[plum123456]

My (now ex) boyfriend was prescribed 50mg of Quetiapine for mixed bipolar disorder a few months ago. The doctor recently upped his regular dosage to 75mg a night and suggested he take 25mg "as needed" when he feels a mood swing coming on.

He recently complained that he has trouble feeling emotions now, and I started searching online for side effects of Seroquel. I stumbled upon the blog "The Last Psychiatrist" and it showed how anti-psychotic medicines behave at different dosages. Apparently until about 300mg, Quetiapine does not block the D2 receptor and does not function as a bipolar medication; at 75mg, it is functioning as an antihistamine. A few more searches and I see that many people are prescribed 25-75mg/night just for insomnia.

When I told him this, he became very upset and told me that the Seroquel is working. And I said he may be feeling better because at that dosage, it acts as a sedative. That made him even more mad.

He is extremely irritable, everything offends him, he picks apart all my sentences, and he thinks I am out to get him. Anything I say is met with "SO WHAT'S YOUR POINT? WHAT IS YOUR OBJECTIVE? ARE YOU TRYING TO DESTROY ME? THIS IS MY LIVELIHOOD. THIS IS HOW I SURVIVE. I NEED THIS MEDICATION TO LIVE." However, upon getting diagnosed, he did very little research on the medication and has not been supplementing treatment with talk therapy.

I did suggest he see a different doctor and he told me I was completely out of line. I can't have a functional relationship with someone who is angry all the time; his instability negatively affects me and our relationship, so I don't think I was out of line to suggest that. Every single thing I say is put to a test. I could say the sky is blue and he would argue with me and tell me how wrong I was to make such an assumption and that the sky is actually periwinkle. I can't ask questions about how he is doing or make suggestions like when he goes without sleeping or goes without eating or tells me he is having a hard time--he does not want to hear that maybe he should see a new doctor. He takes it as an insult and told me I was humiliating him. There is absolutely no way to talk to him about this without pissing him off. But I can't handle it! He goes back and forth from telling me that he is the way he is because his "life has changed" and tells me I have "no idea what [he] is going through" etc. to telling me that he actually just can't stand me.

I can't even pick apart what is what anymore. This relationship has been a rollercoaster at just 9 months, and I have struggled with knowing I need to get out for my own health but wanting to be there for him and be supportive.
I can no longer deal with this so I ended the relationship.

I should add however, that he has an appointment coming up with his psychiatrist. After telling him what I read on the blog, he asked me what he should ask the doctor. I said to see if she can explain the pharmacology of the medicine and ask why she prescribed the particular dosages she did. He told me that she gave him that dosage because a higher dose would make him too sleepy.

My questions are:
1) Is this blog correct? Is 75mg too low for the medication to work as an anti-psychotic?
2) If 75mg has worked to stop 'racing thoughts' and made it possible for him to function and get out of bed and avoid 'highs,' is he truly bipolar? Or were mood swings a function of severe anxiety?

[Travelinglady]

I can't say for sure, but I do know that the same drug can work differently for different people. For example, a certain level of Seroquel could knock one person out, but another person could still be going strong. It is true that Seroquel is used to treat various ailments, but I'm not sure such strict levels as you read are true for everyone.

[optimize990h]

Hi plum123456.

Check these links:

Psych Central - Medication Library

Top 25 Psychiatric Medication Prescriptions for 2011 | Psych Central

Forums at Psych Central - Search Results

[-jimi-]

Never forget everyone is different and dosages have to do with how fast you metabolize a med. Part from that, The last psychiatrist rocks.

[~JD~]

Your research is correct. Under 100mg, it acts like a completely different drug than it does at 150mg (XR) and higher.

It's given at 25-75mg for help sleeping, and <25mg for help with anxiety, agitation, anger, etc.

It will still act as a mood stabilizer because of its sedative effects. It will dull out
any sort of emotion. When you hit the levels that it was actually approved for, though,
you hit a total and complete "zombie" level.

Also, Seroquel IR (instant release, normal form) isn't really given all that often as a mood
stabilizer or to counteract psychotic symptoms. Seroquel XR (extended release) is used much more often
these days for treating those.

[plum123456]

Originally Posted by ~JD~

Your research is correct. Under 100mg, it acts like a completely different drug than it does at 150mg (XR) and higher.

It's given at 25-75mg for help sleeping, and <25mg for help with anxiety, agitation, anger, etc.

It will still act as a mood stabilizer because of its sedative effects. It will dull out
any sort of emotion. When you hit the levels that it was actually approved for, though,
you hit a total and complete "zombie" level.

Also, Seroquel IR (instant release, normal form) isn't really given all that often as a mood
stabilizer or to counteract psychotic symptoms. Seroquel XR (extended release) is used much more often
these days for treating those.

Thank you so much JD.

[Odee]

I don't know much about Seroquel, but I have to say, OP, you are one smart girl!! You have a great understanding towards what needs to be done during treatment and you took yourself out of a toxic situation. Your actions were perfect.

Originally Posted by ~JD~

It will still act as a mood stabilizer because of its sedative effects. It will dull out any sort of emotion. When you hit the levels that it was actually approved for, though, you hit a total and complete "zombie" level.

I'm on quetiapine/Seroquel 400mg at the moment as a mood stabiliser. I started on 25mg and titrated up, but I have to disagree with what you said about it dulling emotions and causing zombie-level sedation. My pdoc warned me that it would probably knock me out at 25mg, but that the sedation would decrease as the dosage increased. I'm guessing that's because it's acts more as an antihistamine at lower doses which would cause sedation. I didn't find that 25mg knocked me out AT ALL, and neither does 400mg or any dose in between FOR ME. Everyone is different and I don't think a blanket statement about side effects does anyone any favours as it may put people who read stuff like this off from trying a med that could really help them.

Originally Posted by Odee

I don't know much about Seroquel, but I have to say, OP, you are one smart girl!! You have a great understanding towards what needs to be done during treatment and you took yourself out of a toxic situation. Your actions were perfect.

Yes I agree. You are very well informed. It's just a shame your bf didn't appreciate that. However leaving an unhealthy relationship was the right thing to do for you. You have to look out for yourself first. Wishing you the best of luck

*Willow*