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Decoding Bipolar Drug Information - Seroquel (Part 1)

August 9, 2010 Natasha Tracy

Seroquel was the 5th grossing drug in 2009, with revenue of $4.2 billion. That’s more money than any pain-killer, antidepressant or erectile dysfunction medication. And my guess is that many of you reading this right now, are on it.

And I also guess almost none of you have taken the time to read the prescribing information on Seroquel.

Some Psychotropic Drug Facts

According to the May 2010 issue of Pharmacy Times:

  • Seroquel is the highest grossing psychotropic medication. (FYI, $4.2B doesn’t include the sales of Seroquel XR, which are also substantial.)
  • Other top performers include Abilify at $4 million and Cymbalta at $2.8 million.
  • 6 of the top 20 grossing drugs in 2009 are psychotropic and 3 are antipsychotics.
  • Antipsychotics are the highest-grossing class of mediations pulling in $14.6 billion in 2009.

(2009 drug stats source)

Patient Information on Seroquel

Patient information is available all over the place for any drug. Your pharmacy probably gave you a printed sheet when you got your prescription. And there’s nothing wrong with this information per se, it just isn’t nearly enough on which to base an educated decision.

But It’s Patient Information. I’m a Patient. Why Wouldn’t I Want That?

Well, it’s up to you but these information sheets omit certain important facts and don’t provide any realistic information on how likely it is you’ll experience certain side-effects, or how impactful those side-effects may be. They don’t tend to list necessary tests to be done while on medication and they provide so little detail it’s not clear what they really mean. A pile of 40 side-effects in a big list isn’t that handy. What’s a lot more handy is a prioritized list with probabilities.

There’s a Colossal Pile of Prescribing Information

Yes, I know. Sorry about that. That’s the kind of thing that the FDA requires. But if you take some time to look at this information then at least you know you are getting the most accurate information at the time and not a subset that someone considered “relevant” to the patient.

These are medications you might be on for years. It’s worth taking the time to understand at least one complete medication information sheet. If you never look at another prescription information sheet for the rest of your life, at least you know you've taken a look at what they have to offer.

Full Prescribing Information on Seroquel

quetiapine_structure

Seroquel is an atypical antipsychotic and is commonly used to treat bipolar, schizophrenia and depression. This drug has received a lot of positive press in terms of efficacy and lots of negative press due to debilitating side-effects and questionable advertising practices.

This is part one in looking at the full prescribing information on Seroquel, section by section. (This full sheet can be found in multiple locations online, lest you think I’m partial to only what is on HealthyPlace.)

Warnings

Yes, there are warnings on drugs and on drugs used to treat depression there’s always a warning of suicide. I think these are overstated and misused, but that’s a discussion for another day.

Indications and Usage

This section gives information on the approved uses of the medication. Your doctor may have prescribed this medication for a different reason. That can be OK, and is a point of discussion with your doctor.

Dosage and Administration

Now here IS something to care about. You should know:

  1. What strengths the drugs are available in
  2. The typical starting dose for the drug
  3. When the drug is typically given (day/night)

If your doctor has chosen something different for you, that’s a discussion you can have with him. Keep in mind the dosing schedule listed is almost always too aggressive for people. (It’s the kind of schedule they’d give you in the hospital.) In other words, if you followed that schedule you would likely find the side-effects intolerable in your everyday life.

Here's how you might use this information: If your doctor started you on 100mg of Seroquel but you couldn’t tolerate that dose due to side-effects, you can see that 50mg and 25mg pills are also available. You could start on a lower dose and work your way up. Getting onto a medication can be hard work and seriously impact your life so you may need to take a while to do it.

Should you doctor give you this option? Probably. But I can’t promise they will.

(Never cut or crush a drug unless you’ve asked your doctor about it. Some drugs are designed with specific layers extending absorption times and you should not mess with that. Seriously.)

Contraindications

Always good to check out. In this case, none.

