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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by SadDoggie on February 3, 2005, at 5:31:01
Can you believe my INCOMPETENT psychiatrist prescribed Seroquel to my mother just so she could sleep? She's not schizophrenic or anything like that, he just prescribed it to aid with sleep. Is that the craziest thing you've ever heard? Just thought I'd share that :)
Posted by med_empowered on February 3, 2005, at 6:02:14
In reply to My incompetent psychiatrist, posted by SadDoggie on February 3, 2005, at 5:31:01
hey! lots of shrinks are doing this...unfortunately, they tend not to explain to their patients that an antipsychotic is an antipsychotic, no matter what its used for, and they neglect to mention many side-effects. Seroquel gave me nightmares and caused all kinds of problems, and then my then-shrink had the nerve to ask me to take it again, in lower doses, for sleep. Pshaw. I said no, got a straight up SLEEPING PILL (Ambien), and had insomnia no more. The use of seroquel for sleep may be trendy, but I think sleep disorders are best treated with therapy, benzos, and, rarely, short-term use of the barbiturates.
Posted by reefer on February 3, 2005, at 6:09:31
In reply to My incompetent psychiatrist, posted by SadDoggie on February 3, 2005, at 5:31:01
Where i live(Sweden), most doctors go nutty if you even dare to ask for a sleeping pill. Once i asked a psychiatrist what she thought about benzos. And she said she never prescribes them unless she gets a patient that's already on them. So i asked, what if someone has so much anxiety they want to kill themselves, would you still not prescribe it? And she said that she wouldn't prescribe them anyway. So i just had to laugh her straight in the face and say goodbye and leave her office. Anyway now i have a good doc which prescribes most things after being presented with some research except for opiods.
Posted by SLS on February 3, 2005, at 6:35:58
In reply to Re: My incompetent psychiatrist, posted by med_empowered on February 3, 2005, at 6:02:14
> hey! lots of shrinks are doing this...unfortunately, they tend not to explain to their patients that an antipsychotic is an antipsychotic, no matter what its used for, and they neglect to mention many side-effects. Seroquel gave me nightmares and caused all kinds of problems, and then my then-shrink had the nerve to ask me to take it again, in lower doses, for sleep. Pshaw. I said no, got a straight up SLEEPING PILL (Ambien), and had insomnia no more. The use of seroquel for sleep may be trendy, but I think sleep disorders are best treated with therapy, benzos, and, rarely, short-term use of the barbiturates.
I should think that short-term use of Seroquel would be preferable to using a barbiturate. There is far less risk of developing a life-threatening event taking an overdose of Seroquel than of dying of respiratory depression from a barbiturate should someone opt to go to sleep permanently. 50mg of Seroquel seems to act wonderfully as a sleep aid. I would agree that it should not be used as a first-line treatment for insomnia in cases where psychosis is not involved. There are too many other drugs to choose from. Even the use of low dosages of sedating antidepressants is an option, in my opinion. I don't see why barbiturates should be brought in to the equation so early. Maybe I am just biased against them because I haven't seen them used in recent years for anything other than seizure disorders.
- Scott
Posted by med_empowered on February 3, 2005, at 7:56:11
In reply to Re: My incompetent psychiatrist, posted by SLS on February 3, 2005, at 6:35:58
hey! barbiturates are RARELY used these days, accounting for about 10% of all prescriptions for anti-anxiety/hypnotic drugs...I think this excludes most high-dose phenobarbital prescriptions, written obviously for convulsions. Anyway, seconal and nembutal, occasionally Tuinal, are still utilized in treatment resistant insomnia...doctors are understandably hesistant to do this, some insurance companies will only cover these drugs after speaking with the doctor, and patients generally don't seek barbiturates anymore, but specialists in sleep and some psychiatrists can and do write prescriptions for those in need. In addition, instead of using antipsychotics for treatment-resistant anxiety (think anxiety thzt doesn't respond adequately to drug combos involving benzos), doctors will still sometimes use barbiturates and/or Miltown.
Posted by banga on February 3, 2005, at 8:07:57
In reply to barbiturates for sleep, posted by med_empowered on February 3, 2005, at 7:56:11
My pdoc just said tha Seroquel is "black-boxed" (first time I have headr that term, I assume it means warning in the least). Sh said that for some people it can cause evere live damage. The problem is--it can happen anytime, not just in very long-term use.
She is perhaps overcareful--but if it is black boxed, this must mean something.
