![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by sk85 on December 5, 2010, at 12:24:03
Maybe this has been asked before.
I'm suffering from unipolar depression and wondering if Seroquel as a monotheraphy would be of help. Can anyone share their experiences with Seroquel as a mood booster? What was the dose and did it matter a lot?
Also does it like SSRIs cause worsening of symptoms in the initial phase of treatment. I seem to be especially sensitive to that effect as some pills have made me really depressed initially before giving an antidepressant effect.
Posted by Phillipa on December 5, 2010, at 13:03:26
In reply to Seroquel for unipolar depression, posted by sk85 on December 5, 2010, at 12:24:03
I wish I had more to offer but was on one day and I nearly passed out and couldn't talk as so sedated but wide awake. I have some of the same problems as you with meds. Very sensitive. Phillipa
Posted by sk85 on December 5, 2010, at 13:15:54
In reply to Re: Seroquel for unipolar depression » sk85, posted by Phillipa on December 5, 2010, at 13:03:26
> I wish I had more to offer but was on one day and I nearly passed out and couldn't talk as so sedated but wide awake. I have some of the same problems as you with meds. Very sensitive. Phillipa
Yeah it is very sedating in the beginning. But I've been taking it for 3 months 100 mg and it no longer causes daytime grogginess nor does it make me hungry. I'm just wondering if higher doses are worth it for hoping an antidepressant effect...
I've posted before on Seroquel and it's effect on EPS for which I've found it to be beneficial, but my depressive swings are still coming and going.
Posted by ace on December 5, 2010, at 23:59:24
In reply to Seroquel for unipolar depression, posted by sk85 on December 5, 2010, at 12:24:03
> Maybe this has been asked before.
> I'm suffering from unipolar depression and wondering if Seroquel as a monotheraphy would be of help. Can anyone share their experiences with Seroquel as a mood booster? What was the dose and did it matter a lot?From my own experience and from what i have seen, I really don't think seroquel would be a good choice for a pure depressive problem. certainly not a first line treatment. When used with other agents I believe it can have a synergistic effect, but I would recommend as first line a TCA or an MAOI. But these can have pronounce s/effects (as can Seroquel- esp weight gain)
> Also does it like SSRIs cause worsening of symptoms in the initial phase of treatment. I seem to be especially sensitive to that effect as
On the whole, and after a great deal of research and observation and experience, i have not really seen the SSRI's to be off great value in the treatment of any psychopathology. They can have horrid withdrawal syndromes, a myriad of s/effects (sometimes totally unexpected ones).
However, i am sure they do work for some. I just can't recommend them personally.
some pills have made me really depressed initially before giving an antidepressant effect.This, a lot of the time CAN, predict a very good therapeutic response. But even this phenomenon- the initial worsening of symptoms leading to a greater antidepressant effect- I have not seen it much, if at all, in the SSRI's either.
Unfortunately all the poor doctors are taught "SSRI's, SSRI's, SSRI's!!!!!" "They are the way!!" And they simply don't have the time to do their own independent research.
If SSRI's were taken off the market tomorrow, i don't think it would be such a bad thing.
Like I said, i would personally try a TCA or an MAOI.
All the best!
Posted by sk85 on December 6, 2010, at 5:26:22
In reply to Re: Seroquel for unipolar depression » sk85, posted by ace on December 5, 2010, at 23:59:24
> On the whole, and after a great deal of research and observation and experience, i have not really seen the SSRI's to be off great value in the treatment of any psychopathology. They can have horrid withdrawal syndromes, a myriad of s/effects (sometimes totally unexpected ones).
I concur, SSRIs can be pretty messy drugs and their long-term effectiveness is very dubious. Thanks to Prozac I ended up with permanent dystonia and despite it's somewhat initial positive effects, it lost most of its effectiveness by the end of the 4 month. Absolutely pointless drug in my opinion.
> some pills have made me really depressed initially before giving an antidepressant effect.
>
> This, a lot of the time CAN, predict a very good therapeutic response. But even this phenomenon- the initial worsening of symptoms leading to a greater antidepressant effect-Yes, I've experienced that aswell. For example Effexor made me feel really terrible for the first week, after that came enormous relief to most of my symptoms. But because Prozac made so much damage before it, I started getting worsening dystonia also on Effexor, so I had to discontinue it.