In part II we'll be discussing Seroquel warnings and precautions. And in part III I discuss Seroquel adverse reactions and just why you should know this information anyway. Stay tuned, it's just getting good.

[I should remind you that I am not a health care professional and anything concerning to you should be discussed with your doctor.]

You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.

APA Reference
Tracy, N. (2010, August 9). Decoding Bipolar Drug Information - Seroquel (Part 1), HealthyPlace. Retrieved on 2022, June 28 from https://www.healthyplace.com/blogs/breakingbipolar/2010/08/decoding-bipolar-drug-information-seroquel-part-1



Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate, and author of Lost Marbles: Insights into My Life with Depression & Bipolar. She's also the host of the podcast Snap Out of It! The Mental Illness in the Workplace Podcast.

Find Natasha Tracy on her blog, Bipolar BurbleTwitter, InstagramFacebook, and YouTube.

Debbie
March, 14 2018 at 8:55 am

Sadly i can no longer read,My good memory has gone i now struggle with remembering what i done yesterday.
I don't like to be around people anymore either..
Life for me without serequel would be a end to my life now.

Angela
June, 26 2017 at 11:05 pm

I started taking Seroquel to help ease my depression, along with many other medications. I rapidly worked my way up to 500 mg but had to go to a lower dose as my limbs were heavy and weak and I kept falling. I'm now at 400 mg and still fall a lot. I have a severe parasite phobia and this dose of Seroquel seems to help a lot. I can touch my cat, don't think I have a new parasite every week and don't go off the deep end if I see a creepy crawly. The sensation of bugs crawling on me and biting me has also lessened. But I don't read anymore. Reading was about the one thing I enjoyed in life and the pleasure is gone. I don't know for sure that it's the Seroquel. First off, has anyone else with a parasite phobia found anything to be effective? I feel I have tried about everything but maybe not. Second, has anyone else on Seroquel lost interest in reading?

Eliza
January, 18 2017 at 8:53 pm

Hi, I take a pretty high dose 900 Meg's of Seroquel for bipolar 2 and insomnia. I'm have been waiting n it for 12 years. Without a doubt this is a highly effective drug. I've been careful to keep my insurance because for ages it was very expensive. Now fortunately, it's available as a generic.
I do think about the lost hours when I'm dead to the world when I go to bed with my meds and while I'm able to hold down a job and have a pet I do feel like I have lost a bit of my personality and am a bit more sedate all the time. There are trade off's but I'm pretty healthy and thanks to seroquel I can sleep pretty well. I'd love to be on a little less and with a strong support network (a therapist) I will discuss it with my psychiatrist.

Bobbi g Ausubel
April, 1 2016 at 12:41 pm

I am taking low dose S. 6-12 mg for sleep only. How does it affect the brain long term?

Linda
February, 18 2016 at 12:34 pm

Does anyone have a problem with hot & cold at night with serquel?

Isobel
July, 18 2015 at 3:59 am

Quietapine has ruined my life. I was put on it for two months in an NHS hospital. When I came home, I had all the symptoms of Parkinson's disease - I can no longer walk normally or drive. My doctor confirms that these affects are likely to be permanent. This drug should be taken off the market.

Poppa Pill
March, 31 2015 at 9:26 pm

I started using Seroquel for insomnia. I was on 200mg daily but I'm now up to 1200mg/day. Without it I don't sleep.
Three times I've tried to come off it cold turkey resulting in 4 consecutive sleepless nights each time, after which I'd be able to sleep poorly for two hours then I'd be awake again until I took my normal dose.
I've never been able to quit. The need for sleep is just too powerful. It's all you can think about!
Like some have said, Seroquel does help people who need it. Given the correct dose and information it can make life better especially as it clears a lot of cognitive congestion that might otherwise cause excessive procrastination and self doubt. This makes life a little easier.
Keep things in check with your doctor or a trusted friend who can tell you if/how your behaviour is changing.

melissa
April, 15 2014 at 3:12 pm

Natasha what are your credentials?

