Seroquel (quetiapine): Uses and Using

Brand & Generic Names; Drug Classes

Drug Class(es)

Approved & Off-Label Uses (Indications)

Seroquel’s US FDA Approved Treatment(s)

Immediate-Release Seroquel

Immediate-release Seroquel was originally approved in September 1997 to treat schizophrenia in adults . Since then its approvals have been expanded to include:

• Treatment of schizophrenia in adolescents aged 13 to 17 .
• Acute depressive episodes in bipolar disorder .
• Acute manic episodes in bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex, in adults as well as children and adolescents aged 10 to 17 .
• Maintenance treatment of bipolar I disorder as an adjunct to lithium or divalproex .

Extended-Release Seroquel

Seroquel XR is rated XR, in that it is for adults only. Otherwise its approvals are almost identical to vanilla¹, immediate-release Seroquel:

• Schizophrenia
• Acute depressive episodes in bipolar disorder
• Acute manic or mixed episodes in bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex.
• Maintenance treatment of bipolar I disorder as an adjunct to lithium or divalproex.
• Bonus approval: adjunctive therapy to antidepressants in major depressive disorder .

Uses Approved Overseas but not in the US

Off-Label Uses of Seroquel

• Insomnia
  • Although it didn’t beat the placebo in this small study. Either Seroquel really works for you or does nothing.
  • Then again, Seroquel seems to work best for sleep if you’re crazy.
    • Although it works for tamoxifen-induced insomnia. But tamoxifen is used to treat bipolar disorder, so maybe that explains it.
  • Like when combined with other meds to treat bipolar or unipolar depression.
  • Or treatment-resistant depression.
  • Or when used by itself to treat bipolar depression.
  • Seroquel works great in Hungarian to prevent suicide in insomnia-exacerbated depression. Or you can read the abstract in English.
  • Seroquel helps people with dementia sleep. Like all APs it must be used carefully given to someone with dementia.
  • Seroquel and SSRIs are effective for the insomnia that accompanies schizophrenia in women with comorbid alcoholism, personality disorders, and a history of attempted homicide. Oh-kayyyy.
  • Most of these studies support something we’ve known here at Crazymeds since forever (i.e. 2004): that Seroquel is best for sleep at a dosage of 25–100mg a night.
  • Even at a low dosage expect minor weight gain
• AstraZeneca was going for full-on, FDA approval for Seroquel XR to treat generalized anxiety disorder (GAD) and as monotherapy (used by itself) for major depression/depressive disorder (MDD) . The FDA thinks Seroquel XR is effective in treating both, but the side effects suck too much when compared with what is already on the market. So Seroquel does work for GAD. Here are some of the data from the clinical trials:
  • It can work in a week.
  • It can keep you anxiety-free for a year.
  • It works great as monotherapy for the combination of GAD and bipolar depression. One pill once a day for two conditions. That makes everyone’s lives easier.
  • Seroquel vs. Paxil for GAD: Seroquel works better and faster than Paxil. You can take Seroquel and be fat, horny, lazy, and maybe shaky, or take Paxil and wait for it to work, and never want or be able to have sex.
  • You can tell AstraZeneca was concerned about weight gain and associated conditions like diabetes. The giveaway: “with tolerability results consistent with the known profile of quetiapine.”
• Monotherapy for MDD - if antidepressants don’t do it for you, even if combined with other APs I can understand giving Seroquel a go. Unlike GAD, I agree with the FDA, who unanimously voted that the side effects don’t justify using Seroquel as monotherapy for depression.
• Parkinson’s
  • Including Othello syndrome in patients with Parkinson’s disease. Othello syndrome is a freaky rare side effect of dopamine agonists used to treat Parkinson’s and RLS, such as Mirapex (pramipexole) and Requip (ropinirole). Such drugs are commonly used off-label to treat depression, especially bipolar depression.

When & If Seroquel Will Work

Seroquel’s Usual Onset of Action (when it starts working)

Unlike other antipsychotics, which can start getting your symptoms under control within 24 hours, Seroquel can take up to a week to work. Unless you’re taking it for sleep. That first 25mg knocks out most people.

Likelihood of Working

Approved uses: Pretty good for schizophrenia, so-so for bipolar mania, fairly good for bipolar depression.

Off-label uses: Excellent for insomnia, good for anxiety. Due to the way Seroquel works and the nature of anxiety spectrum disorders, Seroquel can potentially make your anxiety better or worse at first, then do the exact opposite at a higher dosage. Even if you’re not taking it specifically for anxiety.

Taking and Discontinuing

How to Take Seroquel

Manufacturer’s Recommendations

• For Adults with Bipolar Disorder 1, manic or mixed : start at 300 mg taken once a day. Increase that to 600 mg a day on day two, and on day three you and your doctor can figure out where in the range of 400 to 800 mg a day should work for you².
• For Adults with Bipolar Disorder, Depressive Episodes : start at 50 mg taken once a day. Increase to 100 mg a day on day two, 200 mg on day three, and 300 mg on day four.
• For Adults with Bipolar Disorder 1 - maintenance therapy : 400 mg to 800 mg taken once a day.
• For Adults with Schizophrenia - acute treatment : start at 300 mg taken once a day. Increase by however much you and your doctor think is required, by up to 300 mg! a day, until your symptoms are under control.
• For Adults with Schizophrenia - maintenance therapy : 400 mg to 800 mg taken once a day.
• For Adults with Major Depressive Disorder - Adjunctive Therapy with Antidepressants : start at 50 mg taken once a day. Increase to 150 mg a day on day three. After that there is no clear instruction on reaching the target dosage of 150–300 mg a day for maintenance therapy.

--Seroquel XR PI sheet:

Crazymeds’ Suggestions

• Bipolar Disorder: We suggest starting with one 50 mg dose at night if you’re taking another mood stabilizer, or 100 mg a day if you aren’t. If you need to increase by 50mg a day every 3–4 days and stay at whatever dosage gets your symptoms under control.
  • Unless you’re seriously flipping out, in which case follow the PI sheet’s guidelines until your symptoms are under control or you hit 800 mg a day.
  • By “seriously flipping out” I mean you’re hospitalized, or close to being hospitalized.
• Schizophrenia: We suggest starting with 50 mg a day and, as with bipolar disorder, increasing by 50 mg every 3–4 days until your symptoms are under control.
  • If you’re crazy enough to be getting coded messages in your cereal, especially if you’re NOT eating Alpha-Bits, then get to 300–400 mg by day four. If not sooner.
• As an add-on for MDD: Sorry, I haven’t looked into this.

How to Stop Taking Seroquel (discontinuation / withdrawal)

Your doctor should be recommending that you reduce your dosage by 25–50mg a day every other day if you need to discontinue it. You can stop taking all it immediately if it’s an emergency (e.g. a life-threatening allergic reaction), but I wouldn’t recommend doing that without a doctor’s supervision. The major problem with stopping antipsychotics is a sudden return of your symptoms.