You are going to sleep a lot!
If you are planning to take Seroquel (quetiapine), expect that you are going to sleep an awful lot. So much so, that you should assume that you won't be able to do much of anything for 5-7 days after you start taking it. No office work, no social activities, no house work. Don't even assume you'll be able to do little everyday tasks.
The only thing I did in the first five days is sleep, stagger groggily around the house, sleep more, feed the dogs, eat, and then take meds and go back to sleep. Really. For five days.
It started improving somewhat after the 5th day, but slowly.
If you decide to take Seroquel, I recommend that you...
- Take vacation for at least 2 weeks.
- Tell people that you will not be able to attend any social activities for two weeks.
- Hand over all the tasks that you do at home to someone else. This includes tasks like taking out the garbage or doing dishes or cooking.
- Don't expect to be able to drive.
- If you have responsibilities elsewhere, hand them over temporarily to someone else for about 2-3 weeks.
You may not be able to supervise or take care of children or pets for at least a week, so make sure someone else is able to do that. I am not kidding. You are likely to be that groggy.
Start with a low first dose and increase it slowly
Talk with your psychiatrist about starting with a low dose at first (maybe 50-100 mg Seroquel per day) and slowly increasing in 50 mg steps every 2 days until you reach the prescribed dose. That way you have time to get used to the Seroquel.
If your prescribed dose is higher than 300 mg, slowly increasing your dose in steps extends the amount of time you'll be out of commission. Assume that for each additional 50 mg step past 300 mg, you'll need 1-2 days extra vacation.
If you start off by taking a dose of 200 mg or more, there's a good chance you'll sleep for upwards of 20 hours the first night. I was prescribed an initial dose of 200 mg and I then slept for 32 hours! Sleeping for so long is scary and kinda traumatic.
The sleepiness and the grogginess may make you want to stop taking Seroquel. But wait for a 2-3 weeks before deciding - the extreme sleepiness and grogginess passes with time. Contact your psychiatrist to adjust your dose if you find the grogginess is excessive after this time.
Seroquel increases my Productivity
When I take Seroquel, it allows me to make decisions and make things happen. It feels more like something that helps to increase my productivity - more like a focusing and doing aide. For me, Seroquel feels more like an anti-manic or a mood stabiliser - very similar in action to Tegretol.
Seroquel also works as an anti-anxiety drug, and makes me noticeably less anxious and less fearful of people - so I'm more likely to call someone, answer my phone, send or reply to an e-mail, write a business letter, call a friend, or feel comfortable talking to people generally.
...but still makes me groggy
So, if I can communicate with people more and get more done, then this is great, right? Well, it's not quite a free ride. Even after becoming accustomed to the Seroquel, I still felt groggy during the day. In fact I felt like falling asleep every time I sat down, though it didn't interfere with the stuff I wanted to get done.
I found that getting out of chairs can be an effort - it requires me to have two hands on the arm rests and to make a deliberate effort to stand up. I also tend to lean against things when I'm standing up.
...and causes sugar cravings
One of the odd side effects of Seroquel is that I have to have sugar every 1 1/2 to 2 hours - if I don't get the sugar, I get wan, light headed, and groggy enough to pass out.
This means that when I wake up, I have a cup of sweet hot chocolate (2 heaping teaspoons of sugar), and then throughout the day I drink hot chocolate every two hours or so. Or have biscuits (Pepperidge Farm Brussels cookies, yum!). Or Coke. It's a pretty high sugar intake daily and it seems to be necessary.
Oddly enough, coffee doesn't seem to have a noticeable effect in stopping the grogginess. Nor does a regular meal like lunch, unless I have a Coke or juice with it.
...and chapped lips
The other noticeable side effect has been if I don't drink enough fluids, I get chapped lips and dry hands. Given that I drink so much hot chocolate, this hasn't been a big deal, but I'd recommend that you keep moisturising cream and a tube of lip balm close by because the chapped lips can be painful.
Seroquel makes me very sleepy
I take my dose of Seroquel XR (200 mg) on evenings around 6:00 - 6:30 pm. Once I take it, the Seroquel causes me to fall asleep within 2-3 hours, so that I am usually in bed between 8:00 pm and 9:30 pm.
The time before I fall asleep is fairly variable and has varied from as little as 1 hour after taking the meds to up to about 4 1/2 hours.
Crucially, there is very little time between when I realise the Seroquel is going to knock me out and when it actually does - there's about 15 minutes between when I start feeling groggy and when I fall asleep. The sleepiness is intense and it is extremely difficult to fight to stay awake.
...and messes with my social life
What this means is that after I take Seroquel I can't drive at all - I may fall asleep at the wheel. It also means that if I want to do any social activities after 6:00 pm, someone has to provide transport and I may very well fall asleep at a restaurant or in the cinema or at a cocktail party. Or I may stagger around groggily, looking very much as if I am drunk.
