My b/f has decided to stop taking Seroquel

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fear_of_dreaming
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Date Joined Jun 2005
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   Posted 7/22/2005 7:00 PM (GMT -7)   
I just wondered what the effects of this may be...my BP b/f has been taking Lithium and Seroquel for about two years now. Basically, he hasnt had any more psychotic episodes since the last one two years ago, he sleeps regularly etc...He just told me today that for the last two weeks, he has stopped taking his Seroquel and doesn't want to take it anymore because he feels better without it. Any thoughts on what may happen?...I'm worried.

psychnurse
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   Posted 7/23/2005 5:30 AM (GMT -7)   

When did he stop?  What does he mean by feeling "better"?  If he was manic WITH psychosis, he shouldn't just decide to stop it. Do you know how many mg he was taking?  Is his lithium level therapeutic?  What was he like just before he stopped it?   Was he sleepy all the time, drugged?  Or was he doing well (according to you).

It's not a good sign when a BP just decides to up and quit a medication.  Mania with psychotic features does require both a stabilizer and an antipsychotic.  He could certainly talk to the doc about lowering the mgs - Seroquel is one of the most flexible of all of them.  Some BPs can take 400 mg, while others can do well on 25-50 mg.  I would suggest he talk to his doc about lowering the dose, but stopping?  Not a good idea.

Are you sensitive enough to his moods, and symptoms of psychosis (rambling on not making sense to you, delusions that he is somehow "special" and has certain abilities no one else has, halluciations (he probably wouldn't tell you about those, tho.  Is he extremely religious?

 


psychnurse
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   Posted 7/23/2005 6:40 AM (GMT -7)   
 
 
Seroquel, or any antipsychotic is basically a requirement for Bipolar I (mania with psychotic features).  It is also for sleep.  Lithium may improve sleep in bipolar II, but it is not usually effective for type I, especially if he's on an antidepressant.
 
Of course he didn't have any psychosis for the last two years, he was taking it.  This is what BPs do, they self medicate and decide what they will and won't take.  His Seroquel is mandatory because of his history.  It is also very flexible, BPs can take as little as 25 mg in some cases or 400 mg, sometimes more. It depends on the person. I take 100 mg and do fine, no grogginess at all, well, a little foggy in the morning, but by noon, just fine.  It is essential for sleep as well.  It's not a good sign when a BP just up and decides to stop any meds; he may decide to stop all of them.  You say he feels better.  In what way?  Has he gotten more hyper than normal?  better mood?  More talkative?  Please explain.
 
It is possible to bring on a mania, probably much less severe if he stays on his lithium, because he may not sleep enough, and that can be possible trigger for either mania or depression.
 
It's important to tell me what "feeling better" for him is like, from your point of view and his if he has said anything besides "better".
 
 

fear_of_dreaming
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Date Joined Jun 2005
Total Posts : 35
   Posted 7/23/2005 6:22 PM (GMT -7)   
Hi Shannon, thanks for responding...

By better I think he means that he feels more alert, and not as dragged out and sleepy. He is definitely more talkative and says feels like doing things instead of sleeping. Not sure of what the amount of his dose is, but the Seroquel is quite low I think. I spoke to him today, and he says he has an appointment with his psychiatrist in a couple of weeks, so I am encouraging him to talk to her about this situation. I have to say that he says I'm overreacting and acting like his "mother" as he puts it, but my concerns are legitimate.

I've noticed that he is more alert at the present time, not sleeping as much in the last two weeks (in the past I have called him at noon, and he is still sleeping, this is a daily occurrence). He has put on weight since he started the Seroquel, and I know that he wants to lose it, he's just having a really hard time doing that.

During his psychosis two years ago, I noticed that he did talk about himself as being special and being "the king" as he put it...he had auditory hallucinations and yes the religious thing was something that came about with a vengeance. So far none of that is happening at the present time.

psychnurse
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   Posted 7/24/2005 5:50 AM (GMT -7)   

Sleeping till noon?  What time does he go to bed, do you know?  If he goes to bed really late, like maybe 2 or 3 oclock, sure, but if he's going at a reasonable hour, yes, that's way too much.  He could cut back to 50 or so.   I can about guarantee he is on a larger dose, some pdocs get a little "generous" with the mgs, haha, like 200 or so.  I started on that dose and it did the same to me.  I usually take 100 mg now with Trileptal, but still have had trouble sleeping the past week or so.

