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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by KaraS on November 10, 2004, at 16:33:16
A friend of mine is taking Wellbutrin. It is helping his depression and concentration problems but it is exacerbating his anxiety problems. His doctor prescribed Seroquel for him. Aside from my concerns about using APs when not necessary, I am also wondering about Seroquel's efficacy in as an anxiolytic. My friend has been on this medication for a week now. He finds that it helps his sleep when he takes it at night but he isn't finding any relief from anxiety during the day. If he takes it during the day, he's too sleepy to function. He is asking me if he should expect a cumulative effect from taking it that will eventually hit that anxiety. Is that how it is supposed to work?
Also, can you use low dose TCAs like doxepin or trimipramine with Wellbutrin? I don't see TCAs listed as a contraindication at rxlist.com but something tells me it might not be a good combination. I hope I'm wrong as I would really prefer to see him take one of those.
K
Posted by Wildman on November 11, 2004, at 7:13:03
In reply to Seroquel to take the edge off?, posted by KaraS on November 10, 2004, at 16:33:16
I've been using Seroquel in this way for some time now. 25-50mg at night, and maybe 12.5mg during the day. I also take 15mg Lexapro.
It does help with the occasional hypomania - I haven't been anxious for some time now (finally licked that beast!).
I do think there is a cumulative effect, in that if I have to take 50mg per night for more than 2 or 3 nights, I develop bad headaches that go away when I go back to 25mg. Not sure what the half life of that stuff is.
I am not concerned about using an AP in this way. The theraputic dose for psychosis is MUCH more than what I take. At my levels, I am using it for its side effects.
See if your friend could benefit from a half tablet during the day. Take it slow. It used to really knock me out at first, but not as much these days.
Wildman
Posted by dove on November 11, 2004, at 8:43:54
In reply to Seroquel to take the edge off?, posted by KaraS on November 10, 2004, at 16:33:16
>
> Also, can you use low dose TCAs like doxepin or trimipramine with Wellbutrin? I don't see TCAs listed as a contraindication at rxlist.com but something tells me it might not be a good combination. I hope I'm wrong as I would really prefer to see him take one of those.
>
> K
Wellbutrin is combined with TCAs quite often. I've taken Wellbutrin with Amitriptyline, SSRIs, SNRIs, and various other meds. The only problem I ever had was taking high dose Wellbutrin with high dose Prozac, Adderall, Amitriptyline, high dose Neurontin, Serzone, and Klonopin all in one combination. It made me very irritable, nervous and scatter-brained from all my nerves running amuck. It was quickly taken care of by lowering the Wellbutrin though.dove
Posted by KaraS on November 12, 2004, at 0:02:46
In reply to Seroquel to take the edge off?, posted by KaraS on November 10, 2004, at 16:33:16
Thanks Dove and Wildman. I passed your information on to my friend. He was very appreciative. He's going to try taking 1/2 a pill during the day. If this doesn't work out, I will try to get him to ask his doctor for a sedating TCA.
Posted by octopusprime on November 12, 2004, at 8:42:17
In reply to Seroquel to take the edge off?, posted by KaraS on November 10, 2004, at 16:33:16
hi kara:
half-life of seroquel is 6 hours. i am (supposed to be) taking seroquel 25 mg bid (twice a day). when i followed this regimen strictly, i did noticeably perk up around 3 or 4 in the afternoon (i would take morning dose around 8:30am). also while 25 mg is great for getting to sleep, i found i did not sleep soundly thru the night.
what i wound up doing for a while was taking 50 mg at night if i had time to get a lot of sleep, and not take the morning dose. i would get quite irritable during the day trying this (although i was quitting smoking at the same time ... but still should not be hitting my coworkers with rulers no matter how funny i think it is!)
anyway it's a bit of a ramble.
but for your friend:
seroquel half-life == 6 hours
Posted by KaraS on November 12, 2004, at 13:11:15
In reply to Re: Seroquel to take the edge off? » KaraS, posted by octopusprime on November 12, 2004, at 8:42:17
> hi kara:
>
> half-life of seroquel is 6 hours. i am (supposed to be) taking seroquel 25 mg bid (twice a day). when i followed this regimen strictly, i did noticeably perk up around 3 or 4 in the afternoon (i would take morning dose around 8:30am). also while 25 mg is great for getting to sleep, i found i did not sleep soundly thru the night.
>
> what i wound up doing for a while was taking 50 mg at night if i had time to get a lot of sleep, and not take the morning dose. i would get quite irritable during the day trying this (although i was quitting smoking at the same time ... but still should not be hitting my coworkers with rulers no matter how funny i think it is!)
>
> anyway it's a bit of a ramble.
> but for your friend:
> seroquel half-life == 6 hours
So taking it twice a day worked well for you?
