How Should Seroquel be Discontinued
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Q:  How Should Seroquel be Discontinued

I have not been diagnosed with bipolar disorder, although I am being treated for depression with Effexor XR (300 mg.) and Remeron (45 mg.).  I can tell you pretty much that my depression stems from "living with HIV" (that's the preferred terminology for those who are upbeat, which "ain't" me) for the past 13 years.  I was put on Seroquel (4-6 25 mg.) tablets for sleep by my ex-psychiatrist.  We were not getting along (I put black scuff marks on his white couch), and he kicked me out without anyone to be a follow-up.  I saw a new psychiatrist last week, who refused to take me on a regular basis because I can't afford the co-pay ($95 from Medicare and Blue Cross/Blue Shield for 15 minutes wasn't enough for him).  (I'm on SSD and get very little money.)  He did give me enough Effexor and Remeron to last a month, but he was unfamiliar with Seroquel, so I had to stop "cold turkey."  If I wasn't psychotic before, I am now.  I'm climbing the walls and am quite suicidal.    Supposedly, I'm getting some more tomorrow.  (When I called the pharmacy to see if it was in, they said they wouldn't have it until Saturday.  This is Thursday.  I think I raised enough ruckus by threatening to throw myself in front of an "F" train [I live in Brooklyn, NY] that they scrounged some up.)

I know I'm being long-winded, but I guess my basic question is:  Should Seroquel be stopped altogether or should it be cut down gradually?  I'm not particularly happy with it for sleep since it gives me cold sweats.

Dear Mr. S' -- 
Generally speaking it's preferable to taper medications we usually use in psychiatry.  Taper can mean going off over a month, or even a few months sometimes, but generally taking at least a week (with some notable exceptions, such as when the medication is clearly causing a dangerous or severe side effect). 

Dr. Phelps

Published February, 2003


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