He NEEDS to stay on at least a lower dose!  It is used in combination with mood stabilizers to help prevent a relapse into mania, and if he's on an antidepressant, lookout.  He has type I and it's very stubborn to treat.  Please have him discuss this with his doctor.  Just because he didn't relapse right away doesn't matter at all.

That's typical bipolar patient stuff.   Always picking and choosing which meds to take/discard. 

Just keep a very  watchful eye on his behaviour, for talkativeness, rapid speech, not being able to follow him or what he means when he talks.


fear_of_dreaming
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Date Joined Jun 2005
Total Posts : 35
   Posted 7/25/2005 1:19 PM (GMT -7)   
hi...not sure of when he goes to bed Shannon...I think that varies. But I know that despite that, he falls asleep during the day for hours, sleeps late, it always varies. When I mention to him that it would probably help him to have a schedule, he gets defensive.

He did go to see his psychiatrist this morning and got another prescription for Seroquel (Im glad about that), but for some reason, didn't ask her about all the sleeping and how that could be alleviated. I did remind him of this before he went to his appointment, which he also got defensive about. So I don't know what to say. It is his body and life and I don't want to interfere...but these things would definitely have an impact on our lives if we ended up living together. And I'd like to be able to voice my concerns, although it seems like he doesn't want to hear about them. He says I don't understand, I really do try to...but I probably don't.

Post Edited (fear_of_dreaming) : 7/25/2005 2:22:28 PM (GMT-6)


psychnurse
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   Posted 7/25/2005 2:15 PM (GMT -7)   

It's not just his life, like you said it's yours too, because everything he does impacts you tremendously, sometimes family members suffer as much or more than we do during mania.

His sleep habits are atrocious, and that will guarantee him instability.  BPs need a very regular daily routine and sleep schedule.  Varying from that can cause lots of trouble with mood swings (mostly causing mania) and of course, more insomnia.

I am glad he's going to continue the Seroquel.

Maybe he should be changed to another mood stabilizer - lithium is a hard pill to swallow (not literally!) for many BPs.  It's the least tolerated of all of them, but it does a good job if it's at the right dose.  Mainly, the fatigue and muscle weakness are what cause BPs to stop it. 

If that's a problem for him, he should also talk to his pdoc about trying something else, perhaps Depakote?  Other than weight gain, it is very well tolerated.  Of course there are the other epilepsy meds that are used, they may or may not work as well, but if it improves his quality of life and does work, it's worth a try.

You are going to HAVE to have a relationship of trust.  You have to be able to talk, otherwise, you have no say in his behaviour.  You will be the one to notice the signs and symptoms, often we don't.   Or we just defend it.  Have a serious talk about it, and if this is the way it's going to be, tell him you can't continue.  He's sick, but also is responsible for his recovery, and if he isn't willing to work with you and his doc for EVERYTHING, not just what he picks and chooses to mention, your relationship is not going to work.  Family members (especially spouses or SOs) have to be firm with us and not let us walk all over them, because we will, we know how to.   He's a grown man; he doesn't need to be babied.   He needs support, yes, but support is when he's trying hard, not when he is being defensive of bad behaviour and refusing to listen to YOUR feelings.  You are half of this.

I was just like him the whole 10 years of our marriage, defensive, unwilling to get treated, yada yada yada, until he finally gave me an ultimatum.  I guess that's the real test.  It worked for me and I'm forever grateful to my hubby for putting up with me for so long, believing in me and finally demanding I get a grip.  I've never been happier.

If he tries to call your bluff (very likely), stick to your guns.  If you don't, it's an empty threat, and from then on he will know you don't mean it, and that you will still be there to take whatever.  That is very important.

Sounds like he is making a small attempt, so there is hope!  

Shannon


fear_of_dreaming
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Date Joined Jun 2005
Total Posts : 35
   Posted 7/25/2005 6:33 PM (GMT -7)   
Yes, he is trying...and I do believe there is hope. Thank you for the suggestions. One thing though, he has already gained so much weight from the meds he is on, and you mentioned that Depakote causes weight gain...I don't know if that would work for him unfortunately. I will have to talk to him about things. I hate to give ultimatums, but youre right. If we cannot communicate about EVERYTHING honestly, then it will be a very tough road ahead. I have already been in another relationship previous to this one where communication was nonexistent, and I don't think I could deal with it again. Every relationship has its challenges and tough times, BP or not. But in order to have a relationship grow and continue, there also have to be good times. And good communication ensures that.

