Seroquel (Quetiapine) for Irritability
Dr. Danish addresses symptoms of irritability, reactivity, and anger in patients, which can stem from a multitude of underlying causes. While there are numerous treatment strategies available, tailored to the specific needs of each individual, Seroquel (quetiapine) occasionally emerges as a highly effective off-label option. However, it's crucial to carefully balance the potential efficacy of Seroquel against its side effects to ensure the best possible outcome for the patient. Note that Dr. Danish creates these handouts based on research, but they are not meant to be 100% comprehensive, and patients are invited to discuss the ideas brought up in the document with their provider.
FDA-Approved Uses
Schizophrenia: Helps in managing symptoms such as hallucinations, delusions, and thought disorders.
Bipolar Disorder: Used in the treatment of manic and depressive episodes.
Depression: As an add-on treatment when other antidepressants have not been effective.
Off-Label Uses
Irritability and Anger: Quetiapine can be effective in managing symptoms of irritability and anger in some patients.
Anxiety: Helps in reducing symptoms of anxiety in some cases.
OCD: Often used adjunctively along with SSRIs or SNRIs.
Insomnia: Can be used to improve sleep patterns.
Nausea: May help in managing symptoms of nausea in certain conditions.
Appetite: Can influence appetite, sometimes used to manage weight loss or gain.
Evidence for Off-Label Use in Irritability and Anger
Studies and clinical experience have shown that Quetiapine can be beneficial in managing irritability and anger in a subset of patients. However, it's important to note that responses can vary, and approximately 60-70% of patients may notice an improvement in these symptoms. The effectiveness of Quetiapine for these symptoms is supported by its action on neurotransmitters in the brain that are involved in mood and behavior regulation.
In a case study of a seven-year-old girl with Pitt-Hopkins syndrome (PTHS), autism spectrum disorder (ASD), and intellectual disability, traditional treatments with risperidone and fluoxetine exacerbated her agitation without providing benefits. Similarly, aripiprazole and hydroxyzine failed to alleviate her symptoms effectively. However, the introduction of quetiapine (Seroquel) significantly improved her condition. Quetiapine helped extend her sleep to eleven hours, reduced hyperactivity, decreased the frequency of abnormal breathing spells, and enhanced her social communication skills, such as increased eye contact and better response to her name.
This case study aligns with numerous published studies and Dr. Danish's extensive clinical experience, showing that Seroquel effectively addresses insomnia, anxiety, reactivity, and agitation. Anecdotally, Dr. Danish has observed its benefits in thousands of patients over the years for managing anger, intermittent explosive disorder (IED), disruptive mood dysregulation disorder (DMDD), and agitation, sometimes making it a superior choice compared to other medications like aripiprazole and risperidone.
Dosing and Administration
The dosage of Seroquel varies depending on the condition being treated, patient response, and tolerability. For off-label uses such as irritability and anger, lower doses are often effective and can range from 25 mg to 250 mg daily. It's generally recommended to take Seroquel at night due to its sedative effects.
Potential Side Effects
Like all medications, Seroquel can cause side effects. Not everyone will experience these, but it's important to be aware of them:
Drowsiness
Dizziness
Dry mouth
Constipation
Weight gain (which can lead to type 2 diabetes)
Blurred vision
Tardive Dyskinesia (read Dr. Danish’s blog here on this rare but significant lifelong side effect).
Potential Contraindications
Seroquel should be used with caution in patients with:
History of cataracts
Severe cardiovascular disease
Diabetes or risk factors for diabetes
History of seizures
FDA Approval Information
Seroquel was first approved by the FDA in 1997 for the treatment of schizophrenia. Subsequent approvals were granted for bipolar disorder and as an add-on treatment for depression. Its off-label uses, while supported by clinical experience and some studies, are not FDA-approved, and prescribing it for these conditions is at the discretion of the healthcare provider.
Conclusion
Seroquel (Quetiapine) is a versatile medication with a range of uses from its FDA-approved indications to off-label applications such as managing irritability and anger. While it can be beneficial for many patients, it's important to discuss with your healthcare provider whether it's the right medication for you, considering potential side effects and contraindications. Always follow your healthcare provider's instructions regarding dosing and administration.
Related Reading
Insights from what Britain terms “Pathological Demand Avoidance”.
This blog looks at the Matthews Protocol for DMDD.
Here is a great blog on the power of yoga for a variety of mental health disorders.
Here is more on Abilify (aripiprazole), including efficacy, dosing, and potential side effects.
Here is an overview of Risperdal (risperidone) which is one of the stronger medications for irritability and mania, but comes with its own unique side effect profile.