Darren cook
March, 21 2013 at 12:02 pm

What is the issue here.....?
That drug companies make billions.....?
We all know that and they always will
Simply there are billions of sufferers of all kinds of mental conditions all around the world
I don't like to pigeon hole these as a I belief they're all part of the same family
Just different levels of severity
If they make the suffering less painfull for a patient that's all that matters
If you you see someone in visible pain you give them a painkiller....Right ?
It's same thing.
Large corporate drug companies will always make huge profit
But a whole lot of people would be pain/trouble without them
End of.........

Don
June, 10 2012 at 2:09 am

I agree talking with peers about menodatiics should be taken with a grain of salt and not considered definitive information. On the other hand if concerns are brought up with peers about a treatment, it doesn't hurt to raise them with your medical professionals.I do think the problem is deeper than you've indicated here. One issue that wasn't addressed in your blog was why do people turn to peers for medical advice in the first place?I think many people turn to peers for medical advice because they don't have confidence in the doctor. Psychiatrists in the U.S. over the years have reduced the amount of time they spend with their patients due to economic constraints. With such short appointment times, their patients can feel they don't really understand what's happening with them. It can be problematic trying to contact psychiatrists in between appointments to address concerns about side effects.Coming up with an effective treatment plan can often involve a lot of trial and error. This can be in sharp contrast to other forms of medical treatment people have received in the past and contribute to a lack of trust in the psychiatrist as to their competency.For many people, there's a concern about what motivates doctors to prescribe what they prescribe. This takes the form of concerns about undue influences the pharmaceutical industry is perceived to have over doctors.There have been well documented cases of where the psychiatric profession has prescribed menodatiics without adequately testing their effects on specific patient populations (e.g. SSRI drugs for people with bipolar disorder and teens).Many patients feels their doctors don't listen to their concerns about side effects and minimize these concerns. This poor communication between doctors and their patients can lead to putting more trust in peers who do listen and are empathetic to their concerns.I think there is a significant proportion of the population who see psychiatry and medication as a form of mind control rather than a valid medical practice and are therefore more likely to gravitate to peers who are dissatisfied with their psychiatric treatment.You also failed to mention the positive benefits about talking with peers. Talking with people who are satisfied and dissatisfied with particular treatments can reinforce the idea that individuals respond differently to different menodatiics. It can also reinforce the idea that coming up with effective treatment plans can be challenging and doesn't mean their psychiatrist is incompetent. Talking with peers can also open people up to the idea that menodatiics can help and aren't simply a form of mind control. Talking with peers can also help individuals develop better ways of communicating with their mental health professionals too.I think the key issue is people need to develop critical thinking and communication skills so they can evaluate sources of information in order to make more informed decisions about their treatment plans and implement them effectively. This will enable them to put peer feedback into an appropriate perspective.

Graham
November, 21 2011 at 3:21 am

My feelings about this drug are mixed. On the one hand it may do enough harm to shorten someone's life or make the latter parts of it poor because Seroquel has been linked to several very serious side effects, including a 3x increased risk of diabetes, increased blood sugar and weight gain, plus high cholesterol, all of which are likely to cause vascular problems - e.g. heart disease and heart attacks, strokes, cerebral vascular dementia. (This information is available on the Web.) On the other hand, if one is suffering intolerably with the mood swings, anything is welcome! However, someone in the worst of BP is often quite unable to research the risks because their mind is so disturbed, and we cannot rely on our doctors to inform us about them.

Pam
September, 27 2011 at 5:20 am

Seroquel at 100 MG works for me taken in the PM, in the AM I take 50 MG of Zoloft. I feel better today than I have in 10 years....also I exercise, attend Church, small group bible study, joined the DAR, have a great family, and continue to try and understand bipolar mental illness. Don't get me wrong I have my days....sometimes many days, but I stay in One Day At A Time.
Thank you for your blog.
Pam

richard
November, 28 2010 at 5:37 pm

richard...
excellent info, keep it coming...

