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Severe mental health conditions often require intense medications to manage symptoms. These medications are specially formulated to act upon the areas of the brain that are affected by the condition. However, due to the intensity of some of these medications, the side effects and levels of dependence that they create can cause more problems for the person already battling mental illness. Seroquel is one such medication.
While useful to treat the symptoms of serious mental health conditions, Seroquel has its own serious side effects and potential for dependence. We will explain what Seroquel is, how it’s used, its potential for abuse and dependence, its side effects, how to manage withdrawal symptoms.
WHAT IS Seroquel?
Seroquel and Seroquel XR are the brand names for the drug quetiapine. This drug is approved by the United States Food and Drug Administration (FDA) to treat the following mental health conditions:
Quetiapine is also prescribed “off label,” meaning the FDA has not approved use, for these conditions:
Quetiapine works by evening out the levels of dopamine and serotonin in the brain, helping to reduce hallucinations, delusions, and unwanted thoughts. It can also help stabilize severe mood swings and reduce anxiety levels. Improved mood, sleep, and appetite are some of the positive outcomes of using this medication.1, 2
What Classes of Drugs Does Quetiapine Belong To?
The class of drug that quetiapine belongs to is called atypical antipsychotics, also known as second-generation antipsychotics. This class of drugs was developed to attempt to reduce the Parkinson’s-like symptoms that traditional antipsychotic medications often caused. Symptoms such as tremors, walking with a shuffling gait, mask-like facial expressions, and tardive dyskinesia (referred to as extrapyramidal symptoms or EPS) are significantly reduced when atypical antipsychotics are used.3Abilify and Risperdal are also examples of atypical antipsychotic medications.
Quetiapine was developed in 1985. It was first approved for medical use in the United States by the FDA in May 2007 under the brand names Seroquel and Seroquel XR for the treatment of schizophrenia. It was subsequently approved for the treatment of bipolar disorder in 2008 and major depressive disorder in 2009.
Is Seroquel a Controlled Substance?
Seroquel isn’t considered a drug that has a high potential for addiction by the United States Drug Enforcement Agency (DEA); therefore, it’s not included on the schedules of controlled substances as defined by the Controlled Substances Act.
That being said, recent studies indicate that quetiapine is increasingly being misused and abused. This may be partially due to the number of off-label prescriptions issued by physicians who use quetiapine to treat other conditions such as insomnia or agitation in dementia patients. This increase in off-label prescribing may have led to the increased availability of Seroquel on the street.
Is it Used to Treat Substance Abuse?
One trend in off-label Seroquel prescriptions is in the treatment of substance abuse. It’s thought that quetiapine helps to control the psychiatric symptoms of withdrawal, such as restlessness, anxiety, and sleep disorders. However, studies have shown that quetiapine only has this effect in cases of an already existing psychiatric diagnoses. Researchers speculate that the dopamine sensitivities of patients with schizophrenia or bipolar disorder make them more susceptible to the effects of substances, meaning that more individuals who abuse substances also have comorbid mental health conditions. This would possibly create the misperception that quetiapine is useful to treat withdrawal symptoms when it’s treating the symptoms of the comorbid mental health condition.4
People who abuse other substances may seek Seroquel as a treatment for their own withdrawal symptoms because of this misperception, leading to abusing the drug.
Seroquel Misuse and Abuse
Possibly due to the above association between mental health conditions, substance abuse, and the use of Seroquel to treat substance withdrawal symptoms, abuse of quetiapine is on the rise.
Data from the American Association of Poison Control Centers National Poison Data System’s Annual Reports show an increase in intentional exposures to atypical antipsychotics, including quetiapine, from 2012 to 2018, as the chart below indicates :5
These results show a steady increase in the number of intentional exposures over the period, with a more significant increase from 2014 to 2015.
Out of all of the atypical antipsychotic medications, quetiapine is intentionally abused most often. A 2016 study used data on intentional exposures from the National Poison Data System to compare the rate of quetiapine abuse to that of other atypical antipsychotics. Using retrospective data from 2003 to 2013, this study found that out of 3,497 cases of intentional exposure to atypical antipsychotic medications, quetiapine was the medication involved in 2118 or 60.6 % of all cases.6
Abuse in Prison and Clinics
Quetiapine is gaining value as a street drug. Evidence of this includes black market values assigned to quetiapine, diversion in prisons and institutions, the appearance of fake symptoms to gain access to the drug, use of quetiapine by injection or inhaling, and the existence of street names. Here are a few street names associated with Quetiapine/Seroquel:8
Side Effects of Quetiapine
There are many side effects associated with Seroquel. Anyone taking this medication must discuss the side effects with a doctor to determine if these effects are worth possible improvement in mental health.
