In the treatment of psychiatric diseases, it is often impossible to do without pharmacotherapy, and in some cases, drugs - antipsychotics - are the main way to cope with complications.
The line of such antipsychotics has recently been supplemented with a new generation of atypical antipsychotics. These drugs suppress the negative symptoms of mental disorders and show positive results on the patient. In addition, they do not cause at all or almost no extrapyramidal (motor function disorders), hyperprolactinemia (increased levels of the hormone prolactin in the blood), that is, unwanted side effects.
A prominent representative of modern atypical antipsychotics is a drug called Seroquel, which contains the active component quetiapine. The developers recommended this remedy for the treatment of schizophrenia. In the Russian Federation, its use has been approved for the treatment of psychosis and other mental disorders since 1999, and it is also widely used for the same purposes in another seventy countries around the world. The most detailed information about Seroquel and the experience of its use is discussed in the scientific work of psychiatrist (psychotherapist and child and adolescent psychiatrist) Victoria Valerievna Krasavina, on whose material we will rely in this article.
Structure and receptor activity of the drug
Chemically, Seroquel (quetiapine) is a derivative of dibenzothiazepine. This atypical antipsychotic interacts with many neuroreceptors, so its spectrum of therapeutic effects is very wide. The drug blocks H1 receptors according to the following scheme: H1 >α>α1>5-HT 2a>α2>D2>5-HT1a>D1>M1. Due to this binding of quetiapine and blockade of α1 and α2 receptors, a nonspecific sedative effect occurs, and anxious affect and arousal are eliminated.
The absence of side effects (hyperprolactinemia and minor extrapyramidal effects) is explained by the weak effect on 5-HT2a and D2 receptors.
What to do, how to alleviate and get rid of
First, doctors use easy methods for the patient to help eliminate addiction:
- Independent attitude. The patient must be sure that he does not want to use the drug. If the doctor confirms that his health is normal and long-term therapy with antipsychotics is not required, gradual withdrawal of the medication begins.
- Change of environment, place of residence.
- Dependency replacement. A person finds a job that he likes. For example, yoga classes, jogging in the morning, cooking, hobbies.
- Elimination of other bad habits and addictions. If a patient stops using antipsychotics, he will want to replace the substance with other toxic products. It is recommended not to smoke, and it is prohibited to consume alcohol or drugs.
When these steps have been completed, the narcologist or therapist looks at the patient’s condition.
If it is good or satisfactory, he will cope on his own.
When health continues to deteriorate, additional medications are prescribed:
- light sedatives (Novopassit, chamomile, Glycine) – normalize the state of the nervous system, calm, improve sleep quality;
- antipsychotic drugs with fewer side effects and no dependence;
- neuroleptics – drugs that improve brain function;
- tranquilizers – strong sedatives used in emergencies;
- plasmapheresis – washing the blood from toxins, chemicals, and other harmful components;
- infusion therapy is the intravenous administration of drugs that eliminate the underlying disease, for example, schizophrenia.
In addition to medication treatment, a person will need the help of loved ones, relatives, and spouse. Together with them, it is easier for the patient to eliminate addiction. They should guide, be nearby, monitor the absence of the use of prohibited substances, and reassure.
There are 2 types of treatment, depending on the diagnosis and patient’s condition:
- outpatient – a person carries out treatment at home, periodically comes to a clinical institution to check his health, receive new appointments;
- inpatient – the patient is admitted to the clinic and receives daily medication and psychotherapy sessions.
The psychotherapist asks the patient about the symptoms that have appeared and finds out about his well-being. If the doctor doesn’t like something, he will give additional prescriptions.
Seroquel in general psychiatry
At the moment, there is a significant amount of data on the practical use of Quetiapine, accumulated by specialists over the past five years. As already mentioned, this atypical antipsychotic has been introduced as a treatment for schizophrenia. Its long-term use leads to an increase in the general activity of patients, a decrease in autistic manifestations, and an improvement in social adaptation. In this case, hyperprolactinemia and extrapyramidal disorders are not observed.
Seroquel has a positive effect on cognitive function in people with schizophrenia:
• after 3 months of use, attention improves significantly;
• after six months to a year, the quality of executive function and verbal productivity improves.
It should be clarified that this effect is achieved at an average dose of 517.9 mg/day of the drug per day. Long-term use of the drug is not dangerous, as it is well tolerated. Among other things, it reduces suicidal risks.
