senseless: tapering off 25mg Seroquel/quetiapine after being on it for a month

[senseless]

Hi looking for help with a tapering schedule.

 

On the 07/01/2020 i was prescribed 25mg Seroquel for insomnia and took it everyday for the next month.

 

My prescription lapsed 07/02/2020 and initially attempted to Cold turkey it, immediately ran into rebound insomnia most nights.

 

After doing a bit of reading here it seems its best to taper off, even if you have been on a drug for a short period.

 

I decided to go this route and last night reinstated myself at 12.5mg, this allowed me to sleep for 4 hours.

 

So can someone please help me with a tapering schedule, i want to get off this evil drug asap. But i know rushing it could be detrimental. 

[Gridley]

Welcome to SA, senseless.

 

After a month on a psychiatric drug, you are at risk of withdrawal symptoms, as you discovered.

 

We recommend tapering by no more than 10% of your current dose every four weeks.  This link explains why:

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering seroquel, including how to get the nonstandard doses you'll need for a 10% taper.

 

Tips for tapering off Seroquel (quetiapine)

 

I would wait at least a  month before starting tapering to allow your system to stabilize from your cold turkey and reinstatement.  If after a month's time, you're feeling stable, you can begin.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycerinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

Here are some non-drug tips help you with sleep.

 

Tips to help sleep - so many of us have that awful withdrawal insomnia

 

Relaxation exercises, guided meditations, calming videos, sleep hypnosis

 

Tricks and tips to fall asleep faster

http://articles.mercola.com/sites/articles/archive/2017/02/16/tips-tricks-fall-asleep-faster.aspx?utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20170216Z1&et_cid=DM133787&et_rid=1889748952

 

This link contains helpful information, including insomnia and also non-drug coping skills.  

 

Important topics about symptoms, including sleep problems

Some members have found Melatonin helpful with insomnia.   

 

Melatonin for sleep   

 

It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

l

 

 

 

[senseless]

Ok thanks Gridley.

 

I was wondering if i have reinstated too low? 

 

I have taken 12.5mg for the past two nights and although it has allowed me too sleep, i am only sleeping 3-4 hours. Should i try and updose?

 

Also thought the fact i have only been on it for a month it would allow me to taper quicker? 

 

Any help would be appreciated, im currently going through all this alone as the doctor who prescribed me Seroquel had no idea about it i thought i could just cold turkey it. 

 

 

[Gridley]

13 hours ago, senseless said:

I was wondering if i have reinstated too low? 

 

We recommend reinstating much lower than your original dose because your system has been sensitized by the cold turkey.  It's always guesswork about how much to reinstate, and we would rather err on the side of caution than overwhelm your system. I would not reinstate back to 25mg; it might be too much for you.  Two questions:

 

1. How many days were you on zero after your CT before reinstating 12.5?

2. How many days have you been on 12.5?

 

Are you on the immediate release or the extended release?  In this link are instructions on how make smaller doses.  If you're on the immediate release, you could cut the tablets and reinstate a small bit more.  Take a look at this link and see what you think.

 

Tips for tapering off Seroquel (quetiapine)

 

13 hours ago, senseless said:

Also thought the fact i have only been on it for a month it would allow me to taper quicker? 

 

It's possible.  It's to your advantage that you were on it such a short time but there's not an absolute correlation regarding tapering time and how long you've been on the drug.  Once you stabilize from the reinstatement (and if you reinstate further, from that reinstatement), I would stick with the 10% method for three months.  If you're doing well, you could try speeding it up a bit, perhaps to 15% and see how that does.  If you start getting significant withdrawal symptoms, it's a sign you're going too fast and you'd need to drop back to 10%.

Edited February 15, 2020 by Gridley

[senseless]

Ok I’ve been holding at the same dose last two nights, though it’s not exact each night as I am dry cutting with a knife and no scale. (Working on this)

 

My sleep has improved by only one hour. So past two nights have been getting only 4.5-5 hours sleep a night. Which concerns me, should my sleep not be normal if I have stabilised? 

