Reducing Quetiapine: Slow and Steady Wins the Race

I started The Bipolar Project with the intention of tracking my reduction of Quetiapine Fumarate (aka Seroquel). Since reducing the drug in 2011 there have been various issues that have prevented me from reducing at a steady rate throughout the past two years. In fact, in 2012 I didn’t reduce it at all.  Some of these issues have been Bipolar related but most have been completely unrelated circumstances that impacted on my emotional health, left me stressed out and miserable and my life just a little too chaotic to embark on a medication free life.

Slow and steady

If you’ve been with me from the start, I was initially on 400mg. I managed to reduce that by 125mg throughout 2011. When I stopped my contraceptive pill and my mood went haywire, I upped it back to 300mg and left it there for over a year. I started reducing again about four months ago and am now down to 206.25mg nightly. This quick reduction had minimal effect on my mood (apart from taking me a bit longer to fall asleep and feeling a little more tired the next day).  When I reduced it a couple of nights ago I noticed I was a little more irritable for two days afterward.

When I first started I had a number of rules: no alcohol, regular sleep pattern, exercise vigorously and regularly, only reduce by 6.25mg at a time. At the time, exercise was a major mood stabiliser for me and I noticed resistance exercise, like lifting weights, was better for my mood than just cardio.

Now, I’m too unwell to do vigorous exercise and resistance exercises are pretty much out of the question. Surprisingly, that doesn’t seem to have negatively impacted on my mood during the reduction. But I’m still exercising (I walk and do yoga pretty much every day – less than 30 minutes all up), but not the way I used to (spin classes, weights, long horse riding sessions, full length yoga classes).

There haven’t been as many positive effects this time around but these are probably being masked by my poor physical health. I’m so fatigued all the time that if being on less Quetiapine is making me less tired and improving my concentration, then I just don’t notice it.

I’ve slowed down the reduction again because I noticed I was getting pretty emotional, probably because I was extremely anxious and moderately depressed. Again, these seem like pretty normal responses given the events of the past year but ultimately, if my mood is unstable, it doesn’t matter what’s causing it – the reduction must be slowed down. Within the next week or so I plan to bring it down to 200mg and leave it there for a few weeks.

If you’re on psychiatric medications and have tried reducing or stopping your drug, what have you experienced?

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Bipolar and Me: A brief history

In the past I have been diagnosed with and/or treated for Social Phobia, Generalised Anxiety Disorder, Major Depressive Disorder and Chronic Fatigue Syndrome.

I was first treated for severe depression when I was 14 years old. In actual fact I had suffered from both depression and some level of mania prior to this.

I wanted to be a Clinical Psychologist before I knew I had psychological problems.

I was diagnosed with Bipolar Disorder in April 2008 after seeing one clinical psychologist and two psychiatrists.

My official diagnosis is Bipolar I featuring rapid cycling and mixed moods.

Initially, I paid little attention to my diagnosis, had no intention of taking medication and believed I was only showing symptoms because I had read about Bipolar Disorder in one of my textbooks. Later, I believed a brain tumour was responsible.

I know these days people tend to refer to rapid cycling as ultra, or ultradian or some variant of this. I don’t know specific terms because I actually don’t care. Personally, I find it a bit annoying when people specify they are a rapid cycler, or an ultra-ultra rapid cycler. Usually it’s done in a manner which implies “if you don’t cycle as rapidly as me, then things aren’t as bad for you”.  I think that’s bullshit. So, I have had rapid cycling in the past, and it has been really really fast, and it has slowed down over time, and then sped up again. That’s all you really need to know.

I’ve never been hospitalised. It was suggested, and I should have been but the fact I wasn’t was entirely because of the next point.

I am exceptionally good at hiding my symptoms even when severely unwell.

I haven’t had a pure mania since 2008.

I once turned up the emergency department and told them to admit me. I was forced to wait alone for a ridiculous length of time. Given the rapid cycling I mentioned earlier, my mood changed and I seduced a man and left the hospital. My parents were not phoned. No one ever tried to find me.

Even when I was delusional and losing touch with reality, even my best friend thought I was “pretty much okay”.

I started taking Quetiapine at 6.25mg per night. It took me two years to get to 400mg.  This meant my recovery was long and drawn out, but the drug was well tolerated and my adherence exceptional.

I only decided to take medication because I thought I had contracted Genital Herpes (I hadn’t).

I am incredibly loyal. Even when completely manic, I slept with anyone except my friends’ boyfriends; even when they tried it on with me.

I have never purposefully not taken my medication. I forgot once or twice after a night out, and so just took it in the morning instead.

I went to four different high schools.

I have never attempted suicide.

I like writing a blog about having Bipolar Disorder, but I don’t know why.

I have no professional interest in Bipolar Disorder. I used to think I should but I’m just not interested.

I don’t  say “I’m Bipolar” because I’m not. I have this disorder. It doesn’t have me.

I don’t want any new friends, thanks.

300mg Quetiapine (The withdrawal has ceased. There is no timeline to begin again). 

Bipolar and me; we’ve been together for a while. At least 13 years by my count, maybe longer but no shorter. We’re friends really. We’ve spent a lot of time together over the years, been through a lot. There have been good times, and there have been bad times, and there have been plenty of them. Bipolar is quieter now. But every now and then it stops in to say hello. It’s a relationship. A bond. It’s not a battle anymore. It’s just me and Bipolar. We’re together, and I’m okay with that.

I didn’t always think this way. There was a time when I thought Bipolar was the worst thing in the world. Where it seemed completely unmanageable, and insurmountable. Where it seemed as though the suffering would never end. But it did, as it always does, and I bounce back to being me. It’s our pattern. It’s our thing, and I’m okay with that.

But close friendships like this, they best work in pairs. That’s what I think. There’s no room for intruders. We don’t want to share our space, our secrets, our lives with anyone else. It’s me and bipolar, and no one else. I learnt to be okay with that.

Except, now we have Arthritis at our door, and it won’t leave us alone. Like an unwanted visitor, it showed up one day when we least expected it and refuses to leave because it knows that we’re inside. It saw me turn the lights off when it pulled up in the drive. I’ve got the door  firmly shut but it’s sitting out there, waiting for us to let it in.

Knock, knock, knock.

But, bipolar and me, we won’t answer. We’re not in. No one is here. We don’t need anymore friends.

Except, this is not how things work in reality. I’d like to say it is, but it isn’t. There is no door, and if there was, arthritis would have broken it down long ago and I’d be lying on the couch in an illness sandwich. Mental on one side, physical on another, and me in the middle. They’d think it was a game, fun even but it wouldn’t be. No one likes to get squished.

The truth is, no matter how hard I want to close that door and pretend that arthritis isn’t out there. It is. And it’s not really out there at all. It’s in me. It’s in my house. It’s  made itself at home.

Threesomes have never been my thing. But at some point, I’m going to have be okay with it.