Posted by med_empowered on February 3, 2005, at 9:07:11
In reply to Seroquel warning ?!, posted by banga on February 3, 2005, at 8:07:57
hi! The "black box" I believe is the FDA's strongest warning measure...its something that can be done just short of resheduling a drug or ordering it off the market. Anyway, the antidepressants are now supposed to be "black boxed" with suicide warnings (tricyclics have been for years; the ssris now have to follow). It makes sense that seroquel would be black boxed...in MAD IN AMERICA, the author cites a number of letters, obtained through the Freedom of Information Act, that the FDA sent to the makers of the atypical antipsychotics (including the seroquel people). Anyway, even though the FDA did approve seroquel, there were found to be serious flaws with the seroquel studies (and the zyprexa studies, and the risperdal studies), and therefore any claim of superiority over conventional antipsychotics is highly suspect.
Posted by ravenstorm on February 3, 2005, at 16:00:46
In reply to Re: Seroquel warning ?!, posted by med_empowered on February 3, 2005, at 9:07:11
Are you sure you are not thinking of serzone? That has a black box warning for liver problems. Unless the black box warning for seroquel is new, I have not heard of it.
Posted by banga on February 3, 2005, at 16:35:56
In reply to Re: Seroquel warning ?!, posted by ravenstorm on February 3, 2005, at 16:00:46
Hi,
Uh oh....I know I asked her about SEROQUEL--but maybe as it was in the context of dicussions on antidepressants, she either assumed or heard 'serzone' instead. I hadn't made that conection! I did know about the serzone problems.
SO I withdraw this statement until I clarify with her regarding which med she was talking about. If I do find out this was a misunderstanding, I sincerely apologise for the statement!!!
Posted by Phillipa on February 3, 2005, at 16:38:11
In reply to Re: Seroquel warning ?!, posted by ravenstorm on February 3, 2005, at 16:00:46
And the new pdoc just asked me if I had taken serzone in the past. For some reason I continuously awaken after about 4 hours and require more benzos to get any more sleep. The new pdoc, says she wants to address the sleep problem. Hense, she is weaning me off the chloral hydrate and klonopin and won't allow more than 1.5mg of xanax a day. She also Rx'd l5mg of remeron, and l0mg of ambien which I took last night for the first time. Still woke up after 4 hours. Could this just be the way I am? She is talking sleep studies too. Fondly, Phillipa PS she really wanted me to take l00mg of seroquel, but I said no.
Posted by med_empowered on February 3, 2005, at 21:26:20
In reply to Re: Seroquel warning ?! » ravenstorm, posted by Phillipa on February 3, 2005, at 16:38:11
hey! Sorry about your sleep troubles. 4 hours really isn't a lot of sleep at all...to me, it sounds like the ambien may be just enough to control rebound insomnia from discontinuing your other sleep meds. Since Ambien acts kind of like a super-targeted benzo, my thought is that maybe its picking up only some of the slack as you withdraw, so for a while maybe you won't sleep quite that much.
Posted by Phillipa on February 3, 2005, at 22:06:21
In reply to Re: Seroquel warning ?!phillipa, posted by med_empowered on February 3, 2005, at 21:26:20
Thanks for the good information. Again, I am amazed at the knowledge on this Board. May I ask if you are in the medical profession? Fondly, Phillipa
Posted by med_empowered on February 3, 2005, at 22:40:26
In reply to Re: Seroquel warning ?!phillipa » med_empowered, posted by Phillipa on February 3, 2005, at 22:06:21
Hi! My post was just a guess, kind of based on my own experience with multiple sedatives and some benzos. I am not a medical professional; I just find the information fascinating and, well, very necessary since I have symptoms that even a shrink told me are "hard to categorize, but absolutely must be treated". That shrink ended up putting me on a med regimine that involved about 7-8 daily meds at its peak (bummer) and never really diagnosed me; rather, I just got a list of symptoms and components of my illness (I think he was a good doctor, just a little med-heavy). When you can't neatly fit into "depression" or "anxiety" or even "bipolar", its really up to you to research your symptoms, your meds, and your options if you seriously want to get well. Thanks for your compliments, and I wish you the best!
Posted by Sabina on February 4, 2005, at 0:31:04
In reply to Seroquel warning ?!, posted by banga on February 3, 2005, at 8:07:57
Here is a link to all 2004 FDA Safety Warnings for drugs:
http://www.fda.gov/medwatch/SAFETY/2004/safety04.htm#drugs
Seroquel is one of the many drugs on the list, outlining a potential "increased risk of hyperglycemia and diabetes" while taking the drug. And yes, Serzone is there, too! It's warning mentioned "hepatic failure" along with some other things. I didn't notice the words "black box" on this page, unless that is synonymous with Safety Alerts in FDA speak.