Experts who have used the atypical antipsychotic in practice indicate its positive results for depressive symptoms. It has a stronger antipsychotic effect than haloperidol, surpassing it and other drugs in antidepressant, anti-anxiety and anti-manic properties.
Such abilities of Quetiapine made it possible to use it and prove its effectiveness in the treatment of:
• anxiety states;
• affective disorders;
• behavioral disorders;
• bipolar disorders, etc.
The drug has also been successfully used to relieve hostility and aggression, in acute mania, and to reduce psychotic symptoms.
The following positive points can be mentioned:
1. Thanks to Seroquel, monotherapy has become possible, that is, treatment of mental disorders with excellent results without side effects is available using only one, maximum two drugs.
2. If we talk about obsessive-compulsive disorders, then Seroquel has also been tried to treat patients with strong resistance to antipsychotics such as selective serotonin reuptake inhibitors. However, a small dose of the drug in monotherapy was ineffective. But, in cases of combination of Quetiapine with SSRIs, patients experienced significant improvement in their condition.
3. They tried to use an atypical antipsychotic in the treatment of post-traumatic stress disorder. 18 war veterans with this problem took Seroquel for 6 weeks, 25-300 mg per day. By the end of therapy, the patients' condition improved significantly; no deterioration in neurological parameters or negative changes in internal organs were recorded. As a result, it was decided to expand research on the use of the drug in the treatment of this disorder.
4. There is evidence of success with this antipsychotic in elderly patients with psychotic symptoms, Parkinson's disease and Alzheimer's disease. Elderly patients had improved quality of life, motor functions, decreased behavioral disorders, and improved sleep. The attending physicians clarify that to achieve a positive effect, you should start with small doses of the drug and not increase them much.
5. There are isolated cases of effective use of Quetiapine for a patient with a mental illness aggravated by drug addiction and alcoholism.
Symptoms and signs
When medication withdrawal is done under the supervision of a physician, side effects are rare or absent.
If you stop taking the drug on your own, the following negative effects occur:
- dyspeptic disorders (nausea, vomiting, impaired stool formation, abdominal pain, flatulence, bloating);
- tremor - involuntary trembling of the arms and legs that cannot be controlled;
- cramps, muscle twitching, convulsions;
- psychosis, neurosis, depression, stress (an increase in mental disorders is observed);
- sudden mood swings from euphoria to depression;
- surges in blood glucose, leading to weakness, exacerbation of diabetes mellitus (if present);
- sudden rises and falls in blood pressure, leading to hypertensive crisis, heart attack, stroke;
- inability to fall asleep at night;
- exacerbation of the underlying mental illness.
The drug is prescribed to control sleep, eliminate psychosis, schizophrenia and other psychiatric disorders. If it is eliminated instantly, the underlying disease appears within 2-3 days.
Symptoms increase gradually, and general malaise occurs (weakness, fatigue). The person becomes ill, his body aches, and his body temperature rises. Seizures, convulsions, and tremors often occur. This is noticeable in people who have been taking the pills for a long time.
You should not delay visiting a doctor. When the first symptoms appear, contact a therapist, neurologist, narcologist, or psychiatrist.
During the use of the medicine, substances are supplied that are no longer produced by the body on its own. Since their quantity becomes sufficient, the glands and cells do not need to secrete more components. When the supply of substances stops, a deficiency occurs in the body.
Child and adolescent therapy
At this time, few descriptions of the practical use of Seroquel in child and adolescent psychiatry can be found in the specialized literature. But they describe in sufficient detail the specifics of using the drug for this category of patients.
Due to good treatment results and mild side effects, experts suggest more active use of the drug in child and adolescent psychiatry. Already at 3-6 weeks, minor patients with schizophrenia taking Quetiapine in doses from 100 to 800 mg per day demonstrated a decrease in the symptoms of this disease, “extinguishing” hyperactivity and aggression.
Some patients experienced dry mouth, mild tremor, dizziness and hypotension as side effects. However, there were only a few such patients, and such manifestations were very weak. The usual strong increase in body weight after taking atypical antipsychotics was not observed, as well as disturbances in the endocrine system and problems with motor functions.
Also safe for children and adolescents is treatment with Quetiapine for bipolar and schizoactive disorders, antisocial behavior, psychopathy, Gilles de la Tourette syndrome and generalized tics, and other mental disorders. At the same time, experts warn about the danger of an overdose of the drug, which can cause tachycardia, hypotension, and agitation.
How long does withdrawal last?
