View Full Version : To tell my Pdoc I reduced my Seroquel or not?

01-24-08, 04:23 PM
I've had only 1 manic episode a few years ago but always feel atleast mildy to moderatly depressed. I take 25 seroquel, 900 Lithium and 200 Latimcal. The latter 2 are fine without severe side effects but I've always known that Seroquel knocks me out a bit even at that level, causing lathargia, worse focus/concentration.

So last month my Pdoc prescriped me Dexedrine to help with energy, I tried it, hated it and stopped after a couple days. Than I decided on my own to try breaking my Seroquel 25mg in half. Just pour some water on it and it cuts easy. After doing that my mood/energy has significantly improved and thinking is alot more clearer. (its nothing remotly hypomanic)

Now I want to tell my Pdoc about the change I've made, but I worry that he might hate it and tell my to go back up. He might intrepret my improved mood/energy/focus to be some sort of hypomanic making me think I don't need the medication. I wouldn't go back if he told me too, my thinking/energy is alot better and I'd hate to give that up for no real reason. It might slightly reduce my chances of mood elevating too high, but its not worth the reduction in quality of life. Taking 500mg would cause me to sleep all day and be in a zombie state when awake. It would practically eliminate any chances of become Manic but obviously its not a good idea.

That option is definitly out. The better one is to pretend to have the same lack of energy/focus that I had at the last appointment and suggest that I reduce the Seroqeul instead of adding Dexedrine. The problem is still what if he says its a bad idea, I don't want to have to lie to him about. Or he might notice my improved mood and think thats causing me to want to reduce meds which is far worse.

I could simply decide to not tell him. That way he won't tell me to do something I won't do and I don't have to lie to him. He also won't worry about hypomanic causing me to not want to take all of the meds.

01-24-08, 05:41 PM
I could simply decide to not tell him. That way he won't tell me to do something I won't do and I don't have to lie to him. He also won't worry about hypomanic causing me to not want to take all of the meds.

Now I don't want to promote being dishonest with one's doctor; however, after reading about your situation I agree that simply NOT SHARING your decrease in Seraquel with your doctor seems best. Please know that I have NOT experienced bipolar illness myself (that I'm aware of anyway) - so what I think may not matter that much. (I'm sure more members of "the cycling team" will reply soon.) Still - not SHARING with him at this point in time makes TOTAL SENSE to me.


01-24-08, 06:28 PM
Hey, you're back, Colossus :) It's been a while since I've seen you.

Med issues...grrrrrrr. :mad: It's so upsetting isn't it? Here's what jumped out at me while reading your post....I don't feel you should have to lie to this doc for the simple fact that it's your treatment. You pay him, it's his job to work WITH you to find what works FOR you.

I think you ought to be able to just tell this guy that you tried the Dex for few days, hated it and therefore don't want it any longer. I also think it should be fine to tell him that you aren't happy with the current dose of Seroquel and think it's time to adjust that. :rolleyes:

I also think that in the real world, this isn't always possible with some of these blasted doctors, and that it sucks. I hate to advise you to lie but I also think you make sense and shouldn't have to stress a simple med tweak :( Isn't having bipolar hard enough?

I think you're grown ;) make good choices and please keep us posted?

Matt S.
01-24-08, 10:19 PM
Collosus, some people are sensitive to medications and when I used to take Seroquel, it had the same effect on me. I don't know about your doctor but a good portion of them agree that it makes no sense to add another medicine if the problem can be solved by decreasing one a little, at least that's been my personal experience. Good to see you are back around.

Crazy~Feet it is good to see that you are back too, the Cycling Team isn't the same without you. You really hold this section together and have a heart of gold. :)

01-25-08, 12:05 AM
I would tell your Pdoc that you reduced the Seroquel. Are you sure that your dr. would think that you're getting hypomanic because of this? Why don't you think he/she would believe you when you explain how you feel. I'm of the opinion that it's always best to take the least amount of medication possible and if you feel better on less Seroquel and your mood is still stable, then you should take less (I take 200 mg. Seroquel and it doesn't stabilize my mood-- I love it though, keeps me calm, helps me think, & gets rid of my headaches. It does give me the brain fog. though. when I increase the dose but it only lasts a day or two and then goes away)

01-25-08, 03:10 PM
I would the let the doc know that you reduced your seroquel, why you chose to do it, and how you felt before and how you feel after the decrease.

I had to do this with zoloft at one time because I couldn't at one time take the full 100mg (had to split them in half for a while because of mania).

02-15-08, 08:59 PM
So I ended up not telling him. About reducing the Seroquel that is, I told him that Dexedrine doesn't work and he didn't mind.

