic Profile Lends Itself To Abuse
Quetiapine is available as an oral tablet in an immediate-release formulation and an extended-release formulation ., Its half-life, about 6 hours, is the shortest of all the second-generation antipsychotics.
The short duration to peak plasma concentration with the immediate-release formulation is generally comparable with that of many of the approved hypnotics, including Z-drugs and benzodiazepines. At peak plasma levels, H1-receptor occupancy is more than 90% at just 50 mg of the immediate-release formulation, which is consistent with the receptor profile for strong hypnotic effects even at the lowest therapeutic doses.
Quetiapineâs pharmacokinetic profile may make it more attractive for abuse, especially for crushing tablets for intravenous injection or intranasal snorting. It can also be mixed with other drugs of abuse to achieve faster and more intense effects, such as sedation and relaxation. Quetiapine taken through such alternative routes is associated with an increased risk of neuroleptic toxicity.
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What Other Drugs Will Affect Seroquel
Seroquel can cause a serious heart problem if you use certain medicines at the same time, including certain antibiotics, antidepressants, heart rhythm medicine, antipsychotic medicines, and medicines to treat cancer, malaria, HIV or AIDS. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Seroquel.
Taking Seroquel with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.
Many drugs can interact with quetiapine. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:
-
antibiotic or antifungal medicines
Who Should Be Cautious While Taking Seroquel
- When neonates are exposed to antipsychotics during the third trimester of pregnancy, they are more likely to have withdrawal symptoms and extrapyramidal side effects . Therefore, pregnant women should not use Seroquel without first seeing their doctor.
- Quetiapine has not been authorized for use in children under ten by the Food and Drug Administration .
- Seroquel can be taken at the exact dosages of younger individuals over 65, although initial doses may need to be lower and raised more slowly than in younger adults.
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Studies In Posttraumatic Stress Disorder
Some data support the use of quetiapine for PTSD symptoms such as nightmares and insomnia. A 2005 study in 20 postwar veterans with PTSD found that adding low-dose quetiapine resulted in significant improvements in sleep quality, latency, duration, night terrors, and nightmares.
A 2016 randomized controlled trial investigating quetiapine monotherapy for treatment of PTSD found a statistically significant reduction in the total Clinician-Administered PTSD Scale score and its re-experiencing and hyperarousal subscale scores compared with placebo. No statistically significant differences in weight or blood pressure were found between groups, but quetiapine use was associated with increased somnolence and sedation.
Byers et al compared prazosin and quetiapine for treating nighttime symptoms in veterans with PTSD and found that short-term effectiveness of the 2 drugs was similar at 60%. However, patients taking prazosin were significantly more likely to remain in the study, and those in the quetiapine group were likelier to stop the medication because of side effects.
Risk Of Bias In Individual Studies
The internal validity assessments for all eligible clinical trials were performed by two reviewers . Relying on the Cochrane Collaboration quality assessment, the measurements for the risk of bias were composed of the following: 1) sequence generation 2) allocation concealment 3) blinding of participants, personnel, and outcomes 4) incomplete outcome data 5) selective outcome reporting and 6) other biases.48
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Selective Serotonin Reuptake Inhibitors
These include fluoxetine , paroxetine , sertraline , fluvoxamine , citalopram , and escitalopram . They tend to be the first line choice for multiple anxiety disorders and depression. They are technically classified as antidepressants .
Sertraline is FDA approved for multiple conditions including: Major Depression, OCD, PTSD, Social Anxiety, Panic Disorder, and Premenstrual Dysphoric Disorder. While not all SSRIs have this many FDA approved indications, we often use the other ones for the same conditions. Pharmacy companies do not always bother pursuing FDA approvals due to cost reasons and the realization that the meds will be used off-label. It is completely legal and ethical to use medications for off-label purposes, but ideally the patient and provider should have a discussion about this first.
While SSRIs can have an immediate effect, the full effect can take anywhere from 3-8 weeks depending on the person. They are generic and cheap. I tend to prefer generic meds b/c they have been around longer with a proven track record, and the risks are known too . This is my style, and there is certainly nothing wrong with those who do prescriber newer meds .
While they are overall fairly well tolerated and arguably with less side effects than older classes of antidepressants, some people may be more sensitive to side effects of this class and may do better with older classes like tricyclic antidepressants or MAOIs .
