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  #1  
Old Jul 04, 2019, 04:40 PM
chels127 chels127 is offline
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Hi everyone. I'm new here. And new to the world of Bipolar. Diagnosed this year at age 44. It's thrown me for a loop to say the least. I'm currently experiencing acute bipolar depression. Barely functioning. Lamotrigine isn't helping at all, plus my hair is falling out like crazy. Also taking 300 mg Gabapentin for sleep which also isn't helping. Seeing the nurse practitioner tomorrow and going to try Seroquel again. I'm desperate. I can't seem to find any info on whether extended release of immediate-release is better for this debilitating depression, anxiety, and insomnia. Any info or advice would be much appreciated.
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  #2  
Old Jul 04, 2019, 05:24 PM
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Hi chels. Welcome to Psych Central. I am sorry you are having trouble finding meds to help you.

The XR may be extended release. Only a doctor can tell you which is best for you. I think the XR may be a lot more expensive since I do not think that there is a generic for the XR. Maybe your pharmacist could tell you what costs may be for each.
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  #3  
Old Jul 04, 2019, 06:42 PM
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Hi chels. I have taken both immediate release and extended release. I've been taking the extended release for the last six years. It has been available in generic for me for about two years or so. The instant release generic is likely still cheaper for many people, though with good insurance the extended release generic is not that bad. I think I pay less than $30 in copays per 90-day supply, with my insurance.

I agree that your doctor should know which type of quetiapine (Seroquel) is best for your situation. I think the two types have similar advantages and disadvantages, but in my view have some differences that may make some a fan of one type over another. Experiences obviously vary. All I can say is that I, personally, clearly prefer the extended release quetiapine ER (Seroquel XR). In my particular case, the extended release is more weight "friendly" than the regular instant release. Also, it has been particularly helpful for not only my mania control, but also bipolar depression, anxiety, and sleep. Unlike other antipsychotics, I have not experienced any EPS or hyperprolactinemia on Seroquel.

The tough part for me with both Seroquels was the initial sedation issues, when not manic. Having been on Seroquel XR for a long while, that did eventually ease, but it required patience, tolerance, and strategy. By strategy, I mean taking it at a particular time, going to sleep no later than certain times, and creating a wake up time ritual. If I take it too late, stay up too late, and wake up too early, I sometimes still get what many people call a "Seroquel hangover". If I don't, I don't.
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  #4  
Old Jul 04, 2019, 08:35 PM
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I take 600mg of the regular instant release, it helps me a lot a long with my other meds
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  #5  
Old Jul 04, 2019, 08:52 PM
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~Christina ~Christina is offline
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I was in the XR for a couple years and I think initially it helped me out of a hellish depression. But the weight gain was causing more and more health problems so I did stop it

The IR never did anything for me.

My daughter tried the XR and just was unable to function due to the sedation, she went on the IR and it’s worked amazing her.

When was the last time you had a physical and full blood work? Thyroid and hormonal levels can cause and make depression worse. Best to rule out any possible physical health issues.
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  #6  
Old Jul 05, 2019, 08:11 PM
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Well the 400 mg Seroquel and 4 mg Lorazepam a day routine my pdoc put me on since Wednesday to combat severe anxiety/PTSD seems to be working. I haven’t been able to get out much due to sedation but it is only short term to break me out of the cycle. My stomach is calmer and I haven’t had a panic attack. The PTSD is still bad of course but I think I have avoided IP. I am hoping to reduce the doses in a couple of days and see how I go. My mind is still buzzing with memories so I’m worried reducing the dose will only bring back the hell I was in. I email my pdoc Monday and will see what he says.
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  #7  
Old Jul 05, 2019, 11:40 PM
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Wander Wander is offline
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Quote:
Originally Posted by Wander View Post
Well the 400 mg Seroquel and 4 mg Lorazepam a day routine my pdoc put me on since Wednesday to combat severe anxiety/PTSD seems to be working. I haven’t been able to get out much due to sedation but it is only short term to break me out of the cycle. My stomach is calmer and I haven’t had a panic attack. The PTSD is still bad of course but I think I have avoided IP. I am hoping to reduce the doses in a couple of days and see how I go. My mind is still buzzing with memories so I’m worried reducing the dose will only bring back the hell I was in. I email my pdoc Monday and will see what he says.


Sorry! This was meant to be an update on post 34. Guess it’s kind of relevant. The IR I am taking for severe anxiety is helping way better than XR would. They both work best in different situations for different people.
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  #8  
Old Jul 06, 2019, 07:50 PM
still_crazy still_crazy is offline
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I think...in some studies, they used seroquel up to 300mgs at night in Bipolar I people (depressed)...with good results. that was the IR. The XR was approved later, of course...and after it was approved, all kinds of additional 'yay, seroquel!' data came out (seroquel for unipolar major depression, seroquel for Bipolar I maintenance, etc.).

i think it depends on what the prescriber has seen in practice, too. there's a lot that they see that will never make it into text books or FDA approvals, etc. a former psychiatrist once mentioned maybe trying seroquel in IR form at night -for me- , because I get so agitated while depressed. insurance coverage might play a role in ir/xr selection, too.

sorry about the hair loss w/ lamotrigine. i had it with depakote, but lamictal has been kind to me, in that regard. i hope things get better for you.
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  #9  
Old Jul 09, 2019, 07:37 PM
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Quote:
Originally Posted by Wander View Post
Well the 400 mg Seroquel and 4 mg Lorazepam a day routine my pdoc put me on since Wednesday to combat severe anxiety/PTSD seems to be working. I haven’t been able to get out much due to sedation but it is only short term to break me out of the cycle. My stomach is calmer and I haven’t had a panic attack. The PTSD is still bad of course but I think I have avoided IP. I am hoping to reduce the doses in a couple of days and see how I go. My mind is still buzzing with memories so I’m worried reducing the dose will only bring back the hell I was in. I email my pdoc Monday and will see what he says.
I am all for taking the advice of the professional and not try to alter dosages alone. That is like doing brain surgery on yourself in my opinion. There are too many unknowns and the doc knows all the ins and outs.

If after the change, things happen to get worse, contact them immediately to get their opinion on a good next step.
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  #10  
Old Jul 12, 2019, 12:06 AM
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Pookyl Pookyl is offline
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I take both types.
The IR is for sleep and also to bring down mania.
The XR is to take the edge of the anxiety and to prevent a depressive episode.
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  #11  
Old Jul 12, 2019, 07:40 AM
fern46 fern46 is offline
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Quote:
Originally Posted by chels127 View Post
Hi everyone. I'm new here. And new to the world of Bipolar. Diagnosed this year at age 44. It's thrown me for a loop to say the least. I'm currently experiencing acute bipolar depression. Barely functioning. Lamotrigine isn't helping at all, plus my hair is falling out like crazy. Also taking 300 mg Gabapentin for sleep which also isn't helping. Seeing the nurse practitioner tomorrow and going to try Seroquel again. I'm desperate. I can't seem to find any info on whether extended release of immediate-release is better for this debilitating depression, anxiety, and insomnia. Any info or advice would be much appreciated.
Hi chels. I don't have any advice on these specific meds, but I wanted to offer my support. I am newly affected at age 38 and it is a lot to process after living so long without these types of issues. You seem to be digging in and doing what you can to find meds that can work for you. I hope you find the right mix to allow the depression to ease up soon. Hugs.
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