[TicTacGo]

I am on Seroquel (for bipolar 1 in conjunction with lithium) and I find it to be a very difficult because if I take it too early, I feel sedated, too late and I feel groggy the next morning.
It is a fine balance and there are obviously evenings when I cannot keep this under a certain control.

I have been onall my own experiences)
Risperdal- made me gain weight
Zyprexa- similarly sedating
Abilify- not covered by my insurance
and finally Seroquel.

What other options do I have? I know I could just google "antipsychotics for bipolar" but I want other people's opinions. Those who know the struggle and all that.

[still_crazy]

Geodon works for some people. There's the cardiovascular issue (I don't understand it very well...), and with Lithium I would think EPS would be more of an issue.

Low-to-moderate doses of older drugs sometimes work well for some people. A big study used perphenazine in comparison to a number of "atypicals" and found it worked about as well as the newer drugs, just with a bit more EPS. I don't think perphenazine has any mood benefits by itself, but it is less toxic than Thorazine and less likely to cause pronounced EPS and akathisia than, say, Haldol or Prolixin. There's also loxapine (low doses might be atypical-ish, based on brain imagine studies).

My former shrink suggested amoxapine to me once. I declined because I didn't want any antidepressant, especially a TCA, but...some people swear by it. Its a TCA that partially metabolizes into loxapine. I did a lil Googl-ing, and there have been some small studies using it in Schizophrenia that found it was about as good as Risperdal, and also about as well tolerated (for the group...). Again, with Lithium on board EPS and other adverse effects might become more of an issue.

I seem to recall reading about high doses of Surmontil (trimipramine, maybe?) being effective in psychotic disorders. Something about a close similarity to clozapine. Anyway, its sedating, its a TCA, but it should be generic and it can improve sleep and help mood, anxiety, and agitation.

Other than that, I dunno. Are you sure you need a major tranquilizer? I'm not trying to nit pick or anything, I'm just asking because neuroleptics are heavy artillery, even the new(er) ones. Some people with a diagnosis of Bipolar I absolutely require neuroleptics, at least for a while. Others can take them only as needed, or while deep in severe mania or depression, and then they can taper off and go on about their business on other psych drugs.

I hope you can find something you can tolerate that works well for you.

What kind of Seroquel are you taking? Instant release or XR?

I can't handle instant release for reasons you stated. But XR is MUCH better. I have no problems with it. None of that weird sedation or grogginess.

BTW, seroquel XR is as little as $3 with insurance. There's a coupon thingy that you can use. I only pay $3 for it.

[*Laurie*]

In my experience, bluebicycle is correct about instant release vs. XR.

Also, can you drink coffee? I find a cup or 2 of coffee in the morning really helps clear my brain of the foggy-groggy feeling.

[TicTacGo]

Thanks for the replies so far. Still open to suggestions.

@still_crazy - Yes, as far as I can tell, they want me on lithium and a neuroleptic as my last manic episode happened long after I started lithium. I could ask about Geodon and others mentioned.

@bluebicycle - I take instant release, 200 mg at night. I could also ask about XR. I think this meds controlling my evening activities is ********.

@*Laurie* - The sedation is so bad that it is difficult to stand up and move. All my muscles are heavy.

[*Laurie*]

Yeah, I understand the sedation...I also take Seroquel. I slide very slowly into my day every morning. I start with 2 cups of coffee to help clear my mind, and I make sure I eat breakfast. Food helps dispel the grogginess.

How long have you been on Seroquel? In my experience, the heavy sedation does lessen after some months on Seroquel.

I'm not sure what your medication options are besides Seroquel. I guess it depends upon why, exactly, the Seroquel is prescribed to you. I'm slowly replacing Latuda with Seroquel...Seroquel helps me sleep, but doesn't do anything else, while Latuda helps relieve depression.

[BlessedRhiannon]

I guess it depends on why you are taking Seroquel - what benefit does it have for you. If it's for sleep, I don't really have a better suggestion. If it's for mania or depression or both, I've replaced Seroquel with Vraylar and love it. It's expensive though and your insurance might not cover it, so be sure to check.

[VanGore28]

Seroquel worked the best for me but here it comes...I cant take it anymore because it has affected my thyroid and liver. Meaning I am absolutely shattered, getting hot and cold spells, so looks like I need something else. I was on it for seven years.