Natasha Tracy
October, 10 2010 at 6:31 am

Hi Juliet,
The PDR is simply a compendium of full prescribing information for the drug. It's the FDA prescribing information available on multiple web sites (just as the version I linked to). Of course, you might find it handy to have it in book form, but because this information is updated frequently, books become obsolete almost as soon as they are printed.
Regarding interactions, the PDR is a good place to start, but it's not complete. Physicians these days usually rely on computers to get this sort of information because, as you've pointed out, if you're on multiple medications, it can get pretty complex.
I agree completely that we are often guinea pigs and we should take some responsibility for researching medication. Personally, I don't really trust doctors. But I've been messed with them pretty badly in the past, so your experiences may differ.
- Natasha

Juliet
October, 8 2010 at 3:42 pm

I just found your blog, and so far I love it! I just wanted to contribute to the drug/Seroquel discussion...
I am on Seroquel, and my doctor told me to go look at the website and read the information about the drug before starting it, so I would know about all the potential side effects. I also did a bit of research online and got opinions about it from people who were on it (their opinions would not have swayed me either way on taking it, I just wanted to hear them). I'm currently on 400mg XR daily, and it still makes me sleep like it did when I started it, but that's fine for me because I also suffer from insomnia.
In all my research, I found out about the Physician's Desk Reference. It's not that I don't trust doctors, but I currently have 3 doctors prescribing 6 daily maintenance medications, not counting extra drugs when I'm sick. I just know that not all doctors are 100% knowledgeable about drugs and interactions, and don't always have time to check. So I went to the used bookstore and got myself a copy of the PDR for $10, which has helped immensely. I've read the PI sheets for all the drugs I'm taking, and when something new is prescribed, before I start taking it, I look through all the sheets again to make sure that they are safe to take together. It has helped my anxiety a lot too, because before I would worry that something would interact with something and cause problems.
Anyway, that was a long ramble, sorry about that! But I think that for us bipolars, since we tend to be the guinea pigs at the mercy of the doctors and drug companies, it is very important that we know what we are dealing with in terms of our medications.

Natasha Tracy
August, 25 2010 at 8:03 am

Hi Joe,
In a word, yes.
Drug companies are always going to make drugs, it's their raison d'etre. Drug companies do just fine in countries where what they can charge for their product is regulated. Drug research goes on in every corner of the globe.
I'm not suggesting drug companies shouldn't make money, of course they should, maybe even truckloads. But $14 billion + on antipsychotics - by definition a drug given to extremely desperate people who would do almost anything to get better - sounds more like a guy in a long black trench coat that stands on the street corner than it does an upstanding corporation.
But that's me.
- Natasha

joe toner
August, 24 2010 at 7:43 pm

Seroquel has given me a sense of normalcy I have never known before. Would they have developed it w/o the money involved? This is America.

M. DIPIPPO
August, 24 2010 at 8:28 am

I never had any idea that the ownership pharmaceutical company of
"Seroquel" has grossed 4.2 billion dollars in total sales! After reading
that, I wish I was an employee of Seroquel and Seroquel XR!
I am amazed that the antipsychotics are the highest-grossing medications pulling in $14.6 billion in 2009!
Its to bad that I'm not a volunteer worker, nor a minimal part time hourly employee and earning a salary from the SEROQUEL company and the international worldwide antipsychotics treatment pharmaceutical
companies!

Weight & Fat Loss | Diets
August, 13 2010 at 5:04 am

I Self-Diagnosed myself as Bipolar in November '08?...
I found your entry interesting thus I've added a Trackback to it on my weblog :)...