I don't think I can take anything that hits serotonin hard, because all of these attempts have ended up in terrible EPS. So TCA-s and MAOI-s are out for me. So far Seroquel has not made my condition worse (if not improved it significantly). Although my mood keeps dipping for no apparent reason, so I'm desperately searching for something to help. Mirtazapine is also one possible candidate.
Posted by SLS on December 6, 2010, at 5:48:23
In reply to Seroquel for unipolar depression, posted by sk85 on December 5, 2010, at 12:24:03
> Maybe this has been asked before.
> I'm suffering from unipolar depression and wondering if Seroquel as a monotheraphy would be of help. Can anyone share their experiences with Seroquel as a mood booster? What was the dose and did it matter a lot?Seroquel has been studied only recently for use in unipolar depression.
- Scott
---------------------------------------
Journal of Affective Disorders
Volume 127, Issues 1-3, December 2010, Pages 19-30
doi:10.1016/j.jad.2010.08.032 | How to Cite or Link Using DOI
Copyright © 2010 Elsevier B.V. All rights reserved.
Permissions & Reprints
Review
A pooled analysis of two randomised, placebo-controlled studies of extended release quetiapine fumarate adjunctive to antidepressant therapy in patients with major depressive disorderAlert
This article is not included in your organization's subscription. However, you may be able to access this article under your organization's agreement with Elsevier.Michael Bauera, low asterisk, E-mail The Corresponding Author, Nizar El-Khalilib, Catherine Dattoc, Johan Szamosid and Hans Erikssond
a Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, D-01307 0 Dresden, Germany
b Alpine Clinic, Lafayette, IN, USA
c AstraZeneca Pharmaceuticals, Wilmington, DE, USA
d AstraZeneca R&D, Södertälje, Sweden
Received 24 September 2009;
revised 26 August 2010;
accepted 26 August 2010.
Available online 29 September 2010.Abstract
BackgroundTwo positive studies evaluated adjunctive extended release quetiapine fumarate (quetiapine XR) in patients with major depressive disorder (MDD) showing inadequate response to antidepressant treatment. This preplanned, pooled analysis provides an opportunity for subgroup analyses investigating the influence of demographic and disease-related factors on observed responses. Additional post hoc analyses examined the efficacy of quetiapine XR against specific depressive symptoms including sleep.
MethodsData were analysed from two 6-week, multicentre, double-blind, randomised, placebo-controlled studies, prospectively designed to be pooled. Patients received once-daily quetiapine XR 150 mg/day (n = 309), 300 mg/day (n = 307) or placebo (n = 303) adjunctive to ongoing antidepressant therapy. The primary endpoint was change from randomisation to Week 6 in MADRS total score. Other assessments included MADRS response (≥ 50% decrease in total score) and remission (total score ≤ 8), change from randomisation in HAM-D, HAM-A, PSQI global and CGI-S scores.
ResultsQuetiapine XR (150 and 300 mg/day) reduced MADRS total scores vs placebo at every assessment including Week 6 (− 14.5, − 14.8, − 12.0; p < 0.001 each dose) and Week 1 (− 7.8,−7.3,−5.1; p < 0.001 each dose). For quetiapine XR 150 and 300 mg/day and placebo, respectively at Week 6: MADRS response 53.7% (p = 0.063), 58.3% (p < 0.01) and 46.2%; MADRS remission 35.6% (p < 0.01), 36.5% (p < 0.001) and 24.1%. Quetiapine XR 150 and 300 mg/day significantly improved HAM-D, HAM-A, PSQI and CGI-S scores at Week 6 vs placebo. Quetiapine XR demonstrated broad efficacy, independent of factors including concomitant antidepressant.
LimitationsFixed dosing; lack of active comparator.
ConclusionsAdjunctive quetiapine XR is effective in patients with MDD and an inadequate response to antidepressant therapy, with improvement in depressive symptoms seen as early as Week 1.
Keywords: Extended release; Quetiapine; Adjunctive; Major depressive disorder
Article Outline
Posted by ace on December 6, 2010, at 6:06:14
In reply to Re: Seroquel for unipolar depression » ace, posted by sk85 on December 6, 2010, at 5:26:22
> I concur, SSRIs can be pretty messy drugs and their long-term effectiveness is very dubious. Thanks to Prozac I ended up with permanent dystonia and despite it's somewhat initial positive effects, it lost most of its effectiveness by the end of the 4 month. Absolutely pointless drug in my opinion.It's not good at all that you suffered that. Have you reported it? I really urge you too if you not. SSRI's are pretty much cash cows, and it is a disgrace that they are being dispensed like lollies by many doctors. Dr. David Healy has (bravely and admirably) pointed out the many pitfalls of SSRI's. I'm still not convinced of their potential to cause an actual suicide although.
