1st Seroquel Update - Feeling Excellent. There are no symptoms other than improved stability, clarity, and energy. Oh, and relief.

Hi Jo, and welcome! Congratulations for getting to 150 mg. I'm glad you've had some positive results so far, and it's great that your sleep hasn't been affected too much. I hope things go well with your proposed taper plan. Please keep us updated on your progress and let us know how we can best help you. Feel free to use the Taper Tracker to log your doses and any symptoms. Glad to have you here! Catina ❤️

Hi Catina. This part has been easy because I took it very slow. I needed to gather some skills and info and alter my diet and change a bunch of habits to prepare myself. That continues. Preparation is really important. It's really valuable to have this site up and running, and I look forward to helping us all grow it. More soon! /jo

Hi Jo, and welcome to the community. 350 to 150 over a year is no small thing 👏 congrats on that! I'm really glad to hear it’s been mostly positive and that your sleep is still holding, even if it’s lighter. Your plan for May sounds thoughtful. As you go, just keep letting your body set the pace, especially once you get lower, things can get more sensitive. It seems like you’re doing this carefully and intentionally. Keep going, and reach out anytime as things shift. 💜 Jules

Thanks for sharing, it's good to hear other peoples experiences, also the fact you are noticing positives and sleep is still good is helpful for me, as I also have Seroquel in my taper plan

What I can tell you, Roy E, is that 400 mg of Seroquel (it's quetiapine to be clear) is a lot and you can easily reduce it by half over 6 months with little to zero risk even as you are reducing the Pristiq. This has been my experience at any rate. It is only when I go below 150 or even 100 mg that I expect to see some response from effected receptors. I was at 350 and sometimes 400 mg, and noticed zero problems so far (now at 150 XR). This tells me we were taking far more than any therapeutic effect requires. I have read from reputable sources (Joanna Moncrieff, among others) that quetiapine will shrink your brain faster at higher doses. I think it is reasonable to reduce the Seroquel by 50 mg as a test. If you don't notice any change, drop another 50 and hold there to see if any changes occur. You'd be at 300 and if no changes, go to 250 and wait. Then go to 200. I expect you will find no change at 200 mg/night. But it will reduce the harms while you balance some other factors, and also make it easier to tackle the quetiapine when you're ready. If you discuss this with your clinician, I'd be very interested to hear their response. I feel you can reduce the Seroquel significantly with little or no risk, accelerating your plan safely while reducing unnecessary 'load'. Receptor mechanics work in your favour with Seroquel at this point in your plan.

Yeah the brain shrinkage and induced dementia risk from quetiapine was the primary reason I realised I need to get off or at least significantly reduce the amount of quetiapine I'm taking. I was on 800mg XR for 14 years and barely questioned it. I only learned after that time that I was effectively left on the maximum dose, and I had no psychosis type symptoms at all the entire time, just doctors would see 800mg and assume there is a significant underlying issue and were reluctant to reduce me. I was doing a dual taper recently and switched over from XR to standard release, but I had a sudden onset of extreme daytime exhaustion, brain fog and my mental capacity also seemed to diminish, so since then I've gone up a little bit to a 400mg hold on Seroquel, and I'm increasing the Pristiq to 30mg for a little while. I want to see if the daytime exhaustion starts to go away once the Pristiq is up a little more, which would indicate that the issue is the effects on adrenaline from the Pristiq as the primary issue. I certainly feel somewhat better on half the original dose, my weight is also coming down too, but there is still a long way to go. I did want to reduce the quetiapine as the primary reduction initially, but apparently the anti depressant is recommended to be removed first. If I find myself struggling due to loosing the adrenaline side of the SNRI however, I might need to discuss doing things differently and focusing on the quetiapine first.