From what I understand, all AD's are now under the "black box" warning (as I believe med_empowered mentioned) passed last Fall by the FDA. That's the one that spoke primarily to the increased risk of suicide in children and adolescents:
http://pn.psychiatryonline.org/cgi/content/full/39/21/1
These newest potential Safety Alerts are, of course, in addition to whatever these drugs' *original* potential side effects were. In my experience, all drugs have scary potential side effects in the fine print. Have you heard some of warnings from certain commercials on TV? Good Lord, if our pdocs gave us that kind of sales pitch, we might all go home stunned and empty handed. The inserts on birth control pills scared me so that at one point (years ago, I'm off *all* hormonal BC now) I went to Depo Provera because I was told it was safer. Guess what's on the 2004 Safety Alert? By now I already have susbstantial bone density loss (in my mid 30's!) and directly link hormonal BC to my Fibromyalgia (FM) flare-up/breakdown in 2002 that exacerbated a chemical imbalance and left me searching for meds as a last resort.
For me (just me) Seroquel was literally a lifesaver and well worth the risk. Am I going to obsess about this newer warning? No. Not after all the work I did getting through the first year of worrying that I was going to develop glaucoma, which is listed on the product insert and runs in my family. Still seeing 20/20 today! We all know that these drugs come with a certain risk factor. What we have to do is sit ourselves down with our doctors and ask, Does the risk outweigh the alternative for us? Do we feel comfortable trying this drug and/or giving it some time to work? Though it was a long time ago, I vividly remember that I had a *hard* first couple of weeks with Seroquel.
Ironically, I was suicidal at the time I began taking Seroquel and finally felt kind of foolish realizing that, just as I began finding some relief with the drug, I was spending so much time worrying about maaaaaybee developing a treatable condition as a side effect when I didn't even know if I'd be around until next week or check out by my own hand! I'm only remembering laughing at myself, mind you, not inferring that worry over side effect profiles is foolish in itself or not to be respected.
There may well be "serious flaws" in the drug studies of Seroquel, but I like the pretty rocks balancing on their web site, so I figure they're okay by me. Nah, I'm just kind of getting at the fact that I could probably manage to find something negative about many of the most prescribed drugs mentioned on this site as well. I could probably even find a study promoting use of Seroquel for insomnia. Hmmm...hold on a minute.
Some boys in Gottingen did this:
But m*rde, I gotta tell you, I'd be kicking like a Rockette on crack with akathisia if I hit 100mg at one go on that stuff...even after all this time. On another personal note concerning letting myself be adversely affected by bad press, I've read some pur-etty creepy things (elsewhere) about some shady marketing and studies done of Neurontin; but somehow I'm still considering dumping my Topamax and giving it a try! I just can't stand the stupids anymore. I want to find out just how dumb I am au naturel because with the flippin' FM symptoms I can't tell which is which. Plus, I've lost over thirty pounds on that stuff! I need a change and Neurontin deserves a chance. Then again I don't know if they have cool rocks on their web site. Wait a sec...was there any mention of loss of common sense in those Seroquel studies? Aaaarrrrgh...save me, meds_empowered! OK, just checked...I do *not* dig their web site. My next choice was Gabitril. I wouldn't *really* choose a drug based on it's advert, but I sure does like the GABA. My first choice is actually to stop meds entirely, which I am seriously considering as well. I'm already tapering off the Topa, quite successfully, I might add.
To the first poster in this thread, I applaud you for being so proactive in your mother's care and I hope she's experiencing relief on her current sleep aid. Long term insomnia is one of the most maddening things I have ever experienced. It actually *makes* me hallucinate after a time when left un- or under-treated. I'll just be dozing off and think I hear the telephone ring or the front door slamming when I know I'm alone at home. I have to wait until the dog's lack of barking signals an all clear to let me know that Mama needs to get more sleep! I'd say it makes me nauseated and forgetful as well, but that could be the FM so who can say for sure. I'm *not* saying that your Mom presented with any other complaints, only that I deeply empathize with the physical and emotional distress caused my insomnia.
I know first hand that some docs and nursing homes hand out Seroquel like after dinner mints. Just because I'm a big foam finger fan of the drug doesn't mean that I think it should be in the town water supply, but perhaps your Mom's pdoc chose Seroquel over another sleep aid (for long term use?) as they feel it can also help with any confusion and depression that might be contributing factors to sleeplessness in the "getting older" populations. That's what I've been told, anyway. Just a thought to maybe redeem him somewhat in your eyes? Believe me, I balked a bit at first at the term "atypical antipsychotic" myself, so I understand your anger. And I know nothing about your mother's age or situation, so please don't allow my ill informed comments step on your toes. It's just that I'm "not schizophrenic or anything like that" either, but it was still a good fit for me.
Mostly, I just wanted to pop in and give the links above to clear things up as to the Serzone/Seroquel, "black box" vs. Safety Alerts List. Then I just kept rambling. Sorry.
I was getting distracted anyway. Gotta go pay attention to Lars von Trier's The Kingdom on IFC now. http://www.amazon.com/exec/obidos/ASIN/6304018959/drbobsvirte00-20 I own it but I still like to watch it when it's on. Cheers.
This is the end of the thread.
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