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Dr. M,
Have you used this medication in your practice and with any success? Curious to know your thoughts on it.I use Seroquel often. I am a psychiatrist, after all. 🙂
At one point in time, I was doing inpatient psychiatry and used it successfully to stabilize patients enough to discharge them in about 4 days.
In treating psychotic illnesses, I can use it in monotherapy.
However, I rarely use Seroquel monotherapy.
What I do is to determine what is physiologically wrong in a patient that is causing their mental illness. Often, it takes multiple problems to create a mental illness. It takes multiple medications, hormones, or nutrients to target enough of these problems to optimize a patient’s ability to function.
For example, when one has Chronic Paranoid Schizophrenia, one not only has a psychotic illness, but one also has a mood disorder. Paranoia can be subdivided into psychotic (e.g. illogic) and mood disorder components (e.g. fear). Often, there are problems in nervous system structure, the are signaling problems involving the nervous, immune, and endocrine systems, and there are metabolic-nutritional problems.
The mind is fairly resistant and it takes numerous hits to the body before a mental illness is created.
Seroquel, compared to other antipsychotics, has a significant strength/weakness – it is sedating. This means it can reduce norepinephrine signaling well enough to help a person sleep. Of course, if excessive, it can be oversedating (and thus a weakness). However, helping a person sleep is highly useful, for example in stabilizing mood. Often, norepinephrine signaling is very difficult to reduce in mood disorders – overwhelming what benzodiazepines can do, for example. Sometimes, patients may even react with anxiety or worsened insomnia by using benzodiazepines or other sedatives. Seroquel can overcome this, and thus it has become frequently used.
[As an aside, I would love a perfect and specific presynaptic alpha-2 receptor agonist, since it would knock down norepinephrine signaling significantly which the nervous system would have difficulty undoing. Unfortunately, this doesn’t exist.]
Given its tendency to not fully occupy the dopamine receptor, along with its serotonin-2a receptor antagonism, side effects (such as tardive dyskinesia) from excessive reduction in dopamine signaling are minimized.
Seroquel XR is a long-acting version of Seroquel. It attempts to reduce oversedation from the use of Seroquel. This is admirable when daytime oversedation becomes a limitation in the use of Seroquel. For example, it would be useful in patients where insomnia is already not a large problem, but its antipychotic properties are needed.
I don’t use it as often as regular Seroquel, however because it is precisely the sedative effects of Seroquel that make it more useful in many situations than the other antipsychotic medications.
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