Quetiapine 50mg XL for resistant depression

[Nietz93]

Hello everyone,
I was started on Quetiapine 50mg XL (extended release) insomnia and as an add on to Escitalopram for my resistant depression on the 28th of January. It works wonders for insomnia, I'm able to sleep 8 hours and wake up rested. A few days ago I posted about side effects, but now they are completely gone, thankfully. Today is 1st day of week 3, I wonder I how it will take before I see some benefits with my depression? Also, do you think this dose is too low to help with depression?
At the moment my anxiety is completely under control with Escitalopram, but I have no motivation whatsoever. Getting out of bed is a struggle, also I don't have much energy to to anything which I think it's related to Escitalopram but that's the only medication that helps with anxiety. Should I wait a few more weeks to see if helps with depression and if not talk my GP about increasing the dose to 100/150mg? I currently taking the extended release.
Thank you 🙏🏻

My psychiatrist prescribed Quetiapine in conjunction with an AD for treatment resistant depression. He said it needs to be at least 100-150mg to help the depression but 50mg will help with anxiety and insomnia.

@Nietz93

Two questions if you don’t mind?

What is the difference between Escitalopram and Citalopram please, do you know?

I thought Quetiapine was also used for anxiety, is that not correct?

Oh I see. Has it been helping you with depression?

I never upped the dose myself but I just wanted to pass on what my psychiatrist said. Based on that, you will need to go up to 100-150mg to tackle your depression.

No, I wouldn't never do that myself. I just wanted to know if that helped you so I could try talking to my psychiatrist about it as my depression is so bad still

Sorry, I wasn’t clear. I didn’t go up in dose but based on what my psychiatrist said you would need to be on 100-150mg to treat depression.

Sorry for the misunderstanding. How much are you taking now?

I came off the Quetiapine but I have the same problem as you with zero motivation. I’m just on duloxetine atm

I'm sorry you are feeling that way too. Has your psychiatrist suggested anything to make you feel better?

Citalopram and Escitalopram are both SSRIs used to treat depression and anxiety. In practice, escitalopram tends to work at lower doses and may cause slightly fewer side effects, but clinically they are very similar and used for the same conditions.

Quetiapine is an atypical antipsychotic used for conditions like bipolar disorder and schizophrenia, and sometimes as an add-on treatment for depression. It is also prescribed off-label for anxiety, generalised anxiety disorder, usually at lower doses because of its calming and sedating effects.

Anyone using Quetiapine as an add on for depression?

Thanks very much for the info!

Anyone else?

My DD18 is on quetiapine 150mg for mood stabilisation. She also takes duloxetine 60mg.
Don't know if any of her meds are making a difference. We don't see an even keel. She is better than before (not suicidal just low) but general motivation is lacking. She is also AuDHD so the executive function deficits are very crippling and causing her mood to frequently go down.
We are just surfing along.

Thank you for sharing. I’m really sorry it’s been such a tough journey for your DD — it sounds like you’re doing everything you can to support her!

I really relate to the “not sure if it’s making a difference” feeling. It can be so hard to tell sometimes.
If you don’t mind me asking, how long has she been on the quetiapine and duloxetine?

She started ADs in 2023 after her mental health spiralled and she took an overdose. She was on fluoxetine for a few months which really didn't suit her. She took another OD on it. She was then switched to sertraline which seemed better but really her mood was still up and down a lot. Within a day she would be normal and then dip within half an hour. She was then started on arirpriprazole 2.5 mg to stabilize mood. We upped to 5mg and it caused akathisia so we dropped back to 2.5. she had been on these along with ADHD medication until dec 2025. We saw a private psychiatrist who recommended genetic tests to see if her meds were the right ones for her. Turns out her body does not metabolise ssris and he felt she would do better on duloxetine. She has been ok on duloxetine and we didn't find the switch very difficult. Decision was also made to switch from arirpriprazole to quetiapine as apparently quetiapine does a much better job with depression and anxiety whereas arirpriprazole can be activating. We then started quetiapine roughly a month ago. She didn't ease into it like the duloxetine to be honest. She had many intrusive thoughts and we we thought we should stop. However we also realized the extended release needs to be taken either one an empty stomach or 2 hours after dinner which she wasn't doing. We switched the routine and along with giving it a few more days she seems to be settling on it.
However, as I said, in her case I am not seeing obvious results. She still has daily low moods but she says she can snap out of it easier than before. But she is nowhere the person she was before her MH took a node dive when she was 14.
Sometimes I wish we never started all these meds. We didn't have a choice. She was 16 when she started them and it was a decision she made with the camhs psych. She does want to get off of them but the withdrawal will be brutal and she is nowhere ready for it. She doesn't like how they make her feel and she feels they don't benefit her as much.
Hopefully in the future she will be stable enough and wean off of them.

