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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by ricker on May 20, 2009, at 13:34:18
Hi all,
I started seroquel 3 weeks ago and felt great for 2 weeks. The last 3 or 4 days feels like a switch has been flipped?? I'm getting extremely irritable, expesially in the morning and my jaw seems to be clenching causing pain just below the temple area. Slight muscle spasms in the legs after taking seroquel as well.
I'm taking 100mg so I was wondering if decreasing to 50mg would help.... less irritability, jaw clenching and muscle spasms? Or does it sound like seroquel may not be for me?
I have zydis available and may consider restarting it if I don't get any positive feedback from this post, at least I didn't experience these symptoms when taking it. I could probably live with the zydis weight gain as compared to how I'm feeling now!
Just not fair, feeling good for 2 weeks and now this???? What to do :-(
Rick
Posted by Phillipa on May 20, 2009, at 16:36:41
In reply to Seroquel help needed!, posted by ricker on May 20, 2009, at 13:34:18
Ricker so sorry. Seroquel only took for a few days didn't get those symtoms. Maybe the lower dose will help. Sounds like the l00mg is now built up in bloodsteam and it may not be for you? Love Phillipa
Posted by SLS on May 20, 2009, at 22:32:58
In reply to Seroquel help needed!, posted by ricker on May 20, 2009, at 13:34:18
> Hi all,
>
> I started seroquel 3 weeks ago and felt great for 2 weeks. The last 3 or 4 days feels like a switch has been flipped?? I'm getting extremely irritable, expesially in the morning and my jaw seems to be clenching causing pain just below the temple area. Slight muscle spasms in the legs after taking seroquel as well.
>
> I'm taking 100mg so I was wondering if decreasing to 50mg would help.... less irritability, jaw clenching and muscle spasms? Or does it sound like seroquel may not be for me?
>
> I have zydis available and may consider restarting it if I don't get any positive feedback from this post, at least I didn't experience these symptoms when taking it. I could probably live with the zydis weight gain as compared to how I'm feeling now!
>
> Just not fair, feeling good for 2 weeks and now this???? What to do :-(
>
> Rick
Hi Rick.I think yxibow (Jay) would be a better source of information regarding neuroleptic antipsychotic side effects.
Seroquel has a major metabolite that is a norepinephrine (NE) reuptake inhibitor (like desipramine or reboxetine). Perhaps this produced an energy boost acutely early in treatment that disappeared and turned into dysphoria and anxiety after chronic administration.
Let me sleep on this stuff.
For now, either leave things as they are and hope for a return of an antidepressant response or experiment with both lower dosages and higher dosages.
- Scott
Posted by ricker on May 20, 2009, at 22:49:38
In reply to Re: Seroquel help needed! - yxibow » ricker, posted by SLS on May 20, 2009, at 22:32:58
Thanks for your help Scott. I think I will try reducing the dose and see what happens. Always appreciate your input.
Hope you keep well..... Rick
Posted by Zyprexa on May 20, 2009, at 23:16:01
In reply to Seroquel help needed!, posted by ricker on May 20, 2009, at 13:34:18
Sounds like you should switch meds, go with the zydis. Zyprexa has been a life saver for me. Mucile twitches sounds like TD (Tardive Dysconisa) a bad side effect from anti-psychotics. It does not go away and may get worse or permanent. There are drugs to counter it like cogentin which I take with good success. My muscil twitches from perphenazine are not bad and tolerable with the cogentin, it does not take much of it. The jaw clenching could turn out to be a real problem if it gets worse to the point that its uncontrolable, this is NMS (Nuroleptic malignant syndrom). If its NMS you chould stop the med imediatly and call doctor.
Posted by yxibow on May 20, 2009, at 23:22:29
In reply to Re: Seroquel help needed! - yxibow » SLS, posted by ricker on May 20, 2009, at 22:49:38
> Thanks for your help Scott. I think I will try reducing the dose and see what happens. Always appreciate your input.
>
> Hope you keep well..... RickYes -- I think reducing the dose might be a good idea to see if the side effects reduce.
Sometimes Seroquel is dropped with 25mg increments to see what happens but since you're at a low dose, I don't think going down 50mg is going to be any worse. Dropping it stone cold is another story.
