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Can Seroquel Make You Depressed?


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#1 Anise

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Posted 14 January 2009 - 10:26 AM

Okay, I might as well start off by saying that I hate Seroquel, so it's hard to think of anything good to say about it in the first place. But here's the thing.I'm extremely sensitive to the CYP34A enzyme effect, where a BIG range of foods and drugs effectively raise the dosage of Seroquel that a person is taking. This is best known with grapefruit (although pomegranate is just as bad), but it's amazing how many drugs fit this description too. I REALLY got caught this way with sulfa drugs recently. But I'm extra super sensitive, which my doctor has confirmed (because of my TBI and neurological damage). So I just realized that the grape juice I've been drinking all week has actually had an effect. :mad: Ick!

The point of all this is that whenever this happens for me-- basically the same thing as suddenly going up on my Seroquel dosage by almost half-- the biggest thing I notice is immediate depression. I have never had pure endogenous depression as such. I'd had a few isolated episodes of it that were caused by drug reactions to other drugs, and that immediately disappeared when the drugs were withdrawn. So it seems VERY clear to me that when it happens these days, immediately after the Seroquel incidents, that it's because of the Seroquel.

Does this make any sense? Has anyone else ever had sudden depression happen with a sudden or rapid increase in Seroquel?
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I think everybody should like everybody. -- Andy Warhol
If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!



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#2 Bipolar Bear

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Posted 14 January 2009 - 05:28 PM

Short answer: anything is possible.

For me, not really. I sleep a lot more, but I can't say I get *depressed.*

Lots of people actually notice a lift in depression with Seroquel.

I don't know much about the enzymes and such- is it possible that whatever is upping your Seroquel is lowering the levels of a different med in your system?
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#3 Anise

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Posted 14 January 2009 - 07:13 PM

Short answer: anything is possible.

For me, not really. I sleep a lot more, but I can't say I get *depressed.*

Lots of people actually notice a lift in depression with Seroquel.

I don't know much about the enzymes and such- is it possible that whatever is upping your Seroquel is lowering the levels of a different med in your system?


I still don't know for sure, of course. But I have a couple of theories that make a lot of sense, one of which I could NOT have come up without your idea. And I found some fascinating facts!! Oh, I do love doing research at the University of Tennessee. First of all, quetiapine (Seroquel) is a potent serotonin antagonist at the 5-HT2A receptor. A LOT of antipsychotics work this way. This receptor, you see, is where the hallucinogenic drugs do their work (mescaline, LSD, and so forth.) However, Focalin is *also* a 5-HT2A agonist because it's an amphetamine derivative, although it does a whole lot of other things too, and clearly isn't hallucinogenic. One of the functions of a 5-HT2A agonist is to increase glutamate transmission in the prefrontal cortex, which is a very big help when you've had neurological damage, as I have. (This doesn't seem to interfere with the glutatmate-inhibitory effects of the anticonvulsants elsewhere, because glutamate does all kinds of things all kinds of places all over the brain.) So you see where this is going. Seroquel antagonizes this, and when it overdoes it-- which would happen when the dose suddenly goes up--that could be part of the reason why I can suddenly feel icky and out of it and sludgy and depressed!!! So that could very well be why Seroquel sometimes makes me depressed when it wouldn't have that effect for most people.

But here's the other piece of the puzzle, and this is the idea I owe all to you, BP Bear. :)

I researched the CYP34A enzyme issue as it relates to topiramate. Guess what??? Topamax is a CYP34A inducer, not an inhibitor, which Seroquel is. This means that it works against Seroquel, effectively lowering the dose at least a bit rather than raising it (as grapefruit juice would, for instance), which I couldn't be happier with, to be honest, because I don't like Seroquel one bit. I doubt this has much effect on Seroquel until the Topamax dose gets a lot higher than what I'm taking now. However, this also means that I do have to be very careful with the exact same list of foods and drugs, because they'll have the opposite effect on Topamax no matter what dosage I'm on-- LOWERING the effective dose I'm taking. That would not be good. Also, that means that if I do have one of those foods/drugs,I'm getting a double whammy-- LOWERING the dose of the drug I do like, and RAISING the dose of the drug I can't stand. :mad: But I'm extremely glad I figured this out, because there's NOTHING I hate more than having no idea of what's going on. While there's no way to be absolutely sure, it all makes sense and fits together. Thanks so much for the advice and ideas! :)

Edited by Anise, 14 January 2009 - 07:17 PM.

