In the United States, about one in six people take psychiatric medication. Also known as psychotropic medications, these drugs treat psychiatric conditions. For mental health disorders like schizophrenia, doctors face the challenge of balancing the effectiveness of a psychotropic medication against its side effects.
For example, the first generation of medications for schizophrenia is known for causing significant side effects. It wasn’t until the discovery of second-generation schizophrenia medications, such as quetiapine, that medical professionals could treat patients’ symptoms with a lower risk of side effects.[1]
Schizophrenia is a psychiatric disorder marked by disruptions in emotional responses, thought processing, and social interactions. A common symptom of schizophrenia is hearing or seeing hallucinations. The disease is persistent and can cause severe interference with a person’s daily activities and quality of life. Therefore, finding safe and effective treatments for schizophrenia has been a major goal for psychiatry for the past fifty years.
Worldwide, schizophrenia is one of the top fifteen leading causes of disabilities. Within the U.S., about 0.25% to 0.64% of the population are diagnosed with schizophrenia. Although the estimated number of people diagnosed with schizophrenia is less than 1%, the disorder impacts society in striking ways.[2]
In addition, individuals affected with schizophrenia have a higher risk of premature death than the general population, with a life reduction of twenty-eight and a half years. Tragically, about 4.9% of people with schizophrenia die through suicide.[2]
Drugs used to treat schizophrenia are called antipsychotics. The earlier drugs, called typical antipsychotics, effectively treated schizophrenia; however, these medications came with severe side effects, including tardive dyskinesia and Parkinsonism. Drugs used for schizophrenia that was discovered later are called atypical antipsychotics—one of which is quetiapine.
According to the FDA, quetiapine is a psychotropic medication classified under the class of dibenzothiazepine derivatives. Its full name is quetiapine fumarate, and the brand name it’s sold under is Seroquel.
Quetiapine is currently not a controlled substance. Although primarily used for treating schizophrenia and bipolar disorder, Seroquel is also prescribed for many off-label uses. Prescribed medications are considered “off-label” when the prescriber issues a medication out for reasons other than those recognized by the FDA.[3]
The following are the most common off-label uses for Seroquel:[4]
Seroquel dosages depend on a set of variables, including the client’s age, what the drug is used for, whether the drug formulation is immediate or extended-release, and the client’s condition. For example, Seroquel for sleep may require a lower dose than for the treatment of severe schizophrenia. Generally, Seroquel treatments begin at small dosages and are titrated upwards as tolerated.
The general doses and schedules for quetiapine are:[5]
Target Dosage Range: 150 mg to 750 mg daily.
Although utilized for children over twelve years, safe dosages have not yet been determined for younger children.
The immediate-release version of Seroquel for over twelve years of age is:
Further changes can be made as tolerated in increments of ≤100 mg each day.
Target Dose Range: 400 mg to 800 mg each day.
The extended-release version of Seroquel for children over twelve years of age is:
Further changes can be made as tolerated in increments of ≤100 mg each day.
Although quetiapine has fewer side effects than its predecessors, it’s not without its limitations. Quetiapine side effects are not as disabling as the typical antipsychotics, but they can still interfere with daily life. The following are the common short-term and long-term side effects of Seroquel:[6]
Though very rare, Seroquel withdrawal symptoms may occur when the medication is stopped abruptly. Therefore, individuals taking the medication and healthcare providers prescribing it should be aware of the possible uncomfortable Seroquel withdrawal symptoms. Thus, discontinuing the medication may require a slow titration off the medication, minimizing the chances for Seroquel withdrawal to occur.[7]
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Seroquel contains a Black Box warning from the FDA regarding using the medication to treat dementia in the elderly. Note that this same Black Box warning exists with other atypical psychotropic medications, as they may increase the chance of death. An increase in suicidal thoughts may occur in children and adults using quetiapine.
Another factor to consider is a Seroquel overdose. Though rare, it’s possible. An individual with a Seroquel overdose may become unconscious or experience severe drowsiness.[8]
Every medication has its pros and cons, and quetiapine is no different. Whether quetiapine is prescribed for schizophrenia, insomnia, or depression, it’s possible for the medication to be effective and still come with side effects. Every person may react differently to the medication, making every situation unique. It’s essential for the person taking the medication to have open and honest conversations with their healthcare provider regarding their treatment.
Seroquel works quickly and effectively, and it’s also well-tolerated in most people. Unlike other psychotropic medications, quetiapine doesn’t require any weekly or monthly laboratory work. Additionally, because dosages are easily titrated up or down, it’s possible to find the appropriate therapeutic level for each individual fairly quickly.
Nevertheless, for some, the side effects may overshadow the effectiveness of the medication. The most common side effect is drowsiness and lethargy, which may interfere with school or work. Typically, the severe side effects of quetiapine like tardive dyskinesia are rare but possible.
Quetiapine may interfere with the effectiveness of other medications, primarily Parkinson’s disease medications, such as levodopa and ropinirole.
Most people who use quetiapine don’t experience severe side effects; however, the following symptoms should be reported to a health professional immediately:[8]
People with schizophrenia or insomnia searching for treatment should speak with their healthcare provider to see if Seroquel medication is the right choice. People may find that an off-label use—like Seroquel for anxiety—might be what they need. If you’re currently on quetiapine treatment and have questions about your medication, speak to your healthcare provider.
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