Quetiapine

Quetiapine, commonly sold under the brand name Seroquel, is a type of prescription medication called an antipsychotic drug. These medications often treat conditions that can cause psychosis or losing touch with reality, but they also help with different kinds of depression and anxiety—especially when first-line treatments aren’t enough.

There are two types of antipsychotic drugs. “Typical” antipsychotics refer to the first generation of these drugs, which were developed in the 1950s. “Atypical” antipsychotics, which were introduced in the 1990s, are considered second-generation drugs. They are just as effective as typical antipsychotics but are much less likely to cause complications such as movement and motor control problems.

Quetiapine is an atypical antipsychotic. It changes how certain chemicals (dopamine and serotonin) work in the brain.

Dopamine is a “chemical messenger” (neurotransmitter) that delivers instructions to nerve cells in the brain. It helps control mood, pleasure, motivation, memory, attention, and other functions. Serotonin is also a chemical messenger. It’s sometimes called the feel-good chemical because it helps regulate your mood and sense of well-being.

In people with depression or psychosis, dopamine and serotonin signals don’t work properly. Quetiapine works by blocking these abnormal signals.

Quetiapine comes in two forms: quetiapine immediate-release tablets and quetiapine XR (extended-release tablets). Each is approved to treat different conditions.

The Food and Drug Administration (FDA) approved quetiapine for the following uses:

• Acute treatment of bipolar depression in adults
• Acute treatment of bipolar mania. It can be used alone (monotherapy) in adults and children 10 and older. It can also be used in combination with others drugs (adjunctive therapy) in adults only. 
• Maintenance treatment of bipolar I disorder in adults (as adjunctive therapy only)

Quetiapine XR is approved for: 

• Adjunctive therapy in adults with major depressive disorder
• Acute treatment of bipolar depression in adults
• Acute treatment of bipolar mania or mixed episodes in adults. It can be used alone or as adjunctive therapy.
• Acute treatment of bipolar mania in children 10 and older (monotherapy only)
• Maintenance treatment of bipolar I disorder in adults (adjunctive therapy only)

Quetiapine is also used to treat other conditions, including:

• Generalized anxiety disorder
• Insomnia
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)

At Brightside, our psychiatric providers specialize in personalizing treatment for each person. We give you personal attention and expert advice you can count on. By using our expertise, we’ll work with you to find the right medication for you. It’s important that you understand how medications work and what to expect so that your treatment is worry-free.

Quetiapine offers a wide range of benefits that vary by person. The benefits you may experience depend on several factors, including your diagnosis and the severity of your symptoms.

Symptoms commonly improved by quetiapine include:

• Changes in appetite (loss of appetite or overeating)
• Delusions (false beliefs about things that are not true or real)
• Difficulty concentrating or remembering things
• Disorganized thoughts, speech, or behaviors
• Episodes of mania, which may include racing thoughts, excessive talking, trouble sleeping, and delusions
• Excessive, persistent, or uncontrollable worry
• Fatigue
• Feeling restless or fidgety
• Feeling sluggish
• Feelings of worthlessness or guilt
• Hallucinations (seeing or hearing things that aren’t there)
• Irritability
• Loss of interest in previously enjoyable activities
• Low sex drive
• Persistent low mood or sadness
• Sleep problems (insomnia or excessive sleeping)
• Thoughts of suicide

That’s one of the questions we hear most. Unfortunately, there isn’t a straightforward answer. That’s because many factors influence a person’s response to medication. These differences include our genetics, age, gender, underlying health conditions, and other medications we may take.

At Brightside, we understand the subtle differences between common medications—and why certain treatments may be better suited to some people more than others. You can also take comfort knowing Brightside providers closely monitor your progress to make sure you’re on the ideal medication and dosage.

Quetiapine works fairly quickly. On average, people start to notice improvements in their symptoms after four days of treatment. However, this varies by person; if you’re not sure it’s working, do not stop taking it without talking to your provider. Sometimes a prescribed dosage needs adjustment to provide the maximum benefit.

Remember, whenever you have questions or concerns, please let your Brightside provider know.

The amount of time you’ll need to take quetiapine or any medication depends on your personal treatment plan based on your diagnosis, symptoms, and how well you respond to the medication.

