I think one shouldn’t entitle a post rest my case… because there’s always another thing. In this instance, it’s my own conclusion to seroquel: good to the last drop… and rest my case…. I didn’t get Seroquel® or Seroquel XR®. I had retired from a psychotherapy practice and was comfortably living in the mountains doing not-doctor things. I started volunteering and the patients were on all kinds of medicines – and Seroquel® was among them. I knew nothing about it except that it was an Atypical Antipsychotic. The patients on it weren’t nor never had been psychotic. When I asked them what it was for, they said sleep and to a lesser extent, anxiety. I started reading about it and decided that was a really bad idea, given its side effects. The vast majority had been started on it by Primary Care "country doctors."
When I started trying to get patients off of it, I learned about the withdrawal syndromes pretty fast – from the patients, not the literature. So I started looking into it [series starting with seroquel I: introduction to an “atypical”… and selling seroquel I: background…], and that’s really where this blog started – that and the Chairman of the Department I had been affiliated with turning out to be busted for being an ethical nightmare [Dr. Nemeroff]. Getting people off of Seroquel®, once I learned to taper it, was easier than getting people off of Benzodiazepines – the main difficulty was sleep problems which kind of cleared after a time. I tried Seroquel® as an antipsychotic and, at least in my hands, it wasn’t very effective. I don’t see a lot of psychotic people, but when the ones I saw couldn’t tolerate the older drugs, I tried Atypicals. The only one that was acceptable to the patients [and me] was Risperdal®.
So time passed, and I was spending a lot of time looking at the psychopharmacology literature, which meant seeing ads – Seroquel XR® was everywhere as an adjuct to antidepressants. Then I ran across the papers claiming it could be used as a monotherapy in depression [Extended release quetiapine fumarate monotherapy for major depressive disorder: results of a double-blind, randomized, placebo-controlled study]. That made no sense to me. Why would an antipsychotic be used in depression? But there were so many other things to chase down, that kind of got put aside. When I saw this recent paper by Dr. Trivedi [or AstraZeneca], it came back up in my mind. Is Seroquel® an antidepressant? an adjunct? So these last two posts were picking up an old thread for me. I actually think that the two papers [Evaluation of the effects of extended release quetiapine fumarate monotherapy on sleep disturbance in patients with major depressive disorder: a pooled analysis of four randomized acute studies. and Quetiapine XR monotherapy in major depressive disorder: a pooled analysis to assess the influence of baseline severity on efficacy] inadvertently made the point that Seroquel XR® is not an antidepressant – it helps the depressed people as a sleep aid whether as monotherapy or augmentation [seroquel: good to the last drop… and rest my case…]. So the question is, "Is it rational to take an anti-psychotic as a sleeping pill?" I personally think the answer is a very loud "no!" There are plenty of other options, and also a need to look into why the sleep is disturbed [see this comment].