[PsychoPhil]

Heyo, been a while!

I've been on Quetiapine on and off for the last three years. For psychiatrists the prescription is off label since it's for mood stabilization and not meant to tackle psychotic symptoms. I think my dose of 50mg per day is deemed too low to help with these.

So my generally depressive and miserable condition has vastly improved. However, because of the side effects I went off meds several times for up to a month. Also, as I have been travelling and needed to get by on what I could get without prescription, I reduced my dose to 25mg at times.

Now my observation is that going off Quetiapine, it's not really my mood that's the main problem. I'm obsessing along a persecutory theme that everyone hates me. It's ridiculous, but even faces from advertising billboards look at me disapprovingly. This combines with recurring mirror phobia, where my reflection from blank surfaces or glass walls causes me distress as I'm fantasising about gross deformities. Looking back, this is how the whole issue started when I was a teenager. Back then, seeing my actually normal face in a mirror reconfirmed suspicions of being unacceptable.

Now what I'm describing is also known as BDD - body dysmorphic disorder - which, however, can also occur as a symptom of schizophrenia.

So this is my question: if obsessions along a generally persecutory theme are greatly reduced taking anti-psychotics, does this mean that those obsessions are psychotic symptoms?

Thanks anyone!
Phil

Btw I left Canada and am back in Germany

[Yaowen]

Just read your post but because of a hand injury I am unable to type a worthy response it. I doubt that I have the wisdom to respond helpfully even if I could type for long. I do hope others here will see your post and respond helpful to you and provide an answer to your question. My heart goes out to you!

[PsychoPhil]

Thanks, Yaowen!

Yes, I realize it's a hard question. Yet, it would be great if others here in the forum had an opinion to share.

All best to everyone, Happy Holidays!
Phil

[MuddyBoots]

It's hard to say without a thorough evaluation from a psychiatrist/psychologist, but what you're describing could be psychotic-like symptoms or could be anxiety that was treated by the Seroquel.

[Desoxyn]

I lowered olanzepine from 10mg to 5mg, and the obsessions were the same (That everyone hates me), intrusive past thoughts. It gets so incredibly overwhelming that I often self medicate (But meds help).

I have no idea what would happen if I completely stopped my meds (Or couldn't get them) - I'd lose my ****ing mind.

50mg of quetiapine is a small dose... So you're lucky. I was diagnosed with OCD, and then was diagnosed with schizophrenia - But don't worry about which is which.. They're just labels that shouldn't mean too much.. It's mostly symptoms..

Heavy antipsychotics (Like what I'm on - High dose Invega and olanzepine) can cause neurotoxicity and brain damage (Especially after stopping them cuz of withdrawal) and if that isn't enough, neurotoxicity from psychosis itself.

I wish I stayed on 2mg of risperidone (When I was 16) and didn't stop taking the antipsychotics all of the time, to the point where I had to take it in injectable form. I was told (Just by looking at my records) that I have to be on some sort of antipsychotic for the rest of my life.

[Tart Cherry Jam]

I am surprised your psychiatrist called the use of Seroquel for mood stabilization off label. I am also surprised such a small dose was prescribed with that intention. It is a typical dose for use as a hypnotic. 300 mg and above is more common for mood stabilization and against psychosis. I think you are especially sensitive to this drug in a lucky was such that only 50 mg relieves your symptoms to some extent. Try taking 100 mg to see what happens.

[PsychoPhil]

Off label because of the low dose. I did try 100mg which indeed work better at the cost of more side effects. If I do remember correctly my PDoc said that normally she can prescribe only doses starting from 150mg, because only these had "therapeutic effect".

In my impression psychiatrists follow a general logic that someone getting along without hospitalizations must be doing well enough to not need medication. As if people with less than 2 diopters shortsightedness, who can get by in their daily lives, should never wear glasses. Or should first be run over by a bus to be diagnosed as short-sighted.

I don't think the two PDocs that eventually had the mercy were taking my case seriously. Looking at off-label uses of Quetiapine, it works as an anxiety disorder treatment.

Now, after 3 years on the drug, with maybe five interruptions of 2 weeks to a month, I come to realize that the main driver of my very miserable mood episodes does appear to be a classic paranoid theme with a little twist. I guess one could call that anxiety as well. If anxiety normally includes being followed by your monstrous reflection. Or faces from billboards looking at you disapprovingly. Or that people outside your social circle, that wouldn't reasonably conspire, still see your inherent hideousness. The bit of classical themes, where everyone reads your thoughts, is in my case replaced by a fixed belief that others simply "see" the fact. Naturally, this induces negative expectations that indeed seem to be noticeable to everyone who knows me.

On 50mg Quetiapine, these effects aren't gone, but reduced to an extent that I find sleep and manage.

Edit: Rereading my post, even the bit where I'm convinced my PDocs don't take me seriously would seem to be a classic.

[Tart Cherry Jam]

yeah, sounds like classic psychotic themes...

[*Beth*]

Originally Posted by PsychoPhil

In my impression psychiatrists follow a general logic that someone getting along without hospitalizations must be doing well enough to not need medication. As if people with less than 2 diopters shortsightedness, who can get by in their daily lives, should never wear glasses. Or should first be run over by a bus to be diagnosed as short-sighted.
......
Edit: Rereading my post, even the bit where I'm convinced my PDocs don't take me seriously would seem to be a classic.

Well, if you're psychotic for believing that about pdocs then so am I, and so are about a billion other people.

The attitude most pdocs have (in my 3 decades of experience with pdocs) reminds me of cops not checking out an extremely suspicious person because they "can't do anything unless a crime is committed." Then the suspicious person

Possible trigger:

goes on a shooting rampage.

i.e., Hey pdoc! It's called preventative medicine! Let's remedy the problem before it turns into an IP situation, okay?

Something they apparently don't teach in pdoc school is basic logic. Then again, there are times when I wonder if pdocs actually want a "difficult" patient to end up IP so the pdoc can shove the problem off on someone else.