 

Other possible withdrawal symptoms im experiencing are occasional bursts of anxiety, lower heat tolerance and no libido. 

[senseless]

On 2/15/2020 at 9:54 PM, Gridley said:

 

Two questions:

 

1. How many days were you on zero after your CT before reinstating 12.5?

2. How many days have you been on 12.5?

 

 

 

 

1. A week

2. 4 nights now

[Gridley]

10 hours ago, senseless said:

So past two nights have been getting only 4.5-5 hours sleep a night. Which concerns me, should my sleep not be normal if I have stabilised? 

 

The CT destabilized your system.  It's going to take a while for the reinstatement to stabilize your system.  Is our sleep better now than when you were at zero?  How are your other symptoms now as compared when you were at zero?

 

You've only been on 12.5 for 4 days.  It takes a bit longer than a week for the reinstatement to reach full state in your system.

[senseless]

Ok thanks gridley your words are helping me so much through this. 

The first two days of my CT i was able to sleep for 6 hours, then the rest of my CT i didn't sleep at all.

It just scares me that i have reinstated a drug that has sedative qualities and i am still having sleep issues. 

The past two nights i have slept the following amounts:

 

18.02.2020: 5.5-6hours

19.02.2020: 5 hours

 

I am currently experiencing no other WD symptoms just feeling very depressed and hopeless about the possibility of never sleeping well again.
 

[lxjuice]

Your sleep is clearly on the up even if it doesn't feel like it so I am not really worried about it, to be honest. I would use CBT-I techniques until your sleep improves and then micro-taper. There are no nasty surprises if you micro-taper because the cuts are so small and if you don't get bad symptoms then the micro-taper won't even take much longer than a regular taper. There is a thread on it in the tapering subforum. For example when I cut 25mg/month initially from 200mg, I had zero symptoms 200-175-150mg. Then 150-125mg gave me horrible anxiety, about 8/10 and almost total insomnia for a month. If I was cutting 1mg/day instead of 25mg/month, I would never have made such a destabilizing jump and the rate would actually have been slightly faster.

[Gridley]

22 hours ago, senseless said:

It just scares me that i have reinstated a drug that has sedative qualities and i am still having sleep issues. 

 

 

Reinstatement and updosing do not make things perfect, just better.  Your system is very sensitized and it is, unfortunately, unrealistic to expect perfect or normal sleep at this point.  Really, the amount of sleep you're getting is pretty good.  You're doing fine.

[Altostrata]

Hello, senseless.

 

If I were you, I'd stick with 12.5mg for a while as Gridley suggested. Five hours is not too bad. Your sleep should gradually improve. Please let us know how you're doing.

 

Is your Seroquel immediate-release? When it comes time to taper, you can make a liquid from it. See

 

[senseless]

Thankyou for all the support everyone, i really appreciate it! it helps so much to keep me calm 

 

I realised i was getting a very inconsistent dose dry cutting i think my doses were fluctuating between 12.5 - 15mg,

 

So i have decided to switch to taking my pill in liquid form for consistency at 13.5mg, as i think this is an average of what i have taken over the past week.

 

I'm going to stick at the dose till i have 2-3 weeks of good sleep.

 

Anyway here is an update on my progress

 

20.02.2020: 

Slept 5.5 hours

 

21.02.2020:

Slept 5 hours

 

22.02.2020:

Slept 5 hours

 

23.02.2020:

Slept 7 hours, woooo!!!!

 

 

 

[senseless]

Update:

 

24.02.2020: Slept 5.45 hours

25.02.2020: Slept 6 Hours

26.02.2020: Slept 6.25 Hours

27.02.2020: Slept 6.5 Hours

28.02.2020: Slept 7.2 Hours

29.02.2020: Didn't sleep at all. (Ate very badly this day, had half a block of chocolate 2 hours before bed.)

01.03.2020: Slept 7 Hours.

 

My sleep time is improving, which is good.

 

Though my sleep onset time is increasing, initially i would fall asleep about 30 mins after taking my dose. Now it is taking around an hour.