Jaw clenching while concerning is not an instant alarm of TD -- it is in the EPS spectrum though, I will say.
Are you taking it for sleep, another off label purpose, or for BP or a disorder with psychosis ?
Yes, Scott has noticed my opinions and (unfortunately) effects with APs. But I am fairly an exception to the rule... I'm sensitive to basically almost all APs. Akathisia is a big problem for me. Zyprexa... well... I won't go much further into that anomaly as well because I don't think its helpful for you. It was a rare reaction of stiffness.
If Seroquel doesn't work for you then yes, Zyprexa is pretty low in terms of side effects and tardive phenomenons, although it is fairly strong at D2 as is Clozaril, but due to its mechanism it doesnt hold onto that strongly like Risperdal or Haldol.-- hope you feel better
-- Jay
Posted by ricker on May 21, 2009, at 0:01:37
In reply to Re: Seroquel help needed! - yxibow » ricker, posted by yxibow on May 20, 2009, at 23:22:29
Thanks Jay, I appreciate your input and will take 50 mg. tonight. I am taking it for BP but I'm not sure if I'll get any stabilizing at 50mg, sleep should be okay so I guess it will be a trial. I'm also taking lamictal and zoloft along with clonazepam.
The jaw clenching is actually quite painful but I did not know it was associated with eps, thought it was from the increased irritability?
Again, thank you for sharing your knowledge,Regards, Rick
Posted by ricker on May 21, 2009, at 0:04:15
In reply to Re: Seroquel help needed! » ricker, posted by Zyprexa on May 20, 2009, at 23:16:01
Posted by yxibow on May 21, 2009, at 5:40:49
In reply to Re: Seroquel help needed! - yxibow, posted by ricker on May 21, 2009, at 0:01:37
> Thanks Jay, I appreciate your input and will take 50 mg. tonight. I am taking it for BP but I'm not sure if I'll get any stabilizing at 50mg, sleep should be okay so I guess it will be a trial. I'm also taking lamictal and zoloft along with clonazepam.
> The jaw clenching is actually quite painful but I did not know it was associated with eps, thought it was from the increased irritability?
> Again, thank you for sharing your knowledge,
>
> Regards, Rick
>Its hard to sort out whether its due to increased irritability -- bruxism is associated with anxiety disorders.
At 25-50mg of Seroquel, which is typical for off label use for sleep, there is very little if any appreciable antipsychotic activity in an average adult.
Combined with the Zoloft, it is rare, but possible that the slight D2 activity of Zoloft and an AP may increase EPS. But that's only an anecdotal thing that I have heard of.
There is always a risk of increased EPS with an SSRI and an AP, on the other hand the benefit usually outweighs the risks for the typical situations when they are combined, such as hard to treat OCD.
I can appreciate that bruxism is painful -- I have had it before, and though I have a neurological/psychological tic in my mouth now, which can be and is painful, the sensation would be different with jaw clenching which would feel more like TMJ and even extending up to the ear line in some serious cases.
As for NMS, it is a very rare condition -- so rare that at that level of medication it is nearly a non issue. NMS involves more than just jaw clenching -- delirium, high temperature -- similar to SS (serotonin syndrome) in a way, which is also rare and in that situation the patient is unfortunately sometimes almost unaware of SS.
Have you tried or asked your doctor for extra clonazepam to see if it calms the bruxism ?Also, a small trial of Artane or Cogentin (unfortunately they dumped Akineton from the market, alas, anyhow...) (anticholinergics) might shed some light on whether it is a form of EPS or can control the condition. Artane is a bit less of a sledgehammer in my opinion.
I'm not trying to dismiss any possibilities that Seroquel may not be right for you -- as I said, small augmentations of Zyprexa, even Abilify might be possibilities.
One study quoted the one year risk of TD with Zyprexa to be about 0.5%, and I would say that in general low potency atypicals would probably be similar. Risperdal has been shown to have some higher risks. But then again, these are tardive (late) phenomenons -- in general atypicals have been shown to have about 1/5 the risk of old generation APs.(The British Journal of Psychiatry, Jan 1999; 174: 23 - 30.)
Also, just curious, how much Lamictal are you taking ? I'm not questioning your doctor's judgment but Lamictal alone could stabilize some types of BP. On the other hand, I know of someone who is on a pretty high dose of Lamictal along with Seroquel and has some BP spectrum condition.
