Quetiapine/seroquel?

[MissMacD]

Thanks Meza ;), it's not easy feeling so cruddy all the time and it has been going on for close to a year now. It's been so long since I felt genuinely good, makes it hard to keep my head up but somehow I am still trying to do it. This is the first time in my life that I have slowed down long enough to take care of myself.

I know that I will eventually find something that works, I am just super worn out from trial and error with no success.

 

[Girl3]

I... can't believe so many of your (plural) doctors are prescribing seroquel anymore. If you're psychotic, then by all means, atypical anti-psychotics are not a bad idea. If you don't actually suffer psychotic disorders, stay the hell away from them.

The risk benefit ratio of the atypical antipsychotics is better than the typical antipsychotics for tardive dyskinesia, extra-pyramidal symptoms, but worse for weight gain, diabetes, increased cholesterol/triglycerides, and various effects on the heart. Atypical antipsychotics increase the risk for sudden-death, serotonin syndrome and neuroleptic malignant syndrome.

Some people do have psychosis as part of their PTSD, but this is not the usual. The atypical antipsychotics have also been used off-label for resistant depression, but depression that is part of PTSD isn't pure Major Depressive Disorder. Research hasn't supported the use of atypical antipsychotics in randomized trials and their use in most patients should be questioned - especially if sleep is the relevant issue.

Antiseizure medications like Lamictal, Neurontin, Topomax as well as some tricyclic antidepressants are safer to obtain sleep, less likely to cause untoward side-effects and typically are effective at low doses. For instance, 5-10mg of amitryptiline can induce sleep as can 100-300mg of gabapentin used 30 minutes or so before bedtime.

While some people may require Seroquel for mood stabilization - particularly if they have severe anger issues or have Bipolar with psychotic features in addition to PTSD, patients should question why they are being started on a drug and have a real discussion about the risks involved.

 

[MissMacD]

I woke up today in a psychotic state, went into my kitchen and started slamming stuff around. I knew something was wrong and told my boyfriend that I needed to go to the hospital. The triage nurse noticed that my face was swollen, I then realized that I was having a hard time getting enough air.

Bye bye Seroquel. I have had medication make me psychotic before. What now?

Now I have nothing to help me sleep :(

 

[Girl3]

Alpha-blockers help people get to sleep by blocking the adrenaline receptors in the brain. Prazosin was found in randomized placebo controlled studies to help with nightmares associated with PTSD. The alph-blockers have also been found to be helpful with restless legs and hot flashes. For me, my clonidine - reliable onset of sleep, decreased startle reflex, decreased hot flashes and leg cramps - is the best. And it is an old drug, no longer under patent and so costs 4.00 a month at Walmart or 10.00 for 90 days. Alpha-blockers don't cause serotonin syndrome or tardive dyskinesia.

Small doses of amitriptyline an older tricyclic antidepressant also can do wonders for inducing sleep as well as keeping you asleep. Amitriptyline has a long-ish time of action, around 9 hours so you can't take it at 9pm and expect to be up at 5am ready to roll. 10mg of amitriptyline a night is also 4 dollars a month at Walmart.

Getting into a sleep routine is crucial - quietly winding down, TV off, soothing sounds whether it be a sound machine or some kind of gentle music or even some low-key white noise, reading a book (computers don't count because of the blue-spectrum of light emitted from computer and TV screens tell the brain it is time to be awake.)

It has taken me decades to get it all together where I can get to sleep more nights than not. Staying asleep is tougher because of taking call at the hospital. It's hard to relax when you know your phone can ring at any second and it could be a trauma or a stat C-section or a 3 year old with a broken arm. But even thnose nights I manage to get a bit of sleep. But it has been my biggest complaint with my psychiatrist - that sleep (and bowel functions) sort of get poo-pooed as "just symptoms". But no sleep is so detrimental to spirit and function.

But sleep by itself doesn't fix PTSD. But it sure does help.

 

[MissMacD]

10mg of amitriptyline a night is also 4 dollars a month at Walmart.

Is this over the counter or prescribed? I live in Canada.

My biggest issue right now is that medication is tied in with my trauma experience so it ends up being worse than better for me. Winter has hit with a vengeance and I have been unemployed for about 5 months now. It's probably going to be a few more months before I am back on my feet again and able to work because my trauma has taken so much out of me.

I can't wake up when I take Seroquel and have an alarm set - it's not that I don't want to but my body just doesn't respond to my alarm at all - I am so dopey when I finally fall asleep and it knocks me out for a really long time. Friday night I ended up in the ER because my face got puffy and I was having trouble breathing - I have no food allergies and I have had pretty persistent allergic reaction after taking it but nothing to that degree. I made my nose stuff up, sinuses drip like faucets and my inner ears itchy to no end. I woke each morning with a lung full of crap and now I am fighting off a borderline infection.

If I could get back into working and have income to pay for a hot yoga membership again I know that it would lift a lot of my depression symptoms. I am in therapy full time - CBT once per week, I see a social worker a few times a month and check in with my family doctor a few times a month right now. I have applied for temporary social assistance - which my doctor wrote a leave for me so it should be approved. The problem is finding things to do to burn my energy when I have gone from working full time to not at all and having a reasonable income to nothing. It's hard to do many things without money.

 

[quaintpapercut]

If I could get back into working and have income to pay for a hot yoga membership again I know that it would lift a lot of my depression symptoms.

Most yoga studios will have an energy exchange program where you agree to volunteer, say 4 hours a week, cleaning the change rooms or what not, in exchange for free yoga.

The problem is finding things to do to burn my energy when I have gone from working full time to not at all and having a reasonable income to nothing. It's hard to do many things without money.

I'm in the same boat as you. Its very difficult when your used to having a certain amount of disposable income. I'm in Canada as well and the cold weather combined with the lack of funds has hit me hard recently.

I just got my skates sharpened and have gone out twice already - it's free and gives me some exercise. I like coming in to a warm house and feeling like my body is slightly fatigued from doing something. Always thinking about tobogganing soon too!

 

[Girl3]

MissMacD - sorry for your troubles. Amitriptyline is prescription. Your primary care doc should be able to write that without any issues, as it would be safer than taking a medication that is obviously causing a serious allergic reaction.

Any prescription taken for sleep should be taken based on its clinically effective duration. For instance, amitriptyline has about a 9 hour clinically effective duration. Most oral medications take about 30-45 minutes to start working. So let's say you want to get up at 7am. The drug is going to work for 9 hours so you want to be in bed by 10pm, but you have to take it around 9:15pm for it to actually kick in.

This is one of the most common mistakes with medications prescribed for sleep - people aren't told WHEN to actually take it. Telling a patient to take it before bedtime is meaningless. If your bedtime is whenever you get around to getting into bed, then of course wake up will be difficult if you try to awaken when a drug is still active.

With Seroquel however, serotonin buildup can produce sedation/lethargy/confusion - after it causes anger/agitation/sleeplessness. I think prescribing atypical antipsychotics should be closely monitored, like controlled substances instead of being thrown about like Pez candy.

Any exercise will ultimately make you feel better. Gettting out and walking in the snow - particularly if you can walk to an art museum and enjoy a few paintings or sculptures. When I was young and poor I ran outside in all weather because running made me feel normal. I also filled milk jugs with water and used them as free weights. (1 gallon is 8 pounds of water.)

Hope you can get some sleep soon. Wishing you quiet nights and happy dreams.