Taking 25 mg in the daytime was making him too groggy but taking half of a pill might work. Did you notice a cumulative effect that transcended the half-life issue?Thanks,
K
Posted by octopusprime on November 12, 2004, at 20:06:45
In reply to Re: Seroquel to take the edge off? » octopusprime, posted by KaraS on November 12, 2004, at 13:11:15
hi kara:
gotta say i'm not happy with 25 mg twice a day. what would happen is that i would wake up early (wake at 5 am after going to sleep at 11 pm when alarm goes off at 8 am), not be able to fall asleep for 1/2 an hour, take my morning dose, then in 1/2 hour i'd be ready to nap for two more hours before going to work.
the 25mg dose would not make me tired during the day if i could sleep all night.
at this point i figured it made more sense to take all 50 mg at bedtime. this is better for sedation. i sleep thru the night and wake up a bit groggy but ok. however it means i am unmedicated throughout the day.
i would like to switch to a mood stabilizer (since that's really what i'm using seroquel as a substitute for), but i might be moving to the US from canada and i do not want to do a med switch now when there is a possibility that my health care will be interrupted for a few months.
Posted by KaraS on November 12, 2004, at 21:44:09
In reply to Re: Seroquel to take the edge off? » KaraS, posted by octopusprime on November 12, 2004, at 20:06:45
> hi kara:
>
> gotta say i'm not happy with 25 mg twice a day. what would happen is that i would wake up early (wake at 5 am after going to sleep at 11 pm when alarm goes off at 8 am), not be able to fall asleep for 1/2 an hour, take my morning dose, then in 1/2 hour i'd be ready to nap for two more hours before going to work.
>
> the 25mg dose would not make me tired during the day if i could sleep all night.
>
> at this point i figured it made more sense to take all 50 mg at bedtime. this is better for sedation. i sleep thru the night and wake up a bit groggy but ok. however it means i am unmedicated throughout the day.
>
> i would like to switch to a mood stabilizer (since that's really what i'm using seroquel as a substitute for), but i might be moving to the US from canada and i do not want to do a med switch now when there is a possibility that my health care will be interrupted for a few months.
I see. It hasn't been THE answer for you but you're just biding your time now. I have a feeling it isn't going to be an answer for my friend either but we'll see.Thanks for your help.
Kara
Posted by alexandra_k on November 13, 2004, at 3:38:43
In reply to Seroquel to take the edge off?, posted by KaraS on November 10, 2004, at 16:33:16
Hiya, I used to be on Seroquel, though now I am on Olanzapine. I used to take Chlorpromazine PRN for anxiety (back when I didn't mind being a vegetable). My p-doc told me that I could use Seroquel PRN if I wanted to. Better than Chlorprom.
I find that when I start on an anti-psychotic they knock me around for the first few days and all I want to do is sleep. Then my body adjusts to them ok. So I think that, yes, there is a cumulative effect in the sense that you tolerate what would have made you fall asleep, and it is more a general kind of sedation that is the absense of such anxiety.
Posted by Keith Talent on November 13, 2004, at 20:48:02
In reply to Seroquel to take the edge off?, posted by KaraS on November 10, 2004, at 16:33:16
There's no reason not to take a histamine-1 antagonist with the bupropion. However, these agents are rather "dirty" (i.e. hit multiple targets) compared to, say, clonazepam or even phenelzine.
Of course, taking a separate drug to relieve anxiety should come only after taking the same dose of bupropion for two or three months (to be sure that the anxiety side effect doesn't simply fade away).
Posted by KaraS on November 13, 2004, at 23:47:18
In reply to Re: Seroquel to take the edge off?, posted by Keith Talent on November 13, 2004, at 20:48:02
> There's no reason not to take a histamine-1 antagonist with the bupropion. However, these agents are rather "dirty" (i.e. hit multiple targets) compared to, say, clonazepam or even phenelzine.
>
> Of course, taking a separate drug to relieve anxiety should come only after taking the same dose of bupropion for two or three months (to be sure that the anxiety side effect doesn't simply fade away).He has been on the bupropion for two or three months. He also has Klonopin but his doctor doesn't want him to take it continuously. As for the Nardil, are you suggesting adding that to the Wellbutrin or in place of it? Klonopin and Nardil may be cleaner but there are a lot of other considerations about using them. I'm not thrilled about him using an AP for this purpose but it's really a balancing act - which side effects or risks are you willing to put up with.
Posted by KaraS on November 13, 2004, at 23:54:40
In reply to Re: Seroquel to take the edge off? » KaraS, posted by alexandra_k on November 13, 2004, at 3:38:43
> Hiya, I used to be on Seroquel, though now I am on Olanzapine. I used to take Chlorpromazine PRN for anxiety (back when I didn't mind being a vegetable). My p-doc told me that I could use Seroquel PRN if I wanted to. Better than Chlorprom.
>
> I find that when I start on an anti-psychotic they knock me around for the first few days and all I want to do is sleep. Then my body adjusts to them ok. So I think that, yes, there is a cumulative effect in the sense that you tolerate what would have made you fall asleep, and it is more a general kind of sedation that is the absense of such anxiety.
Thanks. That verifies what I've heard from one or two others here about Seroquel's cumulative effect.I just read on Scott's chart that Zyprexa is used to reduce TD. In that case I would think it would be safer to use Zyprexa than Seroquel or other APs for anxiety. Wonder why Seroquel is prescribed more for this purpose?
Thanks for your input.
Kara
This is the end of the thread.
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