Among the panoply of things I also do take Lamictal -- it by itself can be an antidepressant, or at least an augmentator. It can be good in stabilizing suicidal thoughts.
-- tidingsJay
Posted by Zana on May 21, 2009, at 8:44:02
In reply to Re: Seroquel help needed! - yxibow » ricker, posted by yxibow on May 21, 2009, at 5:40:49
I am actually weaning off seroquel at 50mgs every 3 weeks. I was at 300mgs and am now at 150. I went up 50 mgs at a time because with every increase I got a jolt of anxiety. And I also had weird mouth things going on, like my teeth hurt and I developed cavities all of a sudden (maybe a coincidence) and a weird bony growth in my mouth which has now receeded as I've gone down on the med (maybe a coincidence, who knows?) I didn't like the med at all and two pdocs said that they didn't like it (too many long term side effects) and one said that most people don't like it, don't feel like themselves, feel foggy, tired.
That being said,I don't know exactly what you doc is trying to achieve by adding seroquel to your mix. Do you know what his or her rationale is?
Sound like really uncomfortable and unsettling side-effects. Theres certainly no harm in backing down the dose slowly and seeing what happens to the symptoms. Trial and error is really the only way you or the docs are going to know if it will be helpful for you. I will say that the early side effects, esp. the increase in anxiety, passed.
Hope this helps. Changing meds is such a drag.Zana
Posted by ricker on May 21, 2009, at 13:17:39
In reply to Re: Seroquel help needed! - yxibow » ricker, posted by yxibow on May 21, 2009, at 5:40:49
Hi Jay,
Yes I've wondered about the zoloft potential for interaction with an A/P on D2, but have read of others taking them together, something to consider I suppose?
I agree that Seroquel at 50mg may not help with my hypomania. Last night I took 50 mg at 9pm and lay in bed until 12:30 am, up at 6am for work so I'm feeling a bit tired today along with the irritability/mind racing. I did not experience muscle twitching in my legs though! Yes, the jaw clenching causes pain extending up to the jaw line, in front of my ears, thats where the most pain is currently felt.
My p/doc prescribed lamictal at 150mg; unfortunately I can only take 50 mg due to side-effects... actually increases my irritability at 75mg and beyond, along with extreme hot flashes and facial flushing. I do get some antidepressant benefit from it at 50 mg so will continue to take it. Hence the need for seroquel to address the mania ends of the cycle. But, as you have mentioned, 50 mg may not suffice. I'm not sure it will help with sleep at that dose either, given last nights episode?
I'll probably see how things go for a week and then revisit the Zydis option if I continue to slip down hill. Zydis 5mg helped a lot with my irritability and ocd tendencies although I felt some flattening/detachment after 2 months or so. I was not taking lamictal at the time so perhaps the 2 together would help with that?
Again, thank you for your insight, I certainly appreciate your help and hope you are successful in your treatment.
Take care, Rick
Posted by yxibow on May 21, 2009, at 17:04:30
In reply to Re: Seroquel help needed! - yxibow, posted by Zana on May 21, 2009, at 8:44:02
> I am actually weaning off seroquel at 50mgs every 3 weeks. I was at 300mgs and am now at 150. I went up 50 mgs at a time because with every increase I got a jolt of anxiety. And I also had weird mouth things going on, like my teeth hurt and I developed cavities all of a sudden (maybe a coincidence) and a weird bony growth in my mouth which has now receeded as I've gone down on the med (maybe a coincidence, who knows?)
Caries can develop in the mouth due to dry mouth from one or multiple medications because of the lack of saliva.The calcification I seriously doubt has anything to do with Seroquel.
Bruxism is another story, that's always possible with both APs and SSRIs among others.
I didn't like the med at all and two pdocs said that they didn't like it (too many long term side effects) and one said that most people don't like it, don't feel like themselves, feel foggy, tired.
Most APs have a "blunting" effect. For patients who are schizophrenic especially, this is actually an advantage, it "quells" and reduces agitation.
But yes, I am on a fair load of medications and I do feel that... its hard to say if that is the cause of derealization or whether it is the disorder itself or both.
> That being said,I don't know exactly what you doc is trying to achieve by adding seroquel to your mix. Do you know what his or her rationale is?