 

Is it possible i am building a tolerance to my current dose? Especially when i was unable to sleep on the 29.02.2020.

 

Should i look to taper soon to avoid poop-out?

[senseless]

Update:

 

02.03.20: Slept 4.5 hours

03.03.20: Slept 5.2 hours

04.03.20: Slept 6 Hours

05.03.20 Slept 6 Hours

06.03.20 Slept Maybe 1-3 Hours

07.03.20 Slept 4 hours

 

My sleep seems to be on a down trend and i'm not really sure why, I am quite confused and scared as i thought i was stabilizing. 

 

Is it possible i am experiencing poop out or am i still going through withdrawal?

 

@Gridley @Altostrata @Shep would you please offer your thoughts?

 

Thankyou in advance.

 

[Shep]

Has anything else changed, senseless? Any dietary changes? Are you eating well and drinking plenty of water? Are you taking a walking every day or getting some other form of exercise? 

 

Please see:

 

Tips to help sleep - so many of us have that awful withdrawal insomnia

 

On 2/13/2020 at 10:40 PM, senseless said:

On the 07/01/2020 i was prescribed 25mg Seroquel for insomnia and took it everyday for the next month.

 

Were you able to determine why you weren't sleeping back in January? If it was due to stress, has the stress resolved? 

 

Were you not eating right, working too much, dealing with relationship problems, etc. that led to the insomnia? You don't need to give details, but if you're still dealing with the issues that caused you to start taking this drug, those may have to be resolved for your sleep to get better.

 

You may want to try some magnesium to see if that will help. 

 

Magnesium, nature's calcium channel blocker

 

You can also get magnesium by taking Epsom salt baths. That can be very relaxing in the evening and help ease you into a good night's sleep. 

 

Guided meditations can also help, especially if you're struggling with intrusive thoughts in the evening. Here's an example:

 

Guided Meditation Deep sleep | anxiety and insomnia relief | relaxation before bedtime video (20 minutes)

 

If you don't like that one, there are thousands of others out there. 

 

You may find some other ideas for self-care here:

 

Non-drug techniques to cope with emotional symptoms

 

The more you can do to nurture your nervous system by eating healthy, drinking plenty of water, and limiting stress, the better your sleep will be. 

 

[Altostrata]

Looks like the usual ups and downs to me.

 

Don't eat chocolate before bed, at least until your sleep recovers. Don't worry about time to sleep onset. See

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

and other topics in the Symptoms and Self-Care forum.

[senseless]

17 hours ago, Shep said:

Has anything else changed, senseless? Any dietary changes? Are you eating well and drinking plenty of water? Are you taking a walking every day or getting some other form of exercise? 

 

Hi Shep, thank you for your response it is much appreciated.

 

Are you suggesting that my situation is unusual and i should be experiencing an increase in sleep by now?

 

The quality of my diet has decreased recently due to apathy about my situation. (eating alot of carbs, high fat dressings ect)

 

Also i haven't been exercising much lately, i will try to improve on both of these things if you think its beneficial. 

Is it possible my method of liquid tapering could be a factor? I have read contradictory reports on its accuracy. 

 

17 hours ago, Shep said:

Were you able to determine why you weren't sleeping back in January? If it was due to stress, has the stress resolved? 

 

The depressive episode/crisis that sparked my one night of insomnia has been resolved as much as it can.

[senseless]

16 hours ago, Altostrata said:

Looks like the usual ups and downs to me.

 

Don't eat chocolate before bed, at least until your sleep recovers. Don't worry about time to sleep onset. See

 

 

Ok thank you for the reassurance and advice alto. It helps me so much.

[Shep]

19 hours ago, senseless said:

Are you suggesting that my situation is unusual and i should be experiencing an increase in sleep by now?

 

The quality of my diet has decreased recently due to apathy about my situation. (eating alot of carbs, high fat dressings ect)

 

Also i haven't been exercising much lately, i will try to improve on both of these things if you think its beneficial. 

Is it possible my method of liquid tapering could be a factor? I have read contradictory reports on its accuracy. 

