Quetiapine 25mg side effects so drastic?

[JoeyLin]

Hi, my mum is 65. She has been battling depression / anxiety for about 4 years now. We have tried many things but in the last year she was on Venlafaxine + Mirtazapine. In autumn she dropped the Mirtazapine and has probably been the 'best' she has been in a couple of years - shows a bit more emotion / cries, but its a better thing than being closed like Mirtazapine had her.

However she is only 10% of the person she was, so doctor wants to explore alternatives - things like lithium has been mentioned, and Quetiapine . After some blood tests she has started 25mg of Quetiapine alongside her Venlafaxine.

Now, we can't put our finger on it, but she has been REALLY bad this past week - pacing around, smacking her forehead, feeling desperate. BUT she started Quetiapine 4 weeks ago.

Could it be the Quetiapine ?

Another bit of unfortunate news is that her MH doctor has moved hospital. I dont know if the plan was to increase Quetiapine and how often. I'm inclined to get her seen to, increase the Quetiapine to see whether it is that or not.

maybe remove it rather than increase it, it can cause agitation.

The withdrawal and the gradual reintroduction of quetiapine 2 weeks later, which led to another severe agitation, enabled us to attribute the agitation specifically to quetiapine.

I know - but we are also losing hope on what will help her. after trying so many and combinations, we were hopeful the way the Doctor explained this one to us.

I am not sure what the doctor considered as the thereputic dose of this, and maybe I am thinking if we can at least try it out before ruling it out.

I’m a MH nurse. A usual therapeutic dose of quetiapine for depression is around 100mg to 300mg, towards the lower end for older people, so 25mg is a very low dose and would normally be increased. It’s also true that all antipsychotics can cause agitation as a side effect. This is particularly tricky as you can sometimes get a phenomenon where the lower doses of medication can cause negative side effects but no therapeutic benefits; this is why drugs like quetiapine are usually titrated upwards pretty quickly and then left to “settle”. However not everyone gets on with all medication and this is especially true for psychiatric drugs. Some people derive great benefit from quetiapine whereas other people don’t suit it. When did your mum last see a psychiatrist?

Not that I was fishing for the 'right' answer - but that is what I was thinking too. However with the doctor leaving the hospital we have to now wait until April to see the new doctor (which is a locum). Otherwise her CPN should make contact too.