Yes, the theory that it would reduce whatever unknown etiology is causing an increase in D2, which by theoretical evidence it did.Yes, Seroquel worked for me for about 5 years before it started falling apart -- it greatly reduced some of the visual phenomenon that still continues to occut.
But there were uncomfortable things going on, and don't forget I am really sensitive to APs, and at some point I dropped it, actually three times, several times stone cold, causing withdrawal dyskinesia.
I still take Seroquel today because the benefits outweigh the risks -- I agree I am caught in a quandary with it and with a high dose of Valium.
It would be nice to reduce the Valium but I have gotten to a point where even though it is still doing something for me, I don't feel it any more, and I'd rather be off of it, but it is still doing something.
A similar catch-22 exists with the Seroquel -- if I went off of it, it is likely that I couldn't cope or care for myself very well and my functionality would be greatly reduced and anxiety would flare.
I don't want to continue to have to take it but I know that for better or worse, at least at the moment the benefit outweighs the risks of not having at least part of my functionality here.
It doesn't do what it used to do some years ago, and one can say transmitter overload, or dropping medication many times, there are so many variables.
> Sound like really uncomfortable and unsettling side-effects. Theres certainly no harm in backing down the dose slowly and seeing what happens to the symptoms. Trial and error is really the only way you or the docs are going to know if it will be helpful for you. I will say that the early side effects, esp. the increase in anxiety, passed.
> Hope this helps. Changing meds is such a drag.You're not joking.
> Zana
(At least I hope this was directed towards me... anyhow I answered it if it was....)
Posted by obsidian on May 21, 2009, at 23:27:36
In reply to Re: Seroquel help needed! - yxibow » Zana, posted by yxibow on May 21, 2009, at 17:04:30
> Most APs have a "blunting" effect. For patients who are schizophrenic especially, this is actually an advantage, it "quells" and reduces agitation.
I've been taking only 50mgs for a while now, initially even that low a dose flattened me out a bit, but in some ways it was welcome
I take that along with 1mg of clonazepam, 225 mgs effexor xr and lamictal 100mgs
I find that as time has gone on though it doesn't really give me that blunted feeling as much, and I manage to get agitated just fine ;-)
unfortunately, cutting out the seroquel, even at such a low dose, is likely to get me hyped up, anxious and agitated
> A similar catch-22 exists with the Seroquel -- if I went off of it, it is likely that I couldn't cope or care for myself very well and my functionality would be greatly reduced and anxiety would flare.it sucks doesn't it?
how much do you take?thanks,
sid
Posted by greywolf on May 22, 2009, at 0:39:08
In reply to Seroquel help needed!, posted by ricker on May 20, 2009, at 13:34:18
I'm not sure cutting down that low will help anything. If I recall correctly, I was at 300mg/day for a hopeful therapeutic effect. I doubt you'll achieve any significant benefit going with such a low dosage.
I think the better course would be to contact your doctor, explain the situation, and see if he has another resolution in mind.
Greywolf
Posted by yxibow on May 22, 2009, at 1:00:42
In reply to Re: Seroquel help needed! - yxibow » yxibow, posted by obsidian on May 21, 2009, at 23:27:36
> > Most APs have a "blunting" effect. For patients who are schizophrenic especially, this is actually an advantage, it "quells" and reduces agitation.
>
> I've been taking only 50mgs for a while now, initially even that low a dose flattened me out a bit, but in some ways it was welcome
> I take that along with 1mg of clonazepam, 225 mgs effexor xr and lamictal 100mgs
> I find that as time has gone on though it doesn't really give me that blunted feeling as much, and I manage to get agitated just fine ;-)
> unfortunately, cutting out the seroquel, even at such a low dose, is likely to get me hyped up, anxious and agitated
> > A similar catch-22 exists with the Seroquel -- if I went off of it, it is likely that I couldn't cope or care for myself very well and my functionality would be greatly reduced and anxiety would flare.
>
> it sucks doesn't it?
> how much do you take?
>
> thanks,
> sidI take it (off label for an orphan somatiform disorder); 400mg.
I also take Lamictal - 250mg
And a fair amount of Valium which is another catch-22.
Among the other multitude of medications and supplements.
-- Jay
This is the end of the thread.
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