 

Thanks for your response, senseless. You may want to work with improving your diet and getting some walks in to see if that helps.

 

I would bet that's where the problem is, rather than your method of tapering. Many people find the liquid taper to work well. If you have any questions about how you're doing it, please post. 

 

As Alto wisely noted, this does come with a lot of ups and downs. Good days and bad days. 

 

 

19 hours ago, senseless said:

The depressive episode/crisis that sparked my one night of insomnia has been resolved as much as it can.

 

This is good. So you know a lot of what's going on is related to the drug. 

 

Please let us know how you do as you work to improve your diet and exercise. Avoiding sugar, caffeine, alcohol, and too many carbs and eating plenty of protein, fruits, and veggies will help. 

[senseless]

Ok noted shep, i will improve my diet and exercise routine hopefully that helps.

 

Past two night i'm back to 5.5-6 hours sleep which is ok, i think this may be my WD normal.

 

With that in mind i'm considering tapering a little bit down to 13mg tommorow night, what do you think @Shep?

 

May be a little premature but i really don't want to spend longer on seroquel than is needed and build more of a dependence. 

[Shep]

You may want to hold steady for a couple more days and see if the dietary improvements help. 

 

I know you don't want to be on this drug, but you've been on it long enough to form dependency. And making too many changes too soon can traumatize the nervous system and even lead to nervous system kindling. 

 

Even though Seroquel is technically an antipsychotic, in doses at the 150 mg or less range, it works on histamine more than dopamine. So it's more like an antihistamine at this dose. You're not at risk for the more severe side effects of this drug. 

 

I would hold a bit longer. Please post your thoughts. 

[Shep]

A couple more questions, senseless - how much did you regularly sleep prior to going on Seroquel, and prior to the insomnia episode that landed you on this drug? What would you say is your target amount of sleep? Just asking so we have a baseline.  

[senseless]

I'm going to start doing a daily diary as i believe it may be beneficial in identifying the cause of sleep inconsistencies 

 

10/03/2020

6:30am: Woke up,  stay in bed to attempt light sleep

11:00am: Got out of bed

2:00pm: Had Lunch

6:15pm - 8:15pm: Went skateboarding with friends

9:15pm: Had vegetable curry for dinner

9:15: Started watching tv

11:30: Took 2mg of Circadin(slow release melatonin)

12:00pm: Stopped watching tv

12:00pm: Take 13.5ml of seroquel

12-1230: Read a book

11/03/2020

12:30am: Attempt to sleep

1:30-2:00am: Fall asleep

6:30am: Wake up

[senseless]

18 hours ago, Shep said:

You may want to hold steady for a couple more days and see if the dietary improvements help. 

 

I know you don't want to be on this drug, but you've been on it long enough to form dependency. And making too many changes too soon can traumatize the nervous system and even lead to nervous system kindling. 

 

Even though Seroquel is technically an antipsychotic, in doses at the 150 mg or less range, it works on histamine more than dopamine. So it's more like an antihistamine at this dose. You're not at risk for the more severe side effects of this drug. 

 

I would hold a bit longer. Please post your thoughts. 

 

Ok thankyou for the guidance, i will hold of a little while from my taper.

 

I suppose my concern is that i am building a tolerance to seroquel, as both my sleep onset and sleep time are worsening.

 

So is there not the possibility that waiting for stabilisation could be impossible and potentially make my situation worse?

[senseless]

18 hours ago, Shep said:

A couple more questions, senseless - how much did you regularly sleep prior to going on Seroquel, and prior to the insomnia episode that landed you on this drug? What would you say is your target amount of sleep? Just asking so we have a baseline.  

 

i did have slight sleep issues during the work week, likely due to poor sleep hygiene and going to bed too late.

 

My sleep quality was never this bad though. 

 

But on average i would say:

 

During the week: 6-8 Hours

Weekend: 7-9 Hours

[Shep]

4 hours ago, senseless said:

11:30: Took 2mg of Circadin(slow release melatonin)

 

Thanks for doing the drug and symptoms journal, senseless. This is a rather high dose of melatonin, which is one of those "less is more" supplements. 