The more common side effects include:
Serious side effects are rare, and include:
Dementia patients are more prone to serious side effects of quetiapine and may experience pneumonia, heart failure, or sudden death. Thus, Seroquel should not be used by individuals diagnosed with dementia. This fact is concerning, considering the off-label use of quetiapine by some physicians to treat agitation in people with dementia.
Long Term Effects of Seroquel
Those who take quetiapine may have to be on the medication for many years. Long-term exposure can do some damage to the body. Here are a few conditions that may occur after long term use:
- Metabolic Syndrome: This condition can result in diabetes if not treated and monitored long term. Symptoms include high blood sugar, high cholesterol, and elevated hemoglobin.
Cataracts: Long-term use of quetiapine can result in cataracts, in which the lens of the eye clouds over, impairing vision.
- Tardive Dyskinesia: Tardive dyskinesia is a neurological condition that causes involuntary, repetitive movements. Some of the more common movements include blinking and facial grimaces, but involuntary jerking of other muscles of the body also occurs.
- Extrapyramidal Symptoms: Also mentioned above, these symptoms resemble Parkinson’s Disease and include tremors, stiffness, and a mask-like appearance to the face. When quetiapine is used long-term, these symptoms may become permanent.
The number of deaths shown is a very small percentage of the overall number of exposures, equaling about .05% of all single exposures and 1.6% of people who experience major health problems due to exposure. Still, symptoms of an overdose of quetiapine can be serious and can include:
Typical emergency treatments for overdose, including gastric lavage and activated charcoal, are usually effective in controlling quetiapine overdose. If the overdose is severe, life support may be required until the excess medication has been removed from the person’s system.9
Is Seroquel Addictive?
Another study presented the case of an individual with a history of alcohol and benzodiazepine dependence and cannabis abuse who could not control his use of quetiapine. The man in this case presented with symptoms of quetiapine dependence and withdrawal symptoms when he attempted to stop taking the medication.11
This case supports the theory that quetiapine has the potential for dependence in those who have a history of substance abuse. The evidence from this research has implications for individuals with dual diagnoses of mental health disorder and substance abuse disorder who are considering taking quetiapine.
Physical and psychological dependence are possible with Seroquel use, so withdrawal symptoms are possible when use ends. These symptoms include:12
These symptoms can be controlled by working with a physician to gradually decrease the dose of Seroquel over a more extended period of time, rather than stopping the medication suddenly. Withdrawal symptoms will be more severe if the individual taking quetiapine is also taking other, more addictive substances such as alcohol, cocaine, or benzodiazepines. Please refer to articles on these other substances for withdrawal symptoms that may occur.
Treatment for Seroquel Addiction
Treatment for dependence on quetiapine may not resemble treatment for other addictions. Seroquel may lead to dependence, but the drug itself is a treatment for serious mental health conditions like schizophrenia. How treatment proceeds depends on the initial reasons why the medication was prescribed.
Treatment for Addiction from Recreational Use
If the individual began taking quetiapine recreationally along with other addictive substances, treatment will focus on detoxification and managing withdrawal symptoms for all substances. Seroquel is rarely used recreationally by itself and may not be the primary focus of treatment. Instead, the more addictive substance such as alcohol will be the primary focus. Detox and follow-up treatment will address all substances involved in the addiction, including Seroquel. Details regarding treatment for addiction to these other substances are included in articles about those substances.
Treatment for Addiction from Mental Health Use
If Seroquel was prescribed and used for a serious mental health condition, then treatment must focus on managing that condition after use has ended. The mental health condition may still exist, and symptoms of that condition may return after quetiapine is weaned from the system.
Medical management using safer alternative medications may be required, and other treatments for the conditions should be implemented, including:
These treatments utilize a variety of approaches that are designed to address the unique problems associated with various mental health conditions.
Misuse of Seroquel Requires Treatment
Seroquel can be a useful, therapeutic medication that can help those with schizophrenia, bipolar disorder, and major depression to manage mental health symptoms. The side effects and long-term risks of Seroquel use, however, make it necessary to reconsider this drug’s safety and potential for addiction. If you or someone you love is abusing or misusing Seroquel, seek help today.