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Confused about symptoms
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casa222 posted:
I just came off of a hypo-mania episode that lasted for four months even while I was faithfully taking my medications. I knew something was wrong but I honestly didn't think that it was mania because of being on medication. I decided to admit myself into the hospital because of the extreme anxiety that all of this was causing and after discussing all of my frustrations with the attending physician there, we both talked about discontinuing Seroquel. I had been on a high dose of Seroquel for over two years along with Lamictal and Lithium. The physician suspected that the Seroquel was acting so well as an anti-depressant for me that it was bouncing my mood to far up which triggered the hypo-mania. So I have been off of Seroquel for 3 weeks now and I am feeling confused about my mood recently. I feel extremely lethargic and very mono-toned. My mood is mimicking depression but not like the depression that I have had in the past. I feel numbed and and unsure of what emotion I should be feeling.

So after giving that lengthy background, I was wondering if anyone else has ever experienced anything similar. I can't tell if I could possibly be over medicated by the other two remaining drugs and maybe the Seroquel's heavy side effects were masking that possibility all along or if I am having withdraw effects or if I am just getting plain old depressed. Anyone's feedback is greatly appreciated. I'm just feeling frustrated with my current situation.
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Joseph F Goldberg, MD responded:
Dear casa222,

Seroquel is an antipsychotic that also treats both mania and depression. There is no evidence that it can cause mania. Its antimanic dose in the FDA registration studies for mania was, on average, 600 mg/day -- its antidepressant dose is 300 mg/day. If someone was having manic or hypomanic symptoms despite the combination of Seroquel 600 mg/day plus lithium (with a blood level of 0.8-1.2 mEq/L) and any dose of Lamictal, I would probably call that lack of efficacy against mania (which would be odd -- that's a pretty strong regimen against mania), and consider either adding a third antimanic drug to the lithium and Seroquel (e.g., Depakote or Tegretol) or else switching the Seroquel to a more potent antipsychotic such as Zyprexa.

Dr. G.


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Joseph F. Goldberg, MD, is a Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. He also maintains a private prac...More

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