What Does Seroquel Do
Seroquel works by helping to restore balance to the chemical messengers in your brain. It can help to improve concentration, decrease anxiety, and improve your moods and energy levels.
The exact way in which Seroquel functions in the brain is unclear, but it is believed to help calm your mood and control symptoms of schizophrenia and depression by working on dopamine and serotonin receptors in your brain.
Scientists believe that the drug blocks dopamine receptors in your brain, preventing increased activity of dopamine in your brain. Increased dopamine activity in the brain has been linked to the development of conditions that are characterized by psychosis.
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How Does Seroquel Work
Seroquel interacts with various brain receptors to calm electrical impulses in your brain, improve your mood, relax your body, and alleviate psychotic thoughts. However, researchers are still somewhat baffled about its exact function within the brain and body. Some studies suggest that Seroquel reduces or prevents dopamine and serotonin from activating in your brain.
Too much dopamine can prevent you from becoming sleepy before bed , while too much serotonin can trigger wakefulness, delay sleep, and stop you from falling into a deeper sleep .
Reducing these levels not only improves your mood, but also calms your mind and body , so you can peacefully fall asleep.
Safety And Tolerability Assessments
The incidence, severity, and withdrawals because of AEs were recorded throughout. All AEs and serious AEs , including any ongoing at study end or discontinuation, were followed up until resolution or until the investigator decided that no further follow-up was necessary. Tolerability was assessed through physical examination and 12-lead electrocardiogram recordings , laboratory measurements , and recording of body weight, vital signs, and concomitant medication . The self-administered, 14-item Changes in Sexual Functioning Questionnaire was completed at randomization and weeks 2, 4, and 8, with separate versions for males and females . Barnes Akathisia Rating Scale and SimpsonAngus Scale scores were assessed at randomization and weeks 2, 4, 6, and 8. All investigators performing BARS and SAS ratings received instructions on how to use these scales and it was recommended that the same rater conduct all assessments for a given patient.
During the 2-wk drug-discontinuation phase, treatment discontinuation signs and symptoms were measured using a modified 18-item TDSS scale , which included the additional AEs vomiting, nausea, and insomnia. Patients completing the randomized period were asked to rate discontinuation symptoms using the TDSS scale on post-treatment days 1, 3, 5, 7, and 14. During the drug-discontinuation phase patients were encouraged not to take any medication for anxiety.
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Whats The Best Dosage Of Seroquel For Anxiety
Due to the fact that specific neuropsychiatric diagnosis, severity of anxiety, medical history, and medication regimen is subject to substantial individual variation theres no optimal dose of quetiapine that should be universally recommended for the treatment of anxiety. Only a skilled, licensed psychiatrist is qualified to give dosing advice, and even then, dosing will be adjusted on a case-specific basis not everyone responds to the same dosage. That said, assuming quetiapine XR is being administered as a monotherapy for the sole treatment of generalized anxiety disorder, research supports its usage at dosages of 50 mg/day and 150 mg/day.
Some RCTs suggest that standalone quetiapine XR is effective for the sole treatment of generalized anxiety disorder at 300 mg/day dosages, however, the 300 mg/day dosages are less substantiated than 50 mg/day and 150 mg/day doses. Among patients with comorbid anxiety and bipolar depression research suggests that 300 mg/day and 600 mg/day dosages of quetiapine XR facilitate therapeutic anxiolytic effects. Despite the fact that therapeutic dosing ranges appear in the research, finding the most effective dose of quetiapine for your anxiety may require ongoing psychiatric calibration.
Should You Question Quetiapine
If youâre prescribed quetiapine by your GP or psychiatrist then you have a legitimate case for asking why theyâre using this drug rather than the benzodiazepines and the âZâ drugs that have proven effectiveness in the treatment of insomnia.
Remember this is about your health and your sleep, not theirs. You have every right to discuss the most appropriate treatment for your condition.
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Why Is This Blog About Seroquel For Anxiety Important
Even though Seroquel for anxiety is still not approved officially by the FDA due to health and safety concerns is is prescribed by doctors off-label in the treatment of mental illnesses including anxiety disorders, especially for Generalized Anxiety Disorder.