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I think everybody should like everybody. -- Andy Warhol
If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#4 firewatcher

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Posted 14 January 2009 - 08:54 PM

I don't know how to ask this without it sounding rude, other than to say that I don't mean this in a rude way, but why do you take Seroquel if you hate it so much?

You may have explained this somewhere, but I haven't been on the board for all that long, and don't read every thread, so please forgive me if I missed it.

I'm asking because I'm taking Seroquel, so I have a vested interest.

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FWIW, other Dx include: GERD (chronic acid reflux), Dysautonomia/POTS (Postural Orthostatic Tachycardia Syndrome)
other Rx include: Metoprolol (beta blocker for tachycardia), Florinef (steroid for water/salt retention), Aciphex (for chronic acid reflux)

#5 Anise

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Posted 15 January 2009 - 08:39 AM

I don't know how to ask this without it sounding rude, other than to say that I don't mean this in a rude way, but why do you take Seroquel if you hate it so much?

You may have explained this somewhere, but I haven't been on the board for all that long, and don't read every thread, so please forgive me if I missed it.

I'm asking because I'm taking Seroquel, so I have a vested interest.

Amber


Oh, it's all good. :)

I was having awful mixed states a year ago from taking fluxoxamine (which clearly didn't work out too well! I don't do well with AD's at all.) I don't get classic manic or depressed states because I'm BP-NOS, so mixed states that never quite reach the DSM definitions of mixed states are the only BP things I've ever had (plenty of those, though). I was prescribed Seroquel, and I do have to say that it did bring me back to a more stable state at the time. That state was not exactly anything to write home about, but at least it was an improvement over where I was before. By the time I got to a new doctor, though, there I was stuck with the Seroquel. My new doctor didn't want to me to go off the Seroquel while I was getting stabilized on the new meds,and that stabilization process is still very much going on! So that's why I'm still stuck with Seroquel-- because it might make things even worse to go off it right now, I guess. :mad:

But everybody's different. Some people are very happy with Seroquel. My situation is a little different in that I have neurological damage AND psychiatric stuff going on, and that does change the effects of drugs that might work great for other people. When everything is going smoothly for me, S at least seems to not be causing problems. It just seems like when anything gets off balance, it DOES cause problems, so I guess I could see why abruptly going off of it really could cause even more problems. Still, that gives me the discouraging feeling that I'm always going to be stuck with it!!
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I think everybody should like everybody. -- Andy Warhol
If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#6 firewatcher

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Posted 15 January 2009 - 12:11 PM

Ah, thanks. Your situation actually seems similar to mine in that I have a comorbid medical condition as well, which makes it scary/difficult for me to get all my medical ducks in a row. A drug for my one condition (mental illness) affects my other (physical illness) and vice versa. My physical condition makes me very sensitive to any kind of medication, including crazy meds.

I like Seroquel because it helps me sleep; I've had a life-long problem with insomnia, and it's helped keep me stable before, though I don't know how well it's helping now. I'm going through a bad episode that seems like it's never going to end. I don't know if Seroquel is going to help with the depression.

I'm diagnosed BP or Borderline or Depressed/PTSD/OCD, depending on which psychiatrist or therapist you ask, but I guess I'll just call it Bad Off Crazy NOS.

Anyhoot, thanks for the answer.

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#7 phidippus

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Posted 15 January 2009 - 12:26 PM

YAY! Somebody else who gets depressed when they take Seroquel! Yes, yes and yes, every time I take a seroquel to quell my paranoid thoughts, I usually fall asleep and awake paranoia free but totally depressed.