Natasha Tracy
August, 11 2010 at 9:04 am

Hi Cat,
Yes, Seroqeul is often prescribed off-label for sleep. I don't recall any specific information on histamine interaction but that may be included in the pharmacokinetc section, which I'm not terribly familiar with.
(As you found, altering histamines for sleep does have a number of side-effects long-term.)
It's great you found something that's working.
- Natasha

Cat Wilke
August, 11 2010 at 1:43 am

Just a note -- at a low dosage (25 - 50 mg) - seroquel acts on histamines -- in other words it will be like taking an anti-histamine (like benadryl) and knock your butt out -- but generally does not have that effect at higher dosages like 150 mg +. My hubby is living proof of that (and our pdoc confirmed that -- was not the pdoc at the time of incident) when he was on only 25mg -- was definitely helping him sleep and resulted in the dreaded zombification often complained about with serohaze. Scott now takes 300 mg of Seroquel XR (7 yrs later after discontinuing -- know the years cuz he took 25 mg the night my water broke and I went into labor with my baby girl Melissa -- talk about trying to wake the dead !!) and it works beautifully -- so we are enjoying while we can -- it is not perfect but has been the best mood stabilizer since he was on depakote and got the dreaded black-box rash. can you tell we do nothing normal LOL

Natasha Tracy
August, 10 2010 at 5:06 pm

Hi David,
I understand your frustration and think you make a great point. I say it all the time, Seroquel has saved lives. Period. Seroquel can also ruins lives though and people deserve to know the facts around it.
I try to make it clear whenever I talk about medication that it's a personal issue and no medication is "good" or "bad" per se. Each person has to individually assess the risks and benefits. Everyone is different and has different health concerns. Medications are all appropriate or inappropriate depending on the person.
I picked Seroquel because it's the highest-grossing psychotropic medication and many people are on it for all sorts of reasons. I want to make clear what the real information is about it, how to get this information, and why people should work to understand it. I try to promote education and personal responsibility and decision-making. And I agree, media work to sensationalize and don't represent all sides of an issue.
I understand that most people don't want to do the kind of research I do, and that's OK, but I do think people should at least know the information is available.
All that being said, you are not the only one for whom Seroquel has been a miracle, and I hope it works for you for as long as you need.
[And as a side note, I also hope that more educated patients will force doctors into more accountability for the information they deliver when handing out drugs. I'm tired of doctors not advising people of the risks and not even doing the _bare_minimum_ of testing required while on a medication. And no one can blame Seroquel for that.]
- Natasha

David Stein
August, 10 2010 at 1:41 pm

To me, Seroquel has been amazing and I have seen absolutely no downsides to it. In fact, I am frustrated beyond all reason as to why only the negative side to the debate is coming out. There are a lot of us who have had success with Seroquel and I find it amazing that the news media and most blogs are censoring that.
It just frustrates me that only one side is being allowed to have a voice.
On a side note, your post was very well written and had a lot of great information!
Dave.
(P.s I am on 600mg of Seroquel)

Natasha Tracy
August, 10 2010 at 6:07 am

Hi Buzz,
I personally despise this drug. I think it does all kinds of nasty things to people. Of course, it does save people's lives as well, so it's give and take.
The point though is to illustrate the information available on every medication. The point is to make people aware that this is out there, and they can get it any time they like. And the point is to show how little information is typically shared with a patient by a physician or a pharmacist.
I appreciate how busy and how stressed professionals are, but this is the sort of information that just shouldn't be skipped over. Patients at least deserve the chance to be made aware so they can ask questions and make educated decisions for themselves.
- Natasha

In reply to by Anonymous (not verified)

T. Stone
September, 22 2018 at 11:33 am

Why am I reading an article that keeps talking about long lists of side effects and curiously doesn't mention one. I am tired of the way this author presents her information and am bailing out on continuing to read. Thank you for wasting my time Natasha; and for triggering my anger...good job.

Mental Disorders 101
August, 9 2010 at 8:33 pm

Decoding Bipolar Drug Information ? Seroquel ? Part 1 | Breaking ......
I found your entry interesting do I've added a Trackback to it on my weblog :)...

Buzz Morley
August, 9 2010 at 12:08 pm

Yes, thanks Natasha. One of the best but worst drugs. OK, taking the side effects in mind it does "haul me down." Good thing? Debatable. I have a real love hate relationship (surprise) as with most all I take. M

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