I geuss the true test of whether reduced Seroquel is a problem is in the spring, when Mania Season begins.

02-17-08, 07:05 PM
Hi Collusus,

I have to agree with what you don't want to hear, but ya asked.

You need to be honest. If you have come out of the mania, and are still feeling the same about the Seroquel, and have been honest with the doctor up until this point about your cycles. Then he should understand that you are not having a typical non med compliant moment. If he is familiar with the disease and you, then he will know, like you are finding that it takes awhile to find not only the right med combo, but the right dosage.

My son was on Risperal for mania, and not sleeping. He could override it, and it caused him to be too lethargic to take during the day. Did the same thing with me. They switched him to Seroquel. He overrode small doses, and the larger one's knocked him flat. We found a happy medium and left him at 50mg as apart of the normal daily dosage, knowing we could increase it up to 200mg if we needed to, during a manic time.

They did the same thing with me, but put me on Neurontin. I only take 100mg as a normal dose, and can go up to 300mg if needed.

Either he can let you try the different doses to see what works for you. Or he can try another med. That sadly is part of the journey we face. A good doctor knows this.

As far as the stimulants, if you are stable with the mood stablizers, you should be able to tweak the stimulants as well. I found what I needed at one time to work for my ADD, which was 40mg of Adderall, had to be reduced in half unitl I was completely leveled out on Lamictal and Neurontin combo. So my moods and sleep were as level as we believe they ever will be. Now I can take the 40mg if needed. But often only need the 20mg. He lets me decide as far as that is concerned because he knows the disease, knows me, and I have always been very honest with him. If you are being honest, are educated, and he continues to keep you on a medication that is not working once you have been on it long enough to build a level, then you might want to seek another doctor.

You can also try another stimulant. I have been on all of them except Dexadrine and Strattera. I can't take the Concerta at all, severe aggitation and tardive dyskensia, Focalin doesn't work at all, Ritalin same as Concerta, but the Adderall XR is what works best for me. My son had the same issues with the same drugs as me, except he takes the Serouquel and I don't. Of course genetics have a lot to do with that. But bascially what I am saying is , you have to work at it to find the right combo, be honest with yourself to make sure your motives are really for the betterment of your disease and not because you are being stubborn, and be willing to stand up to your doctor based on your own education about your disease, and because you are completly honest. You do yourself a huge injustice and miss opportunities for the best treatment by not being honest. IMHO.


02-17-08, 08:49 PM
Ummmm, I have a problem with wanting to tell half-truths to my pdoc. I just have this underlying prejudice that I know better or something, because I know just enough about mental illness (have worked in the field) to be dangerous. Unfortunately, this illness makes your mind tricky. When you're hypomanic -- do you really believe you are? Or do you need the input of those around you?

I have been painfully honest with my pdoc this time around, and I will continue to be, even if I don't necessarily like the result. After all, they are supposed to be the expert! If you really feel like the doc doesn't listen to you, then it's time to look around. But I would share your concerns and then let your doc monitor if you do make changes. If you ended up in the hospital, for whatever reason, it would be important for them to know what you are *really* taking, IMHO.

02-21-08, 07:57 PM
I don't want to take any more medication than is necessary, especially for antipyschotics. If tell him that I've reduced Seroquel he will likely want to try a different antipyshcotic instead. I don't want that and feel that I don't need it.

I'd actually prefer If I could go off Seroquel completely and try a different one instead. However Im very dependant on it for sleep and if I go off my sleep will become horrible and I need a good night sleep to function. I might be able to try that route later but right now I just can't.

I do need to try a new stimulant.

02-21-08, 09:05 PM
I hear what you are saying. There are other options for the help wiht sleeping and mania as well besides the antipsychotics?

That is the route he went with me? We tried the Risperdal which is one, and switched to the Neurontin which isn't? It's a anti-seizure med, which is off-label but works much the same way as the anti-psychotics do? It helps wiht both the aggitation and mania for me? Which wiht that comes the issue of sleep? You might be able to discuss that option as well. And I know the risk wiht all of them, but just a reminder the doses we take for both anti-psychotics & anti-seizure meds are very very low in comparison to what they prescribe for the actual reason they were made? So I guess for me I don't worry near as much about the side-effects or long term damage if I know I am taking way less than is required and most of those risks are based on those doseages? Like Neurontin the min dosage starting out for seizures is 300 up to 1000 , for me 50 -100 up to max of 300? Same as the Seroquel, 800mg dosage is not all that unusual. So I don't know if that helps at all, it was just a thought. And if he continues to push somethings on you that you are just not comfortable with, when there are other options, then again perhaps you can consult another specialist? I hope things get better for you.

Hope :)