In my first response I hadn't realized the quetiapine dose was 800 mg. Reducing to 400 is fantastic. If you switched from the whole 400 mg XR does to the immediate release formula, you should expect some problems. The IR tabs last just 5-6 hours, leaving your receptors starving for some of that q. Or perhaps I misunderstand? At any rate, I use the XR tablets as the base. That stays in your system 24 hours, giving those receptors a steady supply. When I went down from 200 mg XR to 150 mg XR, I removed one 50 mg XR tablet and replaced it with two 25 mg immediate release tabs. Then I reduced by one 25 mg tab, and then a few weeks later took the other 25 mg tab away. That strategy 'cushioned' or buffered my reduction, and I never noticed any symptoms at all. I went from 350 XR to 150 Xr over about 9 months. The next nine months may not be so easy though. I will let you know how it's going. By the way, a warm bath with a half cup of magnesium flakes before bed will deeply calm your body and allow you to sleep more easily. Hang in there, man.

Wow. I’ve tried to taper off once before . I’m on 300 Xr now. When I went from 200 mg xr to 150 xr that’s when the rebound depression and anxiety started. you’re lucky .

Hi Jack: I have had an easy time of it so far. The main reason for that is preparation, more than luck. I've learned how to use breath work to manage stress and impose calmness when my system gets 'noisy'. It's very effective and gives me a tool I can use anywhere anytime to assert control over my state. It's been a game changer for me. I also made significant changes to my diet. Very low carb/plenty of healthy fats and proteins on and 18:6 IF schedule has me well fuelled and gives me stable energy. I focus on my metabolic health and exercise and internal work to keep my brain occupied on productive activities. It all helps. There's more to that, including IFS therapy and light. Sunlight in your face and eyes at dawn (or as early as possible) for 20 minutes and again at dusk does reset your circadian clock effectively. Routine matters. The brain understand repetition. Use that to your advantage. The stepping stone approach is a valid strategy wth Quetiapine. The smallest dose of the XR formula I know of is 50 mg. So I removed one 50 mg XR tablet but replaced it with two 25 mg immediate release tablets. Then in a few weeks remove one 25 mg tablet. A few weeks later remove the other. In 6 or 8 weeks you will have reduced the 'base dose' - that is, the XR amount - by 50 mg. Take a break and repeat. Two months later you're down by 100 mg and your receptors don't notice the difference. That's what I did. Now, reality. One 150 mg XR tab/night plus one 25 mg IR seems to be the lower limit for me. I'm good at this dose, and sleeping soundly, but that 25 mg IR tab only lasts about 6 hours. When it wears off I sleep lightly and might toss or turn a bit, but I am rested and alert when I get up. I will soon go to a base of 100 mg XR plus two 25 mg immediate release tablets. I may experience some problems then. I expect to, actually. But I am prepared for that. Whatever happens I know I can impose a kind of control over my body and my nervous systems by using breath work. It literally calms my whole system down and I can use my brain again. For example, my blood pressure drops by 5 to 10 points when I do my full decompression routine, which takes only 15 minutes and leaves me feeling steady, calm. and clear. I can't stress enough how much I love this ability. It is free. It is effective. It is easy to learn. When I'm distressed it is a safety valve. The pressure goes away reliably. Nobody but you can do that for you. I learned breath work in about 15 minutes. It took a few months for it to become routine. Now I do it every day at least twice and it just keeps me level and functional, even when I'm freaked out by something. Give yourself some space to breathe, literally. I hope this helps, Jack. hang in there.

"healthy" — @Jo

how do you do your breathe work ?

The IR tabs last just 5-6 hours, leaving your receptors starving for some of that q. Or perhaps I misunderstand? It does wear off by the end of the day, but it still has an effect to keep me stable, the main issue is I'm just far too tired on the XR version everyday, so having that break gives me some productivity after the 12 hour point of taking it. I'm mainly fighting the tiredness as the main issue at the moment, which complicates things, as I need to work so I can't dedicate all my time just to the tapering alone, trying to do it all while still working everyday is difficult.