For example, once people are diagnosed with bipolar disorder, they often need to take medication for the rest of their lives.

If you use quetiapine combined with other medications to treat major depressive disorder, the amount of time you’ll need to take it is hard to predict. However, providers typically recommend patients stay on their depression medications for at least six months to a year after feeling better.

Most importantly, we recommend that you keep taking your medication until your provider says it’s time to stop—even after you start to feel better. Stopping too early can cause symptoms to return.

To get the best results with medication, it’s important to consistently measure progress during treatment. This is known as Measurement Based Care, and it’s the approach we use at Brightside. It’s common to adjust the dose and/or medication when starting antidepressants until you find just the right fit.

Quetiapine XR was approved as adjunctive therapy for adults with major depressive disorder whose symptoms didn’t respond to other antidepressant medications. Two placebo-controlled clinical trials showed that participants who took quetiapine plus their regular antidepressant had fewer depression symptoms than participants who took an antidepressant alone. These results were consistent no matter what type of antidepressant patients took (SSRIs, SNRIs, etc.).

Quetiapine was approved to treat bipolar depression in adults after clinical trials confirmed it was superior to placebo in improving depression symptoms. 

Additional research suggests quetiapine is an effective treatment for generalized anxiety disorder (GAD)—especially when first-line treatments don’t work. A meta-analysis of three randomized controlled trials with more than 2,200 adults with GAD showed quetiapine worked better than a placebo. It was also shown to be comparable to antidepressants known as selective serotonin reuptake inhibitors (SSRIs)

It’s normal to worry that taking medication will alter your personality. As long as you’re taking the correct dose, quetiapine should not change who you are. Actually, it can help you feel like yourself again; that’s because quetiapine can help you think more clearly and positively, feel less nervous, and take a more active role in your daily life.

Just remember that your symptoms won’t improve overnight. Keep taking your medication as prescribed, and talk to us if you have any questions or concerns.

Like any medication, quetiapine can cause side effects that range from mild to severe. It’s important to review the FDA’s warnings before starting this medication—especially because research has shown that using this medication in elderly patients with dementia-related psychosis increases the risk of death.

One of the most common side effects associated with quetiapine is sleepiness; for that reason, many people take it at bedtime. Other side effects, which typically go away after a week or two, include:

• Constipation
• Dry mouth
• Dizziness
• Headache
• Insomnia 
• Nausea

Some of the more serious side effects associated with quetiapine include:

• High blood sugar
• High cholesterol
• Increased levels of a hormone called prolactin, which can eventually stop menstruation or cause erectile dysfunction. When prolactin levels remain high for a long period of time, there is also an increased risk of bone fractures.
• Orthostatic hypertension, or a sudden drop in blood pressure upon standing (increasing the risk of falls)
• Uncontrolled muscle movements
• Weight gain

At Brightside, your health and safety are our highest priorities. We make sure you get individual attention and guidance to make sure you feel your best.

Taking quetiapine for major depressive disorder, bipolar depression, or other conditions can make you feel better. When this happens, you may think it’s time to stop taking it. But it’s important to remember that quetiapine contributes to those positive feelings.

You shouldn’t stop taking quetiapine without talking to your provider. That’s because sudden, abrupt withdrawal from medication can cause your symptoms to come back or get worse.

If you and your provider decide you’re ready to stop taking quetiapine, you’ll do so by gradually lowering your dosage. This is often referred to as “tapering off.”

It’s important to let your provider know if you’re pregnant or planning to become pregnant. We’ll work together to find treatment options that work for you but won’t harm your unborn baby.

Quetiapine is a pregnancy category C drug. This means studies in animals have shown it can harm the fetus—but there haven’t been enough studies about adverse effects on a human fetus. For this reason, you should only take quetiapine during pregnancy if your provider believes the benefits outweigh the potential risks.

You should also talk to your provider if you plan to breastfeed, as quetiapine can pass into breast milk.

Quetiapine is not considered addictive, and it is not a controlled substance. However, it’s important to remember that you may still experience unpleasant symptoms if you stop taking it suddenly.

You can view the FDA black box warning for quetiapine here. If you have questions about whether the black box warning for quetiapine applies to you, please talk to your provider.