However, results from clinical trials are promising in showing the effectiveness of Seroquel for anxiety.
Still, your doctor is the one that decides whether prescribe this type of medication or another type of medication.
Always consult with your doctor about any possible side effects and the benefits.
Please feel free to comment in the comments section below!
Types Of Outcome Measures
Primary outcome measures
The primary outcome measure was mean change score of a standardized anxiety rating scale .47
Secondary outcome measures
The secondary outcome measures consisted of:
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Seroquel And Serotonin Syndrome
Serotonin syndrome is a life-threatening condition caused by the buildup of serotonin in the body. Serotonin syndrome can present with symptoms that range from mild to life-threatening and requires emergency medical attention.
Certain drugs are more commonly associated with serotonin syndrome, such as antidepressants, opioid pain medications, and triptan migraine medications. However, Seroquel can also be associated with serotonin syndrome.
Symptoms to look out for include agitation, hallucinations, feeling overheated, muscle twitching, and fast heart rate. Serotonin syndrome can occur with normal doses of a drug, and is more likely to occur when a dose is increased, or if too much drug is taken , or when more than one drug associated with serotonin syndrome is being taken. Always tell your healthcare provider about all of the medications you take, including Rx and OTC drugs, vitamins, and supplements. Do not start any new medications unless your healthcare provider is aware and gives you the green light to do so.
Quetiapine Or Sleeping Tablets
One of the most cited reasons for avoiding the use of using traditional sleeping tablets to treat insomnia is a concern that theyâre addictive. This is why GPs look to prescribe alternatives that are not associated with addiction.
However repeated studies have shown that quetiapine has abuse potential. 910111213 This raises serious questions concerning its suitability as a replacement for either benzodiazepines or so-called âZâ drugs.
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Take Seroquel As Directed
Take Seroquel exactly as instructed. Doses will vary, particularly at the beginning of therapy. In order for Seroquel to work, doses must be taken every day following a daily schedule. Dont skip a dose. Take a missed dose unless it is almost time for the next dose. In that case, skip the missed dose and take the next dose on time.
Consume It As Directed
Seroquel should be taken as directed. Doses will vary, especially at the start of therapy. One must take it daily for it to be effective.
It is vital to take your medication exactly as prescribed by your doctor, but missing a dose is not dangerous if you know how to manage it. Take your medicine as soon as you remember. If your next dose is coming, do not take an extra amount to compensate for the one you missed. Instead, continue with the next dose.
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Adverse Events In Older People
A study of residential aged-care facilities in Australia found that 22% of antipsychotic prescribing was off label.27 Prescribing antipsychotics in this population has also been associated with increased risk of fatal pneumonia, stroke, hip fracture and cognitive deterioration.28–30 Orthostatic hypotension could contribute to the risk of falls.
In 2005 the Food and Drug Administration issued a black box warning in the USA because of an increase in sudden cardiac deaths related to antipsychotic drugs in older patients. Despite this warning quetiapine use continued to rise.31
Can I Take Quetiapine If I Am Pregnant Or Breastfeeding
Pregnancy
When deciding whether to take quetiapine during pregnancy it is important to weigh up how necessary quetiapine is to your health against the possible risks to you or your baby, some of which will depend on how many weeks pregnant you are.
Quetiapine is not seen as high risk and has a low rate of transfer across the placenta into a baby.
There does not appear to be an increased risk of malformations, miscarriages or having a baby born early.
From month four of a pregnancy onwards, an increase in dose of quetiapine may be required to keep body levels the same.Quetiapine may slightly increase your chance of getting high blood pressure linked to pregnancy , putting on extra weight and gestational diabetes.
To reduce the chance of a blood clot in your leg you may be advised to have a course of blood-thinning injections. Your doctor can advise you about this.
Post-natal
If you take quetiapine close to delivery your baby may have some side effects or discontinuation symptoms, like being irritable, crying or problems feeding and sleeping. These are usually mild and go away within a few days without treatment.
Breastfeeding
Quetiapine is passed in small amounts to the baby through breast milk. Breastfeeding may help with any discontinuation symptoms.
You should discuss the risks and benefits of breastfeeding with your midwife or doctor.
Make sure that your doctor, nurse, or health visitor checks your baby for any side effects.
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