The duration of withdrawal symptoms depends on the following factors:
- self-relief from the medication or monitoring the patient’s addiction with a doctor;
- age criterion (elderly people experience abstinence longer);
- health status (presence of acute or chronic diseases, for example, diabetes, heart failure, hepatitis);
- main diagnosis (insomnia, psychosis, schizophrenia);
- presence of other addictions (nicotine, alcohol, medications, drugs);
- human response to the elimination of the active substance of the drug.
There are forms of drug withdrawal, for each of which the time of withdrawal syndrome is determined:
- Self-medication. The patient stops taking the medication without the doctor's permission. A deficiency of components immediately appears in the body, and therefore the state of health worsens. First, dyspeptic reactions occur, after 2-3 days - neurological and mental disorders. The condition worsens if he is in a risk group, for example, there is a systemic disease or mental disorder. Withdrawal syndrome lasts from 1 to 2 months. Its symptoms increase quickly and are harmful to health.
- Gradual decrease in drug concentration. The dosage is reduced not in 1 day, but over many weeks. It is gradually reduced to a minimum and the remedy is completely eliminated. If a person develops withdrawal symptoms, slight nausea, sleep disturbances, and mood changes appear. But serious mental disorders do not occur. The duration of abstinence is 2-3 weeks.
The weekly dose reduction depends on the person’s condition, which the doctor identifies after examination. If he has a history of diabetes mellitus, hypertension, heart failure, coronary artery disease, a decrease in the concentration of the substance may take up to 1 month.
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Side effect
As already mentioned, unlike other atypical antipsychotics, Seroquel does not cause negative side effects such as extrapyramidal disorders. The latter property allows the free use of this remedy, both among minors and elderly patients, who are more susceptible to such disorders than other categories of patients.
Data on the effect of the drug on metabolism vary, but most experts say that there is still weight gain, but it is insignificant compared to the effect of other atypical antipsychotics.
As for the side effect of hyperprolactinemia, it is quite serious. An increase in the level of prolactin in the blood, caused by the blockade of certain receptors, leads to the appearance of osteoporosis, galactorrhea (spontaneous leakage of milk from the breast), amenorrhea (lack of menstruation), sexual dysfunction, gynecomastia (breast enlargement in men). Seroquel does not increase prolactin levels and even helps correct sexual dysfunction caused by another drug.
Studies have been conducted on the effect of Quetiapine on the functionality of the cardiovascular system. It turned out that the drug is not cardiotoxin and does not affect intracardiac conduction. It also does not have any special effect on the electrophysiological activity of the brain.
From all of the above, we can conclude that, according to the experience of using Seroquel in world medical practice, the drug has an excellent therapeutic effect for various mental disorders, without serious contraindications or side effects.
Pharmacodynamics and pharmacokinetics
Quetiapine (reviews from those taking the drug indicate its rapid action) is quickly absorbed in the digestive tract. Its maximum concentration in the blood is reached 1.5 hours after administration. Most of the active substance (about 83%) binds to blood plasma proteins.
The breakdown of the drug occurs in the liver, about 5% of the drug is excreted unchanged from the body in the urine or through the intestines. The half-life is 7-6 hours. After metabolism, the drug is excreted mainly by the kidneys (70-75%), and about 20% is excreted through the intestines.
In people over 65 years of age, the time it takes to clear the blood of quetiapine residues increases by 30-50% compared to patients aged 18-65 years. The process is also slowed in people with impaired kidney function and those who have liver damage (such as cirrhosis).
Interaction with other drugs
In case of simultaneous administration of "Quetiapine" with drugs that activate the enzyme system (eg, "Carbamazepine"), there is a possibility of a decrease in the active substance in the blood plasma. In this case, you may need to increase the dose of the medicine. The pharmacokinetics of lithium preparations does not change when co-administered with Quetiapine. Other drugs that depress the central nervous system, as well as alcohol, increase the likelihood of negative reactions during treatment with the drug.
Release form and composition
Dosage form – film-coated tablets: round, biconvex, core and shell almost white or white (in a cardboard box 1 glass, polyethylene or polymer jar/bottle of 30, 60 or 90 pcs. or 1–4, 6 blisters 10, 15, 20 or 30 pcs.).
