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What Causes Difficulty In Waking Up In The Morning While Being On Seroquel?

Posted on Fri, 13 Mar 2015

Question: I was manic for about a month. We got rid of the trazodone that I had been on for 7 years and used ambien to help me sleep. It wasn't working that well, because as you know when your in mania it's hard to get you to sleep. So we increased my seroquel xr from 300mg, all the up to 500mg now. But my mania has passed, and I am having a problem wking up in the morning, and staying awake, and and feel kinda numb, and fatigued. I have only been on 500mg of seroquel xr for 3 days, but I was already starting to come out of mania. But doctor wanted to be sure. I just saw her.Now in the past, when I was on Trazodone, and 600mg of trileptal too, 400mg of Seroquel xr I got really sick. That was my with my old doctor. We couldn't go over 300mg. I am getting some of the same symptoms as then. I have had some doctors say they disliked seroquelxr and others say they liked it. Some said it was well tolerated and others said it wasn't. I am bipolar with anxiety disorder. Was diagnosed 16 years ago. I have been on a ton of different meds, and done good for awhile then bad again. but the seroquel xr at 300mg has kept me stable and leveled the longest for 2 and a half years, until recently. I also take 150 of the trileptal, but i am being weaned off it, my doctor doesn't like it. And 20mg of prozac, 4 mg of klonopin, 10 mg of ambien. I was just wondering if I should discuss dropping my seroquel again. And if I should be worried about it, and how I feel. And if it's a normal dose. And your thoughts on the drug for bipolar.

Answered by Dr. Shubham Mehta (52 minutes later)

Brief Answer:
consider dropping to 400mg.

Detailed Answer:
Hello
Welcome to HCM.
I have read your details. You are currently taking 500mg of seroquel xr. Your mania has passed and now have difficulty in waking in morning and feel numb and fatigued.

May I please tell you some facts and recommendation about seroquel:
1. It is approved as monotherapy for bipolar depression and acute mania in bipolar disorder.
2. However, for maintenance bipolar disorder, it is only approved as an adjunct to anothe mood stabiliser like valproate or lithium.
3. The maximum doses for acute mania are upto 800mg.
4. The drug has tolerability issues for many people. Its sedation is dose independent and people can feel heavy sedation even at low doses. The other problematic side effects are weight gain and orthostatic hypotension.

I think your symptoms of difficulty in waking up and fatigue are most probably due to high dose of quetiapine.

The thumb rule for doses of maintenance is that,'give the same dose in maintenance phase on which the person is settled in acute phase'.

For your case, i would suggest you to consider dropping it to 400mg (under doctor's supervision). This dose would be best suitable for you and effects like fatigue and difficulty to stay awake should go away.

The has excellent efficacy in bipolar depression and acute mania.

Hope this helps.
Feel free to ask futher.
Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shubham Mehta (12 hours later)

I tried 400mg of seroquel xr last night, with 10 mg of ambien, and slept about 7 hours, but woke up anxious. I Was wondering if I should give the 500mg more time, to adjust on it then 3 days. It did keep me calm, and less anxious. And I didn't know if maybe I would get used to the longer I was on it. Anoter doctor I spoke with said 5oomg, was well within a normal range of a dosage of seroquel, with people using it as a maintenance drug. I really didn't give it much time before I thought it wasd to much. I only had the sleepiness and fatigue for 2 days, out of the 3 I was on it. What are your thoughts ? I go back to my doctor on Monday. Should I try to stay on the 5000mg, till i see my doctor on Monday and talk to her ?

Answered by Dr. Shubham Mehta (40 minutes later)

Brief Answer:
continue with 500mg seroquel.

Detailed Answer:
Welcome again.

I can understand your concerns.

You tired 400mg of seroquel and were more anxious.

As I told you earlier, the maximum dose of seroquel in bipolar disorder is upto 800mg. There is always some inter-individual variation in drug tolerability.

We usually go more by client's response to drug, then by what literature suggests.
You had better response with 500mg seroquel as compared to 400mg.
So, I would suggest you to then continue with 500mg. Any dose change may cause discomfort for initial 4-5 days. But once you get used to a particular dose, you will start feeling better.

In short, continue with the 500mg of seroquel till you see your doctor.

Hope this helps.

Feel free to ask further.

Kindly close the discussion if you are satisfied with the responses and give your valuable feedback.

I wish you goo health.

Thanks.
Dr. Shubham Mehta, MD(Psychiatry)

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj