Seroquel for anxiety (A brief guide)
In this guide, we will discuss Seroquel for anxiety, existing evidence in the treatment of anxiety, some of the most common side effects and potential risks.
Seroquel for anxiety
Seroquel for anxiety is still a topic of debate since Seroquel (Quetiapine) has been initially approved to treat schizophrenia and bipolar disorder.
However, due to clinical studies, it has been shown to be effective also in treating mood and anxiety disorders.
According to WebMD, in studies that were looking at the effect of Seroquel for bipolar depression, they noticed that patients’ anxiety levels frequently dropped.
One week after giving patients Seroquel, anxiety symptoms such as trouble sleeping and relaxing began to improve in those patients compared to the placebo group and the improvement continued over the course of the study.
In another study titled “Is quetiapine effective for anxiety?”, they determine how the rate of off-label prescription of second-generation antipsychotics has been estimated to have doubled in the past decade.
Clinical experience and reports from patients also indicate that quetiapine may be useful to treat anxiety.
Compiling research, it has been found that Quetiapine is an FDA approved drug for the treatment of:
- adults and adolescents with schizophrenia
- adults, children, and adolescents with acute manic episodes associated with bipolar I disorder (BDI) as monotherapy or as an adjunct to lithium or Divalproex
- adults with an acute depressive episode associated with bipolar disorder
- adjunctive treatment of major depressive disorder (MDD) in adults
- maintenance treatment of BDI as an adjunct to lithium or Divalproex in adults.
Gören (2012) indicated how neither the immediate-release or XR formulation is indicated for treating anxiety, but quetiapine has been studied as a treatment for several anxiety disorders, including posttraumatic stress disorder, social phobia, obsessive-compulsive disorder, and anxiety secondary to mood disorders.
It has been most extensively studied as a treatment for generalized anxiety disorder (GAD).
She mentions how three studies that involved a significant sample of 2.100 patients suggest that quetiapine XR monotherapy is effective to treat Generalized Anxiety Disorder symptoms when administered in doses of 50 to 300 mg a day.
In the other 2 studies, quetiapine XR was as effective as paroxetine and escitalopram for the treatment of Generalized Anxiety Disorder.
Even though there was convincing evidence to support the use of quetiapine to treating Major Depression and Generalized Anxiety Disorder, the FDA committee concluded that it was not acceptably safe yet since there were concerns involving metabolic side effects such as weight gain, increased cholesterol, and hyperglycemia.
A more recent study from 2016 reviewed the efficacy, acceptability, and tolerability of quetiapine in adult patients with Generalized Anxiety Disorder.
A total of 2.248 randomized participants across 3 clinical trials were included.
They found that “The pooled mean-changed score of the quetiapine-treated group was greater than that of the placebo-treated group and comparable to selective serotonin reuptake inhibitors (SSRIs).
Unfortunately, the response and the remission rates in only 50 and 150 mg/day of quetiapine-XR (extended-release) were better than those of the placebo.
Their response and remission rates were comparable to SSRIs.”
Based on their meta-analysis about the effectivity quetiapine-XR in the treatment of adults with Generalized Anxiety Disorder they found that despite the low acceptability and tolerability, the use of 50-150 mg a day of quetiapine for adults may be considered as an alternative treatment.
However, more studies are needed to prove the effectiveness and benefit of using quetiapine to treat anxiety.
In contrast, there is a study from 2014 that reviewed the literature on quetiapine for insomnia.
It is said that the antagonism of histamine H1- and serotonin type 2A receptors have the added effect of causing sedation, making it used widely off-label as a treatment for insomnia.
However, due to the potential adverse effects it has been recommended only in patients with specific comorbid psychiatric disorders.
In conclusion, they found that “Robust studies evaluating the safety and efficacy of quetiapine for the treatment of insomnia are lacking. Given its limited efficacy data, its adverse-effect profile, and the availability of agents approved by the Food and Drug Administration for the treatment of insomnia, quetiapine’s benefit in the treatment of insomnia has not been proven to outweigh potential risks, even in patients with a comorbid labeled indication for quetiapine.”
Another study from 2013 that viewed the efficacy of quetiapine and the off label uses suggested that the strongest evidence exists for anxiety and delirium.
Moderate evidence exists for quetiapine as a pharmacological intervention for insomnia, dementia, and specific personality disorders.
Still, it is suggested that more research is performed to establish the dose relationship to the metabolic side effects to determine whether various off-label uses justify the risk incurred by using this powerful drug.
What is Seroquel?
Seroquel is the brand name for the generic Quetiapine.
This is considered a short-acting psychotropic medication prescribed to treat schizophrenia in adults and children who are at least 13 years old.
It is also known to be used for the treatment of major depression and bipolar disorder.
In addition, it is also prescribed off the label on occasion as an add on treatment for generalized anxiety disorder when people haven’t responded to other therapies.
The recommended dose range for this condition is 200-800 mg a day.