 

You may want to decrease this. Please see:

 

Melatonin for sleep

 

Are you able to get a lower dose slow release? Please note that if you cut the pill to decrease the dose, it will lose its time release. 

 

Melatonin can turn paradoxical at higher doses, especially when you take it close to when you take the quetiapine - the more you dampen down the nervous system with a drug and a supplement that cause sedation, the more the nervous system fights to stay alert. This is the paradoxical reaction. 

 

4 hours ago, senseless said:

12:00pm: Stopped watching tv

12:00pm: Take 13.5ml of seroquel

 

You may want to move your bedtime back to 10 PM and see if you sleep better. Also, you may want to stay away from the TV, computer, and cell phone a couple of hours before bedtime. 

 

 

4 hours ago, senseless said:

But on average i would say:

 

During the week: 6-8 Hours

Weekend: 7-9 Hours

 

You're not too far away from the 6 hour mark that's normal for you during the week. But the quality may not be as good now, in addition to the duration of sleep. 

 

Try reducing the melatonin and getting into bed a bit earlier and see if that helps. 

 

Question - are you taking any other supplements besides melatonin? 

 

[senseless]

54 minutes ago, Shep said:

 

Thanks for doing the drug and symptoms journal, senseless. This is a rather high dose of melatonin, which is one of those "less is more" supplements. 

 

You may want to decrease this. Please see:

 

Melatonin for sleep

 

Are you able to get a lower dose slow release? Please note that if you cut the pill to decrease the dose, it will lose its time release. 

 

 

 

Ok i will i have to make a doctors appointment and get a prescription for melatonin, it is not sold over the counter here.

 

In the meantime do you think i should try taking it earlier? I have tried taking half with mixed results.

 

1 hour ago, Shep said:

You may want to move your bedtime back to 10 PM and see if you sleep better. Also, you may want to stay away from the TV, computer, and cell phone a couple of hours before bedtime. 

 

 

I work till late some nights, so unfortunately i cannot move my sleep back.

 

I will try to avoid screens before bed.

 

1 hour ago, Shep said:

Question - are you taking any other supplements besides melatonin?

 

No i am not.

 

 

Thanks again for your help shep, you have no idea how much it helps. 

[Shep]

1 hour ago, senseless said:

In the meantime do you think i should try taking it earlier? I have tried taking half with mixed results.

 

With your job keeping you late, you may not be able to take it much earlier. It will be a matter of adjusting according to your work schedule. That being said, any chance of limiting overtime or adjusting your schedule in other ways until you're more stable? That may not be possible depending on your job, but just a thought to see if you can make any accommodations or take periodic days or half-days off for self care. Sometimes the best medicine is simply some much-needed down time. 

 

Question - when you were taking half with mixed results, how long a time-frame were you keeping at a consistent dose? If you were experimenting (not judging you for this - we all do it), the mixed results may have been more from the confusion your nervous system was experiencing than from the actual dose itself. 

 

If you can taper down to 1 mg and then hold steady for awhile, you may see better results. 

 

[senseless]

22 hours ago, Shep said:

 

With your job keeping you late, you may not be able to take it much earlier. It will be a matter of adjusting according to your work schedule. That being said, any chance of limiting overtime or adjusting your schedule in other ways until you're more stable? That may not be possible depending on your job, but just a thought to see if you can make any accommodations or take periodic days or half-days off for self care. Sometimes the best medicine is simply some much-needed down time. 

 

 

Unfortunately i lost my full time corporate job due to this whole ordeal, im now working odd jobs to pay the bills. One those jobs being a bartender so no i cant make the adjustments

 

Thankyou for the thoughtful suggestion though shep

 

22 hours ago, Shep said:

Question - when you were taking half with mixed results, how long a time-frame were you keeping at a consistent dose? If you were experimenting (not judging you for this - we all do it), the mixed results may have been more from the confusion your nervous system was experiencing than from the actual dose itself. 

