Quetiapine - can it be a downer?

[Iamnotmad]

I'm on quetiapine (as well an antidepressant for treatment resistant depression). The trouble is I feel quite fatigued on it (100mg) and subsequently I feel "down" because I don't feel very fresh or alert. Had anybody else had this trouble?

I’ve not had it myself but I think it may be one of the medications that messes with dopamine levels, which may explain how you’re feeling now.

Sorry you’re struggling

I’m on 500mg Quetiapine over the course of a day I do get tired easier some days I take it addition to Venlafaxine 375mg plus 10mg diazepam but I still manage to function vaguely normally

I have previously taken Quetiapine and was taken off it as it left me feeling really groggy into the afternoon. It did help with my sleep though. I was offered something to wake me up in the morning but chose to change to Lurasidone. No grogginess but other issues that I can live with.

Thanks for your replies everyone. I'm tired and foggy right into the afternoon on this drug and I would really like to feel more alert. I guess the lockdown is not helping in this respect either.

I spent 4 years on 400mg quetiapine. I found the standard release was better for me instead of the xl / extended release. I was dead to the world when I took it at bedtime but had some semblance of alertness through the day. But the drug has left me with horrific side effects. The withdrawal was brutal, it's also an anti histamine and the hives and itching was horrific. It's destroyed my natural sleep pattern and I haven't slept properly since I came off it 7 years ago. I have also been left with tardive dyskinesia, Brain Zapps and short memory loss. I'm 40.

Tardive dyskinesia - I'm so sorry to hear that you've experienced such a horrific side effect. Has it improved at all since stopping the quet? I didn't take any quet last night, I took a herbal thing (hops/valerian/lemon balm) and that got me off to sleep until about 3.30am then I was wide awake. How are you coping with lockdown? I'm finding it difficult, and even going out for a walk does not perk me up. If anything it's makeing me feel sadder.

I also found that instant release was better than extended release. I now take 2500mg (that’s not a typo) and don’t have any problems with it. I found it most sedating at the 400mg area. I’ve read that it becomes less sedating as you get to higher doses.

My god I cannot even imagine being on 2500mg!

I was on quetiapine 100mg for bpd and I had to come off it because I just couldn't function and I just constantly felt groggy and flat,100mg is a sub therapeutic dose so it didn't have any real benefit for me apart from sleeping and I don't think those side effects get any better. I hope it works out for you.

Apparently I have a very fast metabolism (Normal max dose is 800mg). My pdoc does Q blood levels (not usually done for people on Q) and they aren't even at the lowest therapeutic level so we work up the dose based on blood levels. There is apparently still scope to go higher.

Q has been a fantastic medication for me. I fought it off for a while--I resisted going up to 300mg so could never have thought about 2500mg. But I've had to accept that it really helped the bipolar (almost entirely depression for men). I take 3 other medications so it's not just the Q that's helping, but it you can get past the sedation, Q can be good for a combination of symptoms.

But some med's just aren't suited to you--I've worked my way through many medications that caused side effects that I wasn't/couldn't tolerate. It's taken 10 years of trial and error to get the 4 medications working together at the right dose with minimal side effects.

I’ve just got up to 200mg for bipolar and I’m still not sleeping also I’ve been told we will likely increase to about 600mg I also take zoplicone 7.5 last one tonight only had 2 weeks and I’m still waking at 3 am hope u feel better soon and it might be a stupid suggestion but are you taking it at night ?

Obviously can't answer for the OP, but people do take daytime doses. I take 250mg in the AM and 100mg at lunch time. This isn't necessary on the extended release, but I found that far more sedating. It does keep a more level amount of Q in the bloodstream so that may have been why.

@Harrysmum2020, 200mg is quite low for bipolar. I was always told that 300mg is considered the minimum therapeutic dose for mood stabilisation. It doesn't always guarantee good sleep--it's not remotely sedating to me. I take zopliclone every night, or I just don't sleep.

I was told by my pdoc that when they did trials for quetiapine, they only trialled it up to quite a low-ish 800mg. He said that Q is one medication where there's scope to go higher quite safely, provided you have the regular ECG's etc. This very much depends on how quickly you metabolise it.

Thank you everyone who has joined this discussion. I have found it very interesting to hear other's experiences. I had been taking it at night and still felt tired the next day until the afternoon. I did enjoy the sound sleep at night but as I have to work I need to be alert in the day. I've got problems with my sleep now due to not taking it. I do have some 25mgs so I might take one or two of them to see how I do and wean off that way.

I've been on it since 2012 for bipolar, obviously everyone is different but I need a dose of at least 300 mg for any benefit - 300 - 400 keeps me stable and 600-700 mg when I have an episode. For me the sedation is least at about 400 mg. I'm now on the extended release as it allows me to take higher doses all in the evening as it was difficult to work with split doses.
I find that the grogginess is worse if I sit for too long after getting up, if I get up and am more active it wears off a lot quicker.
How long have you been on quetiapine, from recollection it took about 6 months to fully get used to the sedative properties of quetiapine.

I've been on it since Jan, started at 25mg and worked up.

@Iamnotmad hi there, I wondered if I could ask how you are getting on? I was on Q for my depression but it didn’t work and only made me more tired so I’m reducing down from 200, 50mg / week. Then I’m swapping my mirtazipine for Venlafaxine.