> > some pills have made me really depressed initially before giving an antidepressant effect.
> >
> > This, a lot of the time CAN, predict a very good therapeutic response. But even this phenomenon- the initial worsening of symptoms leading to a greater antidepressant effect-
>
> Yes, I've experienced that aswell. For example Effexor made me feel really terrible for the first week, after that came enormous relief to most of my symptoms. But because Prozac made so much damage before it, I started getting worsening dystonia also on Effexor, so I had to discontinue it.Are you using anything to treat the dystonia?
> I don't think I can take anything that hits serotonin hard, because all of these attempts have ended up in terrible EPS.
You should be OK, EPS usually due to dopamine depletion. It was probably the dopaminergic effect these drugs had
What drugs exactly and what EPS sx?
Their was a MD, forgot his name- have to look it up- he pointed out that SSRI's reduce brain dopamine in the substantia nigra....he mentioned at a certain age we already have such a reduced level, ex SSRI users could be dealing with Parkinson's etc
So TCA-s and MAOI-s are out for me.Well these classes do act on serotonin, but they do so by a different mechanism than the SSRI's.
But they also act on dopmaine, which I suspect could be behind your EPS.
So far Seroquel has not made my condition worse (if not improved it significantly). Although my mood keeps dipping for no apparent reason, so I'm desperately searching for something to help. Mirtazapine is also one possible candidate.Mirtazapine, from what I have seen, is not bad at all. certainly not as efficacious as the MAOI's (IMO), but definitely better than SSRI's. But that is going to hit serotonin, and Seroquel is already messing with your DA levels.
Have you had a full physical examination?
Seen a neurologist?
I am not sure what is accounting for your dystonia. I would certainly sort this out before exploring any other medication. Something doesn't sound right with regards to the EPS and the 5-HT.I wish you the very best, please keep us updated
Ace
Posted by sk85 on December 6, 2010, at 8:23:45
In reply to Re: Seroquel for unipolar depression » sk85, posted by ace on December 6, 2010, at 6:06:14
> It's not good at all that you suffered that. Have you reported it? I really urge you too if you not.
I'm not the first case of dystonia after Prozac. I've found papers reporting this in other people too. Some people get akathisia, others dyskinesia. But its all related to dopamine.
> But they also act on dopmaine, which I suspect could be behind your EPS.
> Their was a MD, forgot his name- have to look it up- he pointed out that SSRI's reduce brain dopamine in the substantia nigra....he mentioned at a certain age we already have such a reduced level, ex SSRI users could be dealing with Parkinson's etcI agree it's certainly dopamine. When this EPS horror hit me I researched months to find out why this happened. SSRIs apparently reduce dopamine in the brain's motor related areas (whereas the older APs block its effect). I understood that once the motor symptoms (spasms, involuntary movements) start the damage is done, because by reducing dopamine in those areas the very delicate receptor balance (dopamine D1 and D2) is messed up.
>But that is going to hit serotonin, and Seroquel is already messing with your DA levels.
> Are you using anything to treat the dystonia?Actually contrary to widespread beliefs that Seroquel is relatively antidopaminergic like all the other APs, in lower doses it pretty much hasn't got an effect on DA. It was even shown that its antipsychotic activity is not related to its DA activity and remains unknown. And what's more compared to drugs like olanzapine, risperidone Seroquel does not alter dopamine receptor balance in the brain's motor areas.
I'm getting botox injections for the afflicted muscles, but because so many different muscles are involved, it's having only the slightest effect. Also tried CoQ10 which helped but it's effects waned.
And this brings me back to Seroquel again as once I found there were reports that Seroquel has been found to be helpful in cases of tardive dystonia (i.e the drug induced form) I asked my psychiatrist to try this option. And so far I can report that it has made it somewhat better (I'd say 30%). Supposedly it antagonizes serotonin's dopamine reducing effect and thus protects against possible motor complications brought on by serotonin.
