Hi ladyconfused. It was a long road getting to my current cocktail. It's hard to know what my situation would have been on my current cocktail, say 10 to 14 years ago. Various factors have gotten me to where I am, including mastery of coping skills, the ending of the "kindling effect", and the change in my life situation (lowered stress levels, healthier lifestyle) to name a few. But that's not exactly answering your question.

Seroquel regular was effective at curbing my mania even years back, but it took high doses in the range of what I take now. I was also on a moodstabilizer, but not Tegretol XR. At times, because I had severe mixed states, some psychiatrists added an antidepressant. That was always destabilizing for me and I rapid cycled (not the multiple times per day kind, but the multiple episodes per year kind). It took a while before finally my private psychiatrist said "No more adding an antidepressant to your mix!" Really, they were bad news! Perhaps Seroquel regular and a moodstabilizer wouldn't have been great back then if the antidepressants weren't sometimes trialed.

Seroquel XR and regular Seroquel were initially over sedating for me, at times, but I grew used to them, and the sedation eased significantly. However, Seroquel has always helped me with sleep, unless extremely manic. That was not always the case with other antipsychotics. Seroquel and Seroquel XR never gave me akathisia. That's something I can't say about three other antipsychotics I took. Seroquel and it's XR never elevated my prolactin level. That's something I can't say about two other antipsychotics I took. Seroquel and XR never caused me a dystonia, which one other antipsychotic caused. So basically, once I got over the over sedation, it's been the most side effect friendly, while still being effective.

I have had periods when I gained some weight on Seroquel (mostly the regular, not so much XR). However, factors like depression, at the time, may have played a role. The reason [I think] regular Seroquel was less weight friendly than XR is because of the sedation spike, as I call it.

Obviously, some people do gain a lot of weight on Seroquel, like BethRags said. However, Seroquel has never been the worst weight gainer for me. Seroquel XR has probably been in the lower quadrant for me, in terms of weight gain, or even weight neutral at lower doses (below 500 mg). We are all different, aren't we? Since starting Seroquel XR about 8 years ago (doses 350 to 700 mg), I have gained 20 lbs. In its defense, that may not have been unusual even if I had taken zero medications. I had been about 5 lbs less than I am now 16 years ago at age 32, having never taken medications at that time. I consider it understandable that I'd be at least my current weight 16 years later in my late 40s, having taken antipsychotics and moodstabilizers for 14 years. My lifestyle has been somewhat sedentary these last 6 years. Perhaps if it had been more active, I'd be thinner now than at a point before bipolar medications.