There is a link between antipsychotics and an increase in the likelihood of suicidiality and OCD symptoms:

Low doses of the newer atypical antipsychotics olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone and risperidone (Risperdal) have also been found to be useful as adjuncts in the treatment of OCD. The use of antipsychotics in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their dopamine receptor antagonism), at high doses these same antipsychotics have proven to cause dramatic obsessive-compulsive symptoms even in those patients who do not normally have OCD. This is most likely due to the antagonism of 5-HT2A receptors becoming very prominent at these doses and outweighing the benefits of dopamine antagonism. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief enzyme that is responsible for metabolising antipsychotics—CYP2D6—so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results. - Wikipedia
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#8 Anise

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Posted 15 January 2009 - 05:25 PM

YAY! Somebody else who gets depressed when they take Seroquel! Yes, yes and yes, every time I take a seroquel to quell my paranoid thoughts, I usually fall asleep and awake paranoia free but totally depressed.

There is a link between antipsychotics and an increase in the likelihood of suicidiality and OCD symptoms:

Low doses of the newer atypical antipsychotics olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone and risperidone (Risperdal) have also been found to be useful as adjuncts in the treatment of OCD. The use of antipsychotics in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their dopamine receptor antagonism), at high doses these same antipsychotics have proven to cause dramatic obsessive-compulsive symptoms even in those patients who do not normally have OCD. This is most likely due to the antagonism of 5-HT2A receptors becoming very prominent at these doses and outweighing the benefits of dopamine antagonism. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief enzyme that is responsible for metabolising antipsychotics—CYP2D6—so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results. - Wikipedia



You know, I was thinking about that antagonism-of-5-HT2A-receptors issue. Now, I don't know if this idea represents medical fact or an interesting philosophical issue, so bear with me. :mad: But this is what was going through my mind. The 5-HT2A receptor is acted upon by psychedelic drugs such as mescaline and LSD-- they are serotonin agonists at this specific receptor. While these drugs are clearly not being recommended here, the point is that studies show the *same* receptors are also engaged by deep meditation. It seems pretty likely that they're engaged by anything we would subjectively call a mystical experience. I was thinking that OCD is absolutely the polar opposite of anything that anybody would ever call a mystical experience. It isn't just DIFFERENT-- it's the complete opposite of mystical in every imaginable way. And then Phidippus provides the info that 5-HT2A antagonism can rev up OCD symptoms!! What do y'all think??
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I think everybody should like everybody. -- Andy Warhol
If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#9 phidippus

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Posted 15 January 2009 - 06:47 PM

And then Phidippus provides the info that 5-HT2A antagonism can rev up OCD symptoms!! What do y'all think??


Well, there's a lot more going on then just 5-HT2A antagonism with OCD. Hypothesis implicate damaged seratonin receptor sites, genetic mutations including lack a gene called SAPAP3, disfunctions of the brain that govern the translation of complex intentions into fundamental actions failing to correctly communicate the chemical message that an action has been completed, but I like this one:

"The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in compulsive behaviors in an attempt to relieve this apprehension.[22] This overactivity of the OFC is shown to be attenuated in patients who have successfully responded to SSRI medication. The increased stimulation of the serotonin receptors 5-HT2A and 5-HT2C in the OFC is believed to cause this inhibition." http://neuro.psychiatryonline.org/cgi/content/full/14/1/88

OCD involves several different receptors, mostly H2, M4, NK1, NMDA, and non-NMDA glutamate receptors. The receptors 5-HT1D, 5-HT2C, and the μ opioid receptor exert a secondary effect. The H2, M4, NK1, and non-NMDA glutamate receptors are active in the striatum, whereas the NMDA receptors are active in the cingulate cortex.
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#10 Anise

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Posted 15 January 2009 - 09:13 PM

Oh, I love these kinds of discussions. :mad:

The thing about OCD, though, is that it doesn't seem to all be created equal. The types that are "treatment-resistant" (well, to SSRI's and dopamine antagonists, that is) do seem to respond to glutamatergic receptor antagonists much better. Here's a good article about a case study (Poyurovsky, M., Weizman., R., Weizman, A., & Koran, L. (2005). Memantine for treatment-resistant OCD. American Journal of Psychiatry, 162(11), 2191-2.) There has been some successful preliminary work with Topamax and certain types of OCD (oh, I can't resist putting in a good word for Topamax whenever possible). I can't help thinking, too, that dopamine *can't* be the entire story-- my OCD issues improved greatly after I started Focalin, which is definitely anything but a dopamine antagonist!

