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What is Seroquel?
When mental health illness results in severe symptoms, treatment may require potent medications to restore healthy brain function. Seroquel, the brand name of the generic drug quetiapine, is an example of such a drug. The FDA-approved antipsychotic is used to treat symptoms of schizophrenia and bipolar disorder. However, the drug’s intensity can lead to severe side effects and has the potential for abuse and dependence. In fact, studies have found it to be the most often abused atypical antipsychotic medication.
What Is Seroquel Used For?
Seroquel is approved by the FDA to treat several mental disorders such as schizophrenia, bipolar disorders, and major depressive disorder when combined with antidepressants. However, clinicians sometimes prescribe Seroquel for non-approved disorders including Generalized Anxiety Disorder, Post-Traumatic Stress Disorder, Obsessive-Compulsive Disorder and several personality disorders. This is called “off label” use, which has made it an increasingly popular treatment.
The drug acts by restoring natural dopamine and serotonin levels in the brain, which reduces severe mental health symptoms such as hallucinations and delusions. As a function of its effect on the brain’s chemistry, it also helps stabilize mood and reduce anxiety.
Is Seroquel Addictive?
Data from the American Association of Poison Control Centers has shown an upward trend in the intentional use of atypical antipsychotics between 2012 and 20181. Of all atypical antipsychotics, Seroquel is abused most often. Quetiapine has also gained popularity as a street drug, where it is known by names such as Susie-Q, Baby Heroin or Squirrel and is administered by inhaling or injecting.
Despite its high potential for abuse, it has not been linked scientifically to addiction. In other words, those who abuse the drug without the recommendation of a doctor may not necessarily develop a chemical dependence on it, the required threshold to be considered addiction. As a result, the drug is not classified as highly addictive by the US Drug Enforcement Agency (DEA). Nonetheless, animal studies2 as well as independent case studies3 have shown that dependence and subsequent withdrawal symptoms are possible.
Seroquel’s Drug Class and Schedule
Seroquel is classified as an atypical antipsychotic, sometimes known as second-generation antipsychotics. These drugs were designed to reduce the severe side effects of traditional antipsychotic drugs such as tremors and facial twitches. They work by blocking chemical receptors in the brain, such as that of serotonin and dopamine, to restore neurochemical balance.
Since Seroquel is not considered to be addictive by the DEA, it is not included in the agency’s schedules of controlled substances as part of the Controlled Substances Act.
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Is Seroquel A Controlled Substance?
Controlled substances are those whose manufacture, possession, and use are regulated by the government under the Controlled Substances Act of 1970. Substances are continuously added and removed from the schedule as well as moved from one schedule to another. Generally, these are drugs that have a detrimental effect on the user and are considered illegal to use without an indicated medical purpose. Since Seroquel has an accepted medical use and is not considered physically addictive, it is not currently classed as a controlled substance.Is Seroquel Safe?
Seroquel is considered safe when used as recommended by the FDA. This means that when used to treat psychotic symptoms of schizophrenia and bipolar disorder, the benefits generally outweigh the risks. Nonetheless, even a drug that is safe to use can lead to abuse, overdose, or have potentially harmful side effects. In addition, Seroquel is not recommended for use during pregnancy as it can harm the fetus.Potential Seroquel Side Effects
Depending on the length of time used, Seroquel can have varying detrimental side effects. It is important to weigh the effect of these side effects against the potential improvement in mental health when consulting with a doctor.
Short-term side effects after administration can include:
- Dry mouth
- Constipation
- Upset stomach and indigestion
- Drowsiness and fatigue
- Dizziness
- Irritability
- Nausea
- Headache
- Increased appetite
Long-term use of Seroquel can lead to more severe and lasting symptoms including:
- Extrapyramidal Symptoms (EPS)
These Parkinson’s-like symptoms can include uncontrollable muscle contractions, bodily tremors, stiffness, and a mask-like facial appearance. After long-term Seroquel use, these symptoms may become permanent.
- Cataracts
Cataracts lead to cloudiness in the lens of the eye which can impair vision.
- Tardive Dyskinesia
This neurological condition causes involuntary repetitive movements including jerking and facial twitching.
- Metabolic Syndrome
Long-term use can lead to elevated cholesterol, blood glucose level, and hemoglobin, which can eventually cause diabetes if not monitored.
Seroquel Withdrawal
To avoid risk and withdrawal symptoms, patients should discuss how to safely stop taking the drug before attempting to stop abruptly on their own. A sudden stop in the use of Seroquel can worsen psychological symptoms. Withdrawal symptoms typically appear about a day after the last dose, and may include:
- Nausea and vomiting
- Diarrhea
- Irritability
- Dizziness
- Headache
- Anxiety
Signs of Seroquel Abuse
Medical professionals and loved ones should be aware of behaviors that can be indicative of Seroquel abuse. These include:
- Exaggerating symptoms to get a prescription
- Going to multiple doctors for prescriptions
- Altering the drug before administration, like crushing it for injection or snorting
- Having prescriptions in other peoples’ names
- Isolation and withdrawal from social life
- Mood swings or changing personality
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Can You Overdose On Seroquel?
Overdose on Seroquel is possible, particularly with people using multiple drugs or those with heart disease. It’s rare for Seroquel alone to lead to death or coma, though it can occur. Visits to the emergency room involving the use of Seroquel increased by 67% from 2005 to 20114. Other serious side effects of Seroquel overdose include drowsiness, loss of consciousness, racing heart rate, and low blood pressure and heart rate.How To Stop Using Seroquel
Discontinuation should be supervised by a medical professional to reduce the risk of side effects and withdrawal symptoms. Seroquel should not be discontinued abruptly as doing so can worsen symptoms of depression and anxiety, leading to higher risk of suicide. In order to prevent withdrawal, a doctor can recommend a gradual reduction in dose over time and monitor discontinuation for the presence of dangerous side effects.Treatment for Seroquel Abuse
Intensive treatment may be necessary to treat Seroquel abuse, especially since abuse is most common among those who were prescribed the drug to treat mental disorders. Thus, treatment should focus on managing the mental health disorder the drug had originally been prescribed to treat. Doctors may recommend safer medical alternatives while the patient detoxes.
Talk therapy or counseling is often recommended while the patient eliminates Seroquel from their system. This can help with the development of stress management skills, life skills, and relaxation techniques. Behavioral therapies can be useful to uncover potential stressors and triggers for Seroquel abuse. In severe cases, inpatient or residential treatment may be preferred in order to have access to round-the-clock monitoring and support.
References:
- https://www.aapcc.org/annual-reports
- Cha H., Lee, H., Ahn, J., Jeon S., Kim E., and Jeong H., (2013). Dependence Potential of Quetiapine: Behavioral Pharmacology in Rodents. Biomolecules & Therapeutics, 21(4): 307–312.
- Yargic, I., Caferov, C. (2011). Quetiapine dependence and withdrawal: a case report. Substance Abuse, 32(3):168-9.
- Mattson, M., Albright, V., Yoon, J., Council, C. (2015). Emergency Department Visits Involving Misuse and Abuse of the Antipsychotic Quetiapine: Results from the Drug Abuse Warning Network (DAWN). Substance Abuse, 9:39-46.