I’m so sorry for you and your daughter Rainy. Please check out this website. I came off antidepressants with the guidance on there. I don’t think you can become a member or post now but there is so much information. https://www.survivingantidepressants.org

I was on quetiapine + sertraline for depression. To be honest, apart from helping with my sleep I didn’t see any difference between sertraline by itself and then combined with quetiapine for depression symptoms. I stopped in the end because I was tired all day and could barely get out of bed so it wasn’t worth it for me

Quetiapine acts on a number of different receptors. At low doses it mostly works as an antihistamine which means it's good as a sedative and for anxiety ~50mg. At middle doses (150-300mg) you start to see more antidepressant properties and at higher doses you get the antipsychotic activity (300+mg)

This is just a loose rule of thumb and people will find it helpful at other doses. I have been on it as a mood stabiliser, antidepressant, antimanic and antipsychotics at doses from 300-800 mg. I was on 800 when experiencing psychotic depression. Once I had recovered from the psychosis they dropped my dose back down to 600 mg as they were concerned that it was no longer optimal for the antidepressant properties and I was getting dulled from it and I did find the drop in dose helpful. I'm depressed again and still on 600mg. I had a discussion today about dropping it down to 500-550 mg. My maintenance dose used to be 450 mg and that was quite a good balance for me. 300mg was good for depression but I was still getting ups and downs in mood.

This isn't quite right. They are the same drug.

In nature there is mirror symmetry. The best example of this is our hands. They are identical but mirror images on one another and cannot be overlaid on one another. Molecules and proteins behave the same. To continue with the hands analogy your hand are the proteins and the drugs are the gloves. The left glove will fit on the left hand and the right glove will fit on the right hand. The two gloves can therefore behave quite differently in the body. It might be that one is much more active or in the case for thalidomide one was therapeutic and the other caused birth defects.

In the case of citalopram and escitalopram citalopram contained both gloves and escitalopram is only the gloves that fits best on the target hand

Are people struggling to get stock on quetiapine extended release?
I went to fill prescription and none of the pharmacies locally had it. Thinking of asking about switching to immediate release. Have people noticed a difference?

The modified release often has supply issues. I have had to switch to 2 x300mg rather than 600mg tablets as there is only one supplier for the 600mg and they often go out of stock.

What dose are you on? The biggest benefit to the extended release is on doses above 300mg as on the standard release these need to be taken as two doses one in the morning and one at night. This isn't always practical although I did quite quickly adjust to taking it in morning. I needed to be able to power through the first half hour of sedation and then I could get on with my day.

I inadvertently took the standard release as extended release for 2 years as I had spotted that they had swapped. I was taking the full dose at night and did find I was quite groggy in the morning. Going back to the extended release made mornings a lot easier but bare in mind I wasn't taking it as prescribed ,

This is something that hopefully your daughters doctor spoke to her about at the time but you have to be careful with prescribing antidepressants to people under either 21 or 25 as they can increase suicidal ideation. Some can not be prescribed at all.

Starting on an antidepressant can be tricky especially the SSRIs as they tend to improve motivation and energy before mood. What you can find is that the depression is self limiting as whilst you might feel hideously depressed but all the slowing down of thoughts and motivation can be a strong protective factor as you don't have the energy to act of the mood. Then you start on an antidepressant your mood takes time to recover but energy can come back first and now you have the energy to give the destructive thoughts more headspace and potentially act on them. This seems to be more pronounced in young people. Antidepressants especially in young people should be part of a broader package of support although costs and resources often mean this isn't the case

@Superscientist
Thanks for your responses. She was just thrown to AD without any therapy from camhs. We did have a private counsellor on the side but it wasn't enough to stop the increase in suicidal thoughts.
She is now on 150mh quetiapine XL. Am tempted to just ask for IR but I dread the change and she may struggle with the sedation effect in the morning.
Equally, I don't fancy the medication hunt from pharmacy to pharmacy each month. Did that with her ADHD medication which has just about stabilised with stock. I am just grumbling I know.
Xx

I was struggling to find it as well. Then I came across the following website and was able to order it:
https://www.pharmacy2u.co.uk/
I hope that helps