Posted by bleauberry on December 6, 2010, at 19:48:05
In reply to Seroquel for unipolar depression, posted by sk85 on December 5, 2010, at 12:24:03
I don't think seroquel would be a good unipolar depression med, but as a wise old pdoc used to tell me..."anything is possible". He had seen it all. Some things just defy logic, especially in psychiatry. My own gut instinct says seroquel might help with some symptoms, maybe create some new problems at some point, but won't ever bring something called remission.
I think when we have had neurological damage following SSRI usage, the game totally changes. It is more difficult. Actually, it was always difficult, they just deceptively made it look easy by handing you a prescription. I am almost tempted to tell you your prognosis is much better in the hands of a skilled Integrative MD, possibly a naturopath, but not someone who is only going to pick from the menu of psychiatric meds. Had no damage been done, maybe my opinion would be different. The dystonia changed the whole scenario. You'll need a comprehensive plan which includes specific food choices, supplements, maybe herbs, maybe meds, some in depth lab tests, and a plan. If your entire healing is based on what a psychiatrist prescribes for you, I personally think the prognosis is not real promising.
Whether to keep seroquel or not depends on whether you find it helpful enough in some ways to keep it. It is always a risk/benefit, or side effect/benefit, situation that we have to personally decide.
Posted by ace on December 6, 2010, at 23:28:45
In reply to Re: Seroquel for unipolar depression, posted by bleauberry on December 6, 2010, at 19:48:05
> I don't think seroquel would be a good unipolar depression med, but as a wise old pdoc used to tell me..."anything is possible".
That is wise words. It's like the old dartboard joke shrinks share!
He had seen it all. Some things just defy logic, especially in psychiatry.I concur. Of necissity, i think they must at times.
My own gut instinct says seroquel might help with some symptoms, maybe create some new problems at some point, but won't ever bring something called remission.
I'm just concerned that it's benefits would far outweigh it's therapeutic gains. Especially when their are better and safer medications out their.
> I think when we have had neurological damage following SSRI usage, the game totally changes. It is more difficult. Actually, it was always difficult, they just deceptively made it look easy by handing you a prescription. I am almost tempted to tell you your prognosis is much better in the hands of a skilled Integrative MD, possibly a naturopath, but not someone who is only going to pick from the menu of psychiatric meds.Very well said.
Had no damage been done, maybe my opinion would be different. The dystonia changed the whole scenario. You'll need a comprehensive plan which includes specific food choices, supplements, maybe herbs, maybe meds, some in depth lab tests, and a plan. If your entire healing is based on what a psychiatrist prescribes for you, I personally think the prognosis is not real promising.I think certain psychtherapeutical tools are extremely beneficial in some px.
> Whether to keep seroquel or not depends on whether you find it helpful enough in some ways to keep it. It is always a risk/benefit, or side effect/benefit, situation that we have to personally decide.Good post.
Ace
Posted by mogger on December 10, 2010, at 23:37:57
In reply to Re: Seroquel for unipolar depression » bleauberry, posted by ace on December 6, 2010, at 23:28:45
After years of trying meds for depression Seroquel has been the ONLY drug that has worked for my sisters suicidal depression. She only takes Seroquel and has unipolar depression. She is on 400mg a day and is as bright as a button. It is her saving grace. I am so grateful for seroquel as I have my sister back.
Posted by linkadge on December 12, 2010, at 20:17:46
In reply to Re: Seroquel for unipolar depression, posted by mogger on December 10, 2010, at 23:37:57
The TCA's effects on serotonin aren't as clear cut as the SSRIs. They can serotonin reuptake to various degrees, but they also inhibit serotonin receptors which can negate some of the antidopaminergic effect. Drugs like amitriptyline exhibit more of an antiserotonergic effect.
A drug like nortriptyline, has little effect on sertonin reuptake. Keep in mind, that a metabolite of seroquel is a NRI. I found that notriptyline was definately more tollerable than seroquel, and a seemingly more potent antidepressant, generally little akathesia too.
Seroquel made me feel fairly flat the next morning (i.e. colors duller etc). It was a decent sleep aid (if insomnia is promenent).
Linkadge
Posted by linkadge on December 12, 2010, at 20:22:15
In reply to Re: Seroquel for unipolar depression, posted by mogger on December 10, 2010, at 23:37:57
Seroquel has some inhibitory effects on the sigma receptor. In certain models, both sigma antagonists and agonists appear to improve symptoms of schizophrenia.
In addition, seroquel is a 5-ht7 antagonist. 5-ht7 antagonists appear to reduce symptoms in some models of schizophrenia.
Linkadge
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.