Of course, it really could be worse to just yank Seroquel out from under me at this point. The best thing seems to be to leave everything where it is as much as possible. It's just that if anything happens to effectively increase the dose of Seroquel, then ICK!!! I don't feel more sedated at all, I just feel DEPRESSED. :) Not fun. I probably just need to be as careful as I can and to work on getting everything as stable as possible so I can eventually ease out of Seroquel altogether.
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I think everybody should like everybody. -- Andy Warhol
If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#11 medi

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Posted 06 February 2009 - 02:40 PM

I have been feeling more depressed since I started on 25 mgs ONLY a night, of Seroquel. I have also been feeling more of that mixed state, where I am terrified/paralyzed with fear, yet feel like I could violently hit myself, bang my head or just beat up on the walls.
I don't see why my condition would have evolved into this when it had never (I'm 51) happened before, except at 150 mgs of Seroquel in a far more pronounced way. For a while now, nothing in my meds' regimen has changed. I do have a tremendous amount of stress, no job, and about to lose my home.
Could those 25 mgs of Seroquel be causing more depression and mixed episodes? Do I stand to lose anything by testing my hypothesis and dropping them?
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<p>Dx Axis 1: BD II. Had been diagnosed with MDD. Am sometimes also diagnosed with PTSD.Has undergone ECT in 2008.Current Meds: Lithium 600 mg, Synthroid 75 mcg, Inderal 40 mgs, Ativan 2 mg or more, as needed, Zolpidem.Have had experience with: Tricyclics (useless back then), Paxil, Celexa & Lexapro ( the three caused jitteriness&/or mixed states), Wellbutrin (also jitteriness, more severe), MAOI-B (Emsam patch)(hypomania, fun, but no way I could sit at my desk and think), Neurontin (innocuous), Depakote (too much weight gain, hair loss, sleepiness, lack of energy, and no noticeable benefit), Topamax (I'll only cite the suicidality obsession as of 75 mgs....), Lamictal (no benefit), Zyprexa (heart palpitations and shortness of breath at only 2.5 mgs), Abilify 2 mgs (serious GI pain), Calcium Channel Blockers (weak --- verrrry).

#12 Anise

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Posted 06 February 2009 - 06:24 PM

Well, my advice would be to talk to your doctor before you do anything. From what my pdoc says, just dropping Seroquel can get you in a WORLD of trouble. That being said, I just saw him yesterday, and he confirmed that yes, Seroquel CAN indeed tend to make some people depressed. He has many many years of clinical experience and he's a full professor at Vanderbilt, so he truly knows his stuff. But it all depends on the person. There's no way to really say anything based on so little information.


I've got to say, though, that I do not think that Seroquel has mixed well with my PTSD. :) Topamax, OTOH, has opened up the doors and has made it possible for me to do EMDR work. And you know all those coping skills, cognitive-behavioral skills, positive attitude skills, correcting-the-negative-automatic-thinking skills, all those other skills that sound so good when you're not being overwhelmed by flashbacks and nightmares and numbing and hyperarousal and dissociation... something CROSSED OVER in my brain in the past few weeks, and for the first time in my entire life-- EVER-- I have had the power to start using them. If it was a placebo effect, then it certainly seems like I would have already had it from the other 8,000 meds and therapies and techniques I tried, so I'm betting that it's the Topamax. I think T is the greatest thing the world has ever known-- no hyperbole of course.... :mad: But anyway. If I were you, I would talk to your doctor before doing anything.
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I think everybody should like everybody. -- Andy Warhol
If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#13 In_Remission_tigger32446

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Posted 06 February 2009 - 07:00 PM

wow. This has been an awesome discussion and I have learned a lot!