 

If you can taper down to 1 mg and then hold steady for awhile, you may see better results. 

 

 

Haha yeah there was no consistency in taking half, i would just experiment.

 

But yeah that makes sense ill try tapering it down instead.

[senseless]

Hello Update:

 

11/03/2020:6.5 Hours Sleep

12/03/2020:1-3 Hours Sleep

 

I'm really scared i think i know why my sleep/symptoms have been so inconsistent.

 

I  recently realized that seroquel needs to be stored below 30 degrees, the temperature here has exceeded 30 degrees multiple times the past  two weeks.

 

So could this compromise the potency of seroquel? Have i kindled myself

 

I have bought a new batch of seroquel, should i try and account for this drop in potency and taper my dose down maybe to 10mg?

 

@Altostrata @Shep Thoughts? 

[senseless]

Tips for tapering off Seroquel (quetiapine)

 

I also just realised according to the above thread, Seroquel is "most likely stable mixed with water for 24 hours". 

 

I have been making 100mg/100ml batches and using it over several days

 

No wonder im so unstable

[Shep]

Do you have a way of keeping the liquid under 30 degrees?

 

Also, are you able to get 25 mg tablets instead of using 100 mg tablets? 

[senseless]

13 minutes ago, Shep said:

Do you have a way of keeping the liquid under 30 degrees?

 

Also, are you able to get 25 mg tablets instead of using 100 mg tablets? 

I can keep the liquid and tablets In the fridge? 

 

I have 25mg tablets, ill switch to making small batches.

 

Do you think I should drop my dose or stay at 13.5mg? 

[Shep]

Yes, refrigerating it is fine. For best results, keep it in a dark glass bottle. You may not want to keep it for more than 24 hours, as you noted earlier. 

 

The other option is using a scale. 

 

5 minutes ago, senseless said:

Do you think I should drop my dose or stay at 13.5mg? 

 

Please stick with the 13.5 mg dose for a few days. Let's see how you do with the changes in how you're preparing the dose, especially since how this really affected the dose is unknown. 

 

Please let us know how you do over the weekend. 

[senseless]

On 3/13/2020 at 6:41 PM, Shep said:

Yes, refrigerating it is fine. For best results, keep it in a dark glass bottle. You may not want to keep it for more than 24 hours, as you noted earlier. 

 

The other option is using a scale. 

 

 

Please stick with the 13.5 mg dose for a few days. Let's see how you do with the changes in how you're preparing the dose, especially since how this really affected the dose is unknown. 

 

Please let us know how you do over the weekend. 

 

Thankyou once again Shep, you are helping me so much through this.

 

Sleep update:

 

13/03/2020: 5.5 Hours

14/03/2020: 6 Hours

15/03/2020: 6.5 Hours

 

I believe my suspicions of inconsistencies due to my preparation were true and explains the bad sleep nights i have had.

 

I have also talked to the manufacturer and have learnt my medication is not soluble in water, is this a problem?

 

I really feel like i have unnecessarily kindled myself due to all this

 

Do you think i should switch to dry cutting @Shep?

 

[Shep]

8 hours ago, senseless said:

I have also talked to the manufacturer and have learnt my medication is not soluble in water, is this a problem?

 

Not necessarily. Many drugs are not soluable in water, so you're making a suspension, not a solution. But as long as you're being consistent with how you're making your suspension and making small batches that you use quickly, you may do just fine. In fact, your improved sleep is a great sign of this. 

 

8 hours ago, senseless said:

I really feel like i have unnecessarily kindled myself due to all this

 

No, not at all. If you'd kindled yourself, you wouldn't have seen such rapid improvements. 

 

8 hours ago, senseless said:

Do you think i should switch to dry cutting @Shep?

 

Dry cutting is a good method for tapering, but if you're more comfortable with liquid, Seroquel does come in a liquid formula.  I don't know if it's available in your area. You could reach out to your pharmacist to check. 

 

But since you're doing better by making the changes you've already made, you may want to stick to what you're currently doing. I would give it a few more days at least before making any more changes.