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Seroquel for the depression and mania of bipolar disorder

The medication Seroquel® (quetiapine) is approved by the FDA for the treatment of bipolar depression, in both bipolar I and bipolar II. Seroquel was previously approved as a treatment for bipolar mania.

Although Seroquel is in a class of medications called atypical antipsychotics, it is used as a medication for people who have bipolar disorder whether or not they have ever experienced “psychosis.” In addition to its use as a treatment of depressive episodes associated with bipolar disorder, it is used alone or with lithium or divalproex (Depakote®) to treat acute manic episodes. It has been found to be an effective medication for both. Seroquel is also used to treat symptoms of schizophrenia.

How does it work?
These medications are thought to stabilize mood by reducing the effects of the neurotransmitter dopamine (by blocking some dopamine receptors), or by reducing the effects of dopamine together with serotonin. The medication’s effect on histamine H1 receptors may explain why it can cause sleepiness.

How is it taken?
Seroquel tablets come in dosages of 25 mg (round, peach), 50 mg (round, white), 100 mg (round, yellow), 200 mg (round, white), 300 mg (capsule-shaped, white), and 400 mg (capsule-shaped, yellow).

Patients should begin taking Seroquel at a lower dose, gradually increasing the dosage. Some doctors start as low as 25 mg, although the target dose for the treatment of bipolar depression is 300 mg per night. Doctors want to raise the dose as quickly as is tolerable to the target dose, avoiding daytime sedation the following day. That increase may take as little as four days or as long as several weeks.

For bipolar disorder depression, Seroquel should be taken once daily at bedtime to reach 300 mg/day by day four.

For bipolar mania, Seroquel is usually started at 100 mg/day, and increased in increments of up to 100 mg/day to 400 mg/day on day 4. Further adjustments up to 800 mg/day by day 6 should be in increments of no greater than 200 mg/day. The majority of patients respond to dosages between 400 to 800 mg/day.

It’s important to take this medication as directed and not to stop taking it without talking to your doctor.

How fast does it work?
In recent depression studies, there was clear improvement, more than in patients taking a placebo, within a week. Full response to the medication can take several additional weeks.

What are its side effects?
Because of the need to increase the medication slowly, many patients have no side effects at all, except for the daytime sedation which limits how quickly one can go up on the dose. Many side effects appear only briefly as the dose is increased.

The most common side effects include headache, agitation, dry mouth, constipation, pain, vomiting, upset stomach and weight gain. Dizziness, and sometimes fainting, caused by a drop in blood pressure may happen with Seroquel, especially when you first start taking this medicine, if the dose is increased quickly. Prescribing doctors will monitor closely for 1.) glucose increases, which could lead to an increased risk for diabetes, 2.) increases in cholesterol, which raises cardiovascular disease risk and 3.) weight gain. These are all related concerns, sometimes referred to as “metabolic syndrome.”

Seroquel may impair judgment, thinking, or motor skills. You should be careful in operating machinery, including automobiles, until you know how Seroquel affects you.

It is important to avoid overheating and dehydration while taking Seroquel, because it may make it harder to lower your body temperature.

Sleepiness can be a side effect. In clinical trials, according to the manufacturer, when taken alone for bipolar mania 18 percent of patients reported somnolence (sleepiness.) Almost twice as many reported this effect when taking Seroquel with another medication. Twenty-eight percent of participants taking Seroquel alone for bipolar depression experienced it. Not all patients minded the drowsiness. While not approved or marketed as a sleep aid, many doctors prescribe Seroquel for their patients who are suffering from sleep problems.

Studies also reported that no more than six percent of patients reported weight gain. However, doctors and patients frequently report food cravings and added pounds.

Tell your doctor if you have or had heart problems, cataracts, thyroid disorder, high cholesterol or triglycerides, seizures, diabetes or increased blood sugar or liver disease. Tell your doctor if you are pregnant, trying to become pregnant or are breast-feeding.

Be aware of these risks and interactions
Risks

  • Increased chance of death in elderly persons being treated with atypical antipsychotics, such as Seroquel, for dementia
  • High blood sugar and diabetes. Patients with diabetes or who have a higher chance for diabetes should have their blood sugar checked.
  • Avoid drinking alcohol while taking Seroquel.
  • A life-threatening nervous system problem called neuroleptic malignant syndrome (NMS). Call your doctor immediately if you experience high fever, stiff muscles, sweating, a fast or irregular heart beat, change in blood pressure, and confusion.
  • A movement problem called tardive dyskinesia (TD). Call your healthcare professional right away if you get muscle movements that cannot be stopped.
  • Other serious side effects may include low blood pressure seen as dizziness, increased heart beat and possibly fainting, cataracts, seizures, low thyroid, elevated cholesterol or triglycerides, liver problems, persistent erection, increase or decrease in body temperature, and difficulty swallowing.

Interactions
Because certain other medications can interact with Seroquel, tell your doctor about all prescription and non-prescription medications that you are taking. Your doctor may have to adjust your dose or watch you more closely if you take certain medications.

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