Composition of 1 tablet:
- active substance: quetiapine (in the form of fumarate) – 25, 100, 150, 200 or 300 mg;
- excipients (25/100/150/200/300 mg): microcrystalline cellulose – 8.718/34.87/0/69.74/104.61 mg; lactose monohydrate – 4.5/18/30/36/54 mg; sodium starch glycolate – 3.5/14/21/28/42 mg; povidone K-30 – 2/8/12/16/24 mg; talc – 1.25/5/0/10/15 mg; colloidal silicon dioxide – 0.75/3/0/6/9 mg; Magnesium stearate – 0.5/2/0/4/6 mg; calcium hydrogen phosphate dihydrate – 0/0/46, 32/0/0 mg; potato starch – 0/0/15/0/0 mg; calcium stearate –0/0/3/0/0 mg;
- film coating (25/100/200/300 mg): (hypromellose – 0.9/3.6/7.2/10.8 mg; talc – 0.3/1.2/2.4/3.6 mg; titanium dioxide – 0.165/0.66/1.32/1.98 mg; macrogol 4000 – 0.135/0.54/1.08/1.62 mg) or (dry mixture for film coating containing: hypromellose – 60%; talc – 20%; titanium dioxide – 11%; macrogol 4000 – 9%) – 1.5/6/12/18 mg;
- film coating (150 mg): Aquarius Prime BAP21S010 white (hypromellose – 65%; titanium dioxide – 25%; macrogol – 10%) – 9 mg.
Analogues, cost of "Quetiapine"
You can find analogs of “Quetiapine” on sale. These include:
- "Quetiapine Vial";
- "Quentiax";
- "Quetiapine fumarate";
- "Seroquel";
- "Ketiap";
- "Kvetitex";
- "Kutipin";
- "Cumental";
- "Servitel".
The cost of the medicine depends on the dosage of the active substance. Price for 1 package of “Quetiapine” containing 60 tablets. with a dosage of 25 mg, the average will be from 216 rubles. The drug with a dosage of 100 mg costs from 690 rubles. (1 package containing 60 tablets).
"Quetiapine" and its analogues are sold in pharmacies only with a doctor's prescription. Store the medicine in a dry, dark place at temperatures up to 25 ° C. The drug retains its healing properties for 2 years.
Hypnosis is a method of getting rid of the syndrome
Withdrawal is treated with hypnosis. This is an auxiliary method that is not used for all patients. To do this you need to have indications for use.
During a hypnosis session, the psychotherapist suggests to the person that he does not want to use the drug. The method can work in 1 session, but for other patients it produces an effect over a long course.
A person is instilled not only with a lack of attachment to Quetiapine, but also with thoughts of a normal state of health. He begins to believe in it, forgets about addiction.
Hypnosis sessions are carried out rarely, the risk of adverse reactions is high. There may be no effect. A person’s mental function deteriorates, he becomes aggressive and irritable. Therefore, before using the method, the doctor must fully examine the patient and identify his ability to accept the hypnosis method.
Pharmacological properties
"Quetiapine" refers to atypical antipsychotics; its active substance is quetiapine. The dosage of tablets can be as follows: 25, 100, 150, 200 mg. When quetiapine enters the body, it begins to interact with receptors located in the brain:
- 5-HT2 serotonin (mainly);
- D1- and D2-dopamine;
- alpha1 and alpha2 adrenergic receptors;
- histamine.
The duration of interaction of the active substance with D2 and 5-HT2 receptors is at least 12 hours. Standard tests show the antipsychotic activity of the drug. The drug effectively affects both positive and negative manifestations of schizophrenia.
Complications
If you self-medicate and eliminate the remedy in 1 day, the following complications will appear:
- frequent vomiting, leading to dehydration of the body, which causes convulsions;
- worsening sleep, insomnia;
- delusions, hallucinations, psychological disorders;
- relapse of the underlying disease;
- exacerbation of systemic disease;
- suicidal thoughts, attempts to commit suicide;
- increased blood pressure, increased blood glucose;
- addiction to another substance, regardless of origin.
To eliminate complications, your doctor will advise you to start taking the medication again. This is done until the state of health stabilizes. Then the dosage of the drug is gradually reduced.
Contraindications to the use of Quetiapine
Quetiapine is contraindicated in the following cases:
- hypersensitivity to the drug;
- simultaneous use of CYP3A4 inhibitors (antifungal drugs, HIV protease inhibitors, as well as Erythromycin, Clarithromycin, Nefazodone);
- age up to 18 years;
- breast-feeding.
It is prescribed with caution:
- To old people;
- pregnant women;
- people suffering from cerebrovascular, cardiovascular diseases or other conditions that may be accompanied by arterial hypotension;
- with a history of seizures;
- with liver failure.