Medicalxpress.com indicates how “Doctors prescribe quetiapine off-label for various conditions, including anxiety, autism, post-traumatic stress disorder, substance abuse, and obsessive-compulsive disorder. It is also increasingly prescribed off-label for insomnia, usually at lower doses of 100mg or less a day.”
Side effects of Seroquel for anxiety
According to rxlist.com, here is a list of the possible side effects:
Common side effects of Seroquel include:
- hot flashes,
- sensitivity to heat,
- sleep problems (insomnia),
- changes in appetite or changes in weight,
- changes in menstrual periods,
- and temporary hair loss.
Evidence review: efficacy
There are 4 clinical trials (monotherapy) reviewed by the National Institute for Health and Care Excellence which compared prolonged-release quetiapine with placebo or antidepressants.
All of the studies included participants with Generalized Anxiety Disorder.
In the first analysis of 2 RCTs that lasted 8 weeks, prolonged-release quetiapine (50 mg a day) with the first group of 455 participants and another placebo group of 452 participants.
The results showed a statistically significant in favor of quetiapine.
In another analysis of 3 RCTs that lasted 8 weeks, prolonged-release quetiapine 150 mg a day in a sample of 678 compared to 667 placebo group where there was a statistically significant difference in the quetiapine group compared to placebo.
A third 2 RCTs lasting 8 weeks with a 300 mg per day with a representative sample of 448 compared to 450 participants from the placebo group.
Found no difference or statistical significance.
In a fourth 1 RCT lasting 9 weeks, with a flexible dose of 50-300 mg per day, a sample of 223 and 227 placebo they found results statistically significant in favor of quetiapine.
In contrast, there was 1 RCT lasting for 8 weeks comparing Escitalopram (10 mg a day) and prolonged-release quetiapine (150 mg a day).
None of the results was statistically significant, although the RCT may not have had sufficient statistical power to detect the difference between them.
Also, Paroxetine (20 mg a day) and prolonged-release quetiapine (50 mg a day) were compared in 1 RCT lasting 8 weeks.
None of these results was statistically significant, although the RCT may not have had sufficient statistical power to detect such a difference.
Evidence review: Safety concerns
The National Institute for Health and Care Excellence indicates that “The summaries of product characteristics for Seroquel tablets and Seroquel XL prolonged-release tablets state that the most commonly reported adverse effects of quetiapine are somnolence, dizziness, dry mouth, mild asthenia, constipation, tachycardia, orthostatic hypotension, and dyspepsia.”
As we discussed, quetiapine poses several additional adverse effects such as increasing the risk of suicidal thoughts and behavior, vivid/abnormal dreams and nightmares.
Tardive dyskinesia and akathisia, weight gain, hyperglycemia, and elevated cholesterol levels. Hyperprolactinemia and hypothyroidism.
Additionally, other risks include prolonged QT interval, venous thromboembolism, pancreatitis, hepatic effects, dysphagia and aspiration, seizures, neuroleptic malignant syndrome, severe neutropenia, and other blood dyscrasias, and hypersensitivity reactions.
Also, acute withdrawal symptoms (including insomnia, nausea, headache, diarrhea, vomiting, dizziness and irritability) when there is abrupt and sudden discontinuation of quetiapine treatment.
Why is this blog about Seroquel for anxiety important?
Even though Seroquel for anxiety is still not approved officially by the FDA due to health and safety concerns is is prescribed by doctors off-label in the treatment of mental illnesses including anxiety disorders, especially for Generalized Anxiety Disorder.
However, results from clinical trials are promising in showing the effectiveness of Seroquel for anxiety.
Still, your doctor is the one that decides whether prescribe this type of medication or another type of medication.
Always consult with your doctor about any possible side effects and the benefits.
Please feel free to comment in the comments section below!
Frequently Asked Question (FAQs) about
Does quetiapine calm you down?
Quetiapine may help you feel calm and relaxed.
It could take some time for quetiapine to have full effect but it should help you with your problem.
Which antipsychotic is best for anxiety?
It has been said that quetiapine, aripiprazole, olanzapine, and risperidone have been shown to be helpful in reducing anxiety and depression symptoms in people with schizophrenia and schizoaffective disorders, and have since been used in the treatment of mood and anxiety disorders.
Does Seroquel work immediately?
Seroquel won’t work immediately, as with any other drug, it can take- weeks for Seroquel to give its full effect, but for some people it may be faster, getting good results during the first week.
What is Seroquel 25 mg used for?
Seroquel 25 mg is used to treat certain mental conditions such as schizophrenia, bipolar disorder, sudden episodes of mania or depression associated with bipolar disorder.
Seroquel (quetiapine) is known to be an antipsychotic drug from the atypical type.
How will quetiapine make me feel?
Quetiapine can make you feel sleepy and can have some strange effects on your sleep so during the first few days of starting to use quetiapine you can feel extremely sleepy.
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