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Little help understanding Seroquel?


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Hey, all. So I don't understand what's happening or what the action of Seroquel is.


I get off my Prozac back in February of 2019 and have major issues with tears and crying spells. My shrink puts me on 150 mg of Seroquel to help. I'm a crying awful mess, and so we start reducing the Seroquel. The less I take of the Seroquel, the better I feel. I get down to 50 over the course of eight months, and my crying spells have gone but now I'm depressed and unmotivated.


I mention this to my pharmacist and she says, "Of course you're depressed. You're on Seroquel. You probably shouldn't be on it. It blocks dopamine, one of the feel-good neurotransmitters."


If I'm struggling with tears, why am I put on a med that blocks a feel-good neurotransmitter? Why does my doctor put me on it, only for my pharmacist to tell me to get off of it?  If the drug is blocking my brain's re-absorption of the drug, why am I not happy?

As of September 5th, 2022:

13 mg liquid Prozac - Reinstated in March, 2020. Prior to that, 1994-2019

43 mg Seroquel - Started in July 2006

9.375 mg Imovane - Started in March, 2020

20 mg Propranolol 3x a day - June, 2020

0.5 mg Clonazepam 3x a day - June, 2020





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Sorry to hear about this. I could understand why you would be confused about this. Seroquel initially did hit the market as an antipsychotic, designed to treat psychosis, schizophrenia, etc. The theory of schizophrenia is that dopamine (often referred to as "feel good" chemical"), is elevated in certain areas of the brain causing psychosis (causing hallucinations, delusions, etc), and antipsychotics such as Seroquel do in a sense "block" dopamine in certain areas of the brain.


However, it is more complicated than that. Seroquel also impacts your serotonin receptors. It is different from the older antipsychotics (haldol, thorazine, for example) in that regard. There are theories as to why Seroquel may work in depression, but they are just theories, and to be honest likely not worth trying to understand on a neurotransmitter level because the brain is complicated and no one truly knows.  I doubt the doc would be able to provide a very scientific answer to this question either.


So why is it even prescribed for depression? Because it has "proven" itself in clinical trials to be effective; meaning that compared to a placebo (non-active pill), they have shown to alleviate some symptoms of depression in some individuals. The problem with these studies is they are short (often about 6 weeks), and again do not require manufacturers to know "why" or "how" a drug works. They simply know it helps some people, with some symptoms, at least in the short term.


It tends to help the most with symptoms of insomnia and "emotional lability" which can be seen with depression. It helps people fall asleep at night and can level their mood during the day (it is also used as a "mood stabilizer" in bipolar disorder). It can also, as a side effect, make them feel quite sleepy during the day too. The choice was likely made based on your symptom set at the time, and whatever the doc perceives to be your "diagnosis".


I am simply trying to provide some insight into why it was chosen, not justifying the choice, nor telling you how to proceed. Though I think it is very frustrating to hear conflicting messages from prescribers and pharmacists, and I think highlights how much is unknown about the medications, and is why people are seeking sites such as this to find their own answers. 








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The manufacturers of psychotropic drugs, let alone the doctors that prescribe them don't even know how they work or what they actually do to the body and brain.  They have found that the drugs will produce certain responses in the body and they zero in on one of those an say that the drug will help "cure" this problem.  All the other things the drug does are then considered "side effects" and are said to be irrelevant.  So when they prescribe a psychotropic drug they are guessing that it will work for your because is sorta worked for someone else.  This is partly why your doctor and your pharmacist don't agree on the use of the drug.  


Your post also points up the fact the your pharmacist doesn't understand the known basics of how these drugs do function.  Seroquel does not block dopamine, it blocks dopamine receptors so they can't function.  This causes an excess of dopamine in the system (this goes for serotonin also) which is what is meant to make us feel better. But no one really knows who or why, and it's been shown that it doesn't really work for an extended period of time anyway.  At this point we could get off into a big rant on drug profitability and excessive prescribing, but I'll let other people to carry on about that.


None of these drugs will make you feel "happy".  At best they will make you not care how you feel but frequently make it so you feel nothing at all, then there are the times that they can make you feel even worse than when you started.  It is a good sign that you are feeling better as you decrease your dose.  But there are going to be times during your taper when your symptoms will catch up and take over for a while.  This will cause periods of anxiety, depression, insomnia and all the other "wonderful things" we read about daily on this forum.  Once you are completely off of the drug your body will be able to return to it's natural state and the side effects and symptoms will clear up.  This does not mean that any underlying or original condition will have gone away, unless you have been learning coping methods, making lifestyle changes and the like in order to handle them.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Final Dose 0.016mg.     Current dose 0.000mg 04-15-2017


"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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