"how do you do your breathe work ?" — @Jack Ryder

I'm being serious when I say the same way as everybody else. In and out. It's easy to look into the science that describes why controlled breathing affects your whole body including your brain, and that is the real answer. I simply count how many seconds I take to inhale, hold, and exhale, to control the rate or speed. Box breathing is 4 x 4 x 4. There are lots of patterns. Technique, or correct breathing, may take some practice to master but beginners can feel the difference right away, because that's how it works. No mystery. Find a place where you're comfortable and not distracted. Start box breathing for a few minutes and build from there. I can make myself drowsy, alert, or calm in minutes just using breathing patterns. Many guides on youtube. Ancient practice in all cultures. All that's required is your attention and your lungs.

"Box breathing is 4 x 4 x 4." — @Jo

I find box breathing to be very effective. It's great at calming the nervous system. 👍

"trying to do it all while still working everyday is difficult." — @Roy E

That is a challenging situation, Roy. The only leverage I've ever had is the difference between the IR and XR formulations. At 400 mg I would also be unproductive. It's just such a powerful drug. I have no clinician or help whatsoever, but it seems you do. If so, what is their guidance on the quetiapine titration?

@Jo I need to discuss more with my doctor next session, as after a fair bit of research I found something that may be contributing to the issues I'm having with my taper. While the standard release version of quetiapine has a short half life, it also has a metabolite called norquetiapine which is a strong norepinephrine reuptake inhibitor (NRI) medication with serotonin activity too, effectively an anti-depressant similar to Pristiq, with a half life of 9 to 12 hours. So there is more to tapering quetiapine than just the initial drug. At all doses, quetiapine is a extremely strong sedating anti-histamine, where as 150mg to 300mg it also has some serotonin activity, and above 300mg it has effect on dopamine also. However the complication that is going on with me I feel is that norquetiapine hasn't been factored in clearly, and because I was tapering both the desvenlafaxine which is an SNRI, and also at the same time tapering quetiapine, the norquetiapine means I was effectively also tapering two anti-depressant medications at once, along with an anti-psychotic. So although following the guidelines for the pristiq anti depressant taper and the Seroquel taper, it could be the fact norquetiapine is acting as a secondary anti depressant I'm effectively taking and tapering at the same time without knowing, putting the SNRI side of the taper becoming way too fast, which could have lead to a faster withdrawal than is safe and hence causing the sudden exhaustion and also the depression I experienced recently. The symptoms I experienced seem related to a sudden extreme drop in norepinephrine, so it makes sense since norquetiapine is very strong in that regard. So it's really worrying that quetiapine is effectively 3 drugs in one, I may need to choose to taper the Seroquel alone to levels where it's no longer affecting dopamine, while deciding what we do about the SNRI and norquetiapine side after that. It's definitely made things far more complicated.

I will have to do a deep dive on this important info. Thank you, Roy. If the SNRI aspect of your taper was doing dual duty as you suspect, and I think you may be correct, your insight informs other people's journey with some critical lived experience evidence. The 3-in-1 quetiapine effect is probably real as it does affect several actions, though dose-dependence is a new wrinkle. I hadn't construed it this way until now though, and I don't understand the metabolite, norquetiapine, yet. I can understand your situation clearly. Congrats for figuring this out by the way. Very interesting. I tend to agree with you that lowering the quetiapine (seroquel) to reduce its influence on the equation may be the safest climb down route at this time. I hope you find this development stabilizing and reassuring, Roy. You are clearly doing what you must to lick this, and I really want to see you do that. More soon. /j

If I recall you are currently at 400 mg IR, Roy? If so, I'd be tempted to lower that to 300 mg but make it XR and use the 25 mg immediate release (IR) tablets as required for sleep. And then try to get the XR down to 200 mg over a period of 6-8 months. Reducing the need for the Modafinil should be one outcome of that? Please do update when you can, I'm curious to hear more and throw my two cents in.