Thanks again!

psychnurse
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Date Joined Mar 2005
Total Posts : 807
   Posted 7/25/2005 7:53 PM (GMT -7)   
I do hope you two can find some way to communicate, you have found out that without it, there is really no point.  I found that, too. :-)
 
Lithium and depakote both cause weight gain, but other anticonvulsants may not.  Trileptal has been used successfully, it's fairly new and really has no side effects other than dizziness at first.  No weight gain.  Topamax is being used more, but the mind slowing is a problem for many.  Lamictal is also a good mood stabilizer, better for keeping depression at bay, should be used with another stabilizer.
 
Weight gain can cause a whole new set of problems, depression over body image and health problems as well.
 
I hope he can find something that works, and doesn't cause the other problems, it's just a matter of trying different things.

fear_of_dreaming
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Date Joined Jun 2005
Total Posts : 35
   Posted 7/26/2005 1:07 PM (GMT -7)   
yes the weight gain has been significant so far...seems to be a vicious circle where he feels tired from the meds, wants to sleep alot, and finds it hard to get into exercising regularly. I know, it's very hard when you just dont have the energy to do it. I dont love him any less, he is still yummy to me no matter what, lol. But it's not good health wise, as his blood pressure has gone up as well, and the doctor is concerned about that too. I spoke to him today, and he seems open to trying different things. And I think that's great.

psychnurse
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Date Joined Mar 2005
Total Posts : 807
   Posted 7/26/2005 3:25 PM (GMT -7)   
I am glad you two are being able to talk, that's great!
 
It's really hard when BPs are depressed, because even most doctors are not aware that the difference between bipolar depression and regular (clinical) depression is that BP depression causes psychomotor, meaning mind and body, slowing.  We cannot think well, are slower and the body is slowed way down as well.  It's not just the regular fatigue of depression, it's an inability to do what you need to do, of course to varying degrees.  If he is having any depression with or without mania, it will be almost impossible for him to exercise, it's not just a matter of "not feeling like it".
 
Maybe since he is backing down his dose of Seroquel, the energy level will come back a little more.  It can take time.  Meanwhile, he's feeling guilty about not exercising, and its a vicious cycle.  I have been there, adn it's miserable.
 
I hope he can find a better mix of meds so he can feel better in mind and body - both are crucial.

fear_of_dreaming
Regular Member


Date Joined Jun 2005
Total Posts : 35
   Posted 7/26/2005 10:31 PM (GMT -7)   
you do exercise though regularly, right Shannon? Im hoping that once he get his meds sorted out with his doc, it will help him alot. Im pretty active myself, swimming, hiking, city walking, I like going to the gym...Im hoping that eventually we can enjoy doing these things together.

psychnurse
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Date Joined Mar 2005
Total Posts : 807
   Posted 7/27/2005 6:44 AM (GMT -7)   

Yes, I do now.  When I took Depakote I gained 15 pounds in 2 months.  I just couldn't deal with that, not to mention I was in a bad depression, so weak I couldn't even take a walk.  I stopped it and my pdoc put me on Trileptal - it's great, and slowly I was able to do some exercise.  Now I do 40 min of aerobics every other day (DVD at home, no gym!) with 100 ab crunches and a 20 min power walk (with my doggies) most every morning.  I lost 35 pounds, now I weigh 132 at 5'9".   Back to normal!  It just makes me feel so good, I can't imagine not doing it.  Of course, I DON'T look forward to it, the best part is when it's DONE!!!!!

I am not bragging, I am just saying if you gain weight on those meds, try something that doesn't have that side effect, and if you exercise (and watch what you eat) you can lose all of it, and also you will feel tons better energy wise and mood wise.  Of course, you already know that, (wow, I bet you look great!)  but lots of BPs overlook that.


fear_of_dreaming
Regular Member


Date Joined Jun 2005
Total Posts : 35
   Posted 7/28/2005 8:26 AM (GMT -7)   
yeah, Im a firm believer in finding ways to keep healthy....I have a thyroid imbalance, and my weight was way out of control at one point in my life, until I decided to take control. I think no matter what a person's situation, exercise, eating fresh foods (vegetables, fruits, lean meats) and drinking 8 glasses of water a day really helps to alleviate the symptoms of a chronic condition. At least it works for me! And Im glad it has worked for you!!! Im really hoping that my honey can do it too. Im going to try to help him out with that...
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