I'm concerned about the food interactions you mentioned early on. I knew about the grapefruit but not pomegranate or grape. Where can I find a list of foods I should be avoiding while taking Seroquel? (sorry if that is already here some where. I'm still new to the site)

I just started seroquel and prozac 1 week ago. The first time I took the S I was totally hung over the next day, but every day is getting better. I'm still feel a bit sedated and foggy by day. How much is due to S and how much to Prozac? I'm thinking of switching the taking the prozac before bed instead of in the morning.

#14 Anise

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Posted 08 February 2009 - 12:08 PM

I put together a list based on my research; don't worry, it all came from either double blind studies or reputable sources like pharmacology textbooks. :mad:

Here are the CYP3A4 inhibitors that will affect most people; they will basically raise the amount of Seroquel in your body (they have the same effect on a lot of other drugs, Tegretol being the worst offender as far as the ones people around here are likely to take):

Grapefruit juice
Seville oranges (very rarely found fresh, but you might find them in jam, so check the label)
Pomegranates
Starfruit

However, people who are very sensitive to drug interactions and side effects may also want to watch out for these:
Sassafras
Licorice (the herb, not the candy)
Anything with resveratrol:
Red wine, red wine grapes: Vitis vinifera, labrusca, and muscadine grapes, mulberries, peanuts, cranberries

Weak Inhibitors: Probably don’t need to avoid, but maybe don’t eat massive amounts every single day:

Anthocyanins:
blueberries have a little bit but not much (cooking destroys it)
white grapes have a little but not nearly as much as red
Other Berries
Eggplant
Avocado
rhubarb

Very high protein, low carbohydrate diets tend to act like inducers and to do the opposite of what grapefruit juice et al would do.There have been some case studies that show this, so I would not go on that extreme Atkins diet-- or the ketogenic diet, either. If that diet would work for BP folks who are not on meds, I don't know, but I sure wouldn't recommend going off meds to find out!!!


Hope this helps. :)
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I think everybody should like everybody. -- Andy Warhol
If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#15 In_Remission_tigger32446

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Posted 08 February 2009 - 01:49 PM

thanks for the info.

This may explain why I feel more dopey and hung over on some days and less and others. I guess I'll give up my pomegranate and grape juice. Or make sure I drink the same amount every day. ;-)

#16 Darknessiss

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Posted 20 March 2009 - 06:32 AM

The point of all this is that whenever this happens for me-- basically the same thing as suddenly going up on my Seroquel dosage by almost half-- the biggest thing I notice is immediate depression. I have never had pure endogenous depression as such. I'd had a few isolated episodes of it that were caused by drug reactions to other drugs, and that immediately disappeared when the drugs were withdrawn. So it seems VERY clear to me that when it happens these days, immediately after the Seroquel incidents, that it's because of the Seroquel.


So, if I drink grapefruit juice I will double my Seroquil level in effect? Awesome! I have to try that, I read on the bottle and PI sheet to avoid grapefruit juice but it wasn't specific as to what would happen if I did drink Gjuice. I guessed that it would react in me getting me nauseous or so.


Does this make any sense? Has anyone else ever had sudden depression happen with a sudden or rapid increase in Seroquel?

I feel awesome on Seroquel but I do notice that I start to slur my speach and start speaking in circles repeating myself repeating myself (joke) but really I do forget where I was going with whatever I'm talking about and that causes a little bit of anxiety


peace!

-Dark :mad:
  • 0
Prescribed Meds: Vyvanse (lisdexamfetamine dimesylate) 70mg, Seroquel (quetiapine fumarate) 600mg, Effexor XR (venlafaxine Hcl) 300mg, Coumadin (warfarin) 5mg

Supplements: 1000mg Omega-3 (fish oil gels), Mega Men's Supplement (for libido)


DEATH be not proud, though some have called thee
Mighty and dreadfull, for, thou art not so,
For, those, whom thou think'st, thou dost overthrow,
Die not, poore death, nor yet canst thou kill me.

John Donne 1572 ? 31 March 1631

#17 In_Remission_Burright

In_Remission_Burright
  • Guests

Posted 12 November 2010 - 02:57 AM

A person with age-related dementia shouldn't take Seroquel as it increases the risk of sudden death specially for a patient with heart problems.


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