Since the time between when I take the Seroquel and when I fall asleep is so variable, I can't accurately predict if I will be okay when I go out. After a few attempts at socialising where I fell asleep or was extremely groggy, I found it easier to simply stay at home after taking the dose of Seroquel.
Yes, I could take the medications later than 6:00 pm. But how late? Suppose we say about 10:30 pm, so I can go out with friends for dinner.
...and screws up the next day if I take a late dose
With the Seroquel, I consistently sleep for about 9-10 hours every night. If I take the dose at 6:00 pm as I do now, and fall asleep at around 8:30 pm, then I will get up at about 5:30 - 6:00 am. After coping with the groggy morning (all mornings are a bit groggy on Seroquel), I am able to start the day about 8:00 am. Not too bad.
If I take the Seroquel dose at 10:30 pm and fall asleep immediately, I'll wake up 7:30 - 8:00 am. Add in two hours of being somewhat groggy on awakening and I'm not ready to face the morning until about 9:30 - 10:00 am. That's a little late to get the day started, and leaves me out of sorts and fairly unproductive for the rest of the day.
...really messes with my social life!
Bottom line - If I go socialising with friends to even a moderate hour on evenings and take the Seroquel dose on returning home, I lose the following day. If I take the dose before going out with friends or while out with them, I may fall asleep while socialising.
After a while, I started suggesting to friends and family that we meet for breakfast, or lunch, or a coffee at 4:00 pm.
I can't exercise on mornings
It turns out that I also can't exercise on mornings. The grogginess that bothers me on mornings affects my coordination and can leave me staggering about like a drunken man. It's not a state conducive to exercise. The grogginess effect wears off during the day, so the best time to exercise is the 3-4 hours before I next take my medications.
...and travel requires careful planning
If you plan to travel, the grogginess and tendency to fall asleep matters. When I had to travel, I had visions of falling asleep in the airport and missing my flight. Or having flight attendants being unable to wake me at the end of the flight. Or staggering up to an Immigration official as if I was drunk or drugged.
The concern was sufficient that I temporarily stopped taking the Seroquel a few days before I started on my vacation travel.
More prosaically, I wonder if people taking Seroquel who have subway or train or bus rides fall asleep and regularly miss their stops.
My daily schedule on Seroquel...
I suppose I could adjust the organisation of my day so that I can use my evenings more, but I am not sure how. With Seroquel, there seems to be a fixed amount of time that I spend asleep or groggy, about 10-12 hours a day and that amount doesn't seem to decrease with ongoing Seroquel use. The only trade off seems to be between having more awake time on an evening vs. on a morning. Here's my daily schedule
- 6:00 am: Wake up.
- 6:00 am - 8:00 am: Wander around the house groggily and out of focus.
- 8:00 am - 6:00 pm: Do regular activities during the day
- 6:00 pm - 6:30 pm: Take medication - Seroquel XR (200 mg).
- 6.30 pm - 9:30 pm: Stay home and do stuff / relax until I fall asleep.
- 8:00 pm - 9:30 pm: Go to bed
Any time I go to sleep later, I wake up later, and the regular activities of the day start later. It's more like I am rotating the entire schedule rather than adjusting or fine tuning it. That rotation may work better for some of you, but I like the relatively early start of the day.
Should you take Seroquel?
Once, I get past the initial sleepiness, Seroquel does work as a mood stabiliser - it makes me more able to focus, and more able to get things done, and it allows me to interact with people more easily. I get more done and I keep in contact with the people more reliably.
However, balanced against the productivity is the sleepiness / grogginess that never completely went away and which remains an intrusive element in my life. I definitely gain functionality, but I also lose half the day to sleep.
Whether taking Seroquel is a net benefit depends on how functional / productive you are. If you are currently not very functional or have high anxiety, then half a day where you are capable of working and interacting with people is definitely a benefit.
If however, you are already fairly productive, or if you are capable of dealing with people without anxiety, then gains in clarity of thought and reduced anxiety may not outweigh the ongoing sleepiness / grogginess.
Note: If I take any medication regularly, I develop a resistance and it stops working. That's why I stopped taking Seroquel.
You might feel cold when coming off Seroquel
For about six days after I stopped taking Seroquel, I complained a lot about feeling cold. A lot. Didn't matter where I was.
It’s always hard to pinpoint what causes a symptom and after coming off Seroquel I had been getting very little sleep. But the complaints of being cold...
- Only started after I came of the Seroquel, and
- I’ve handled sleepless nights before with fairly mild aftereffects, and
- The temperature here had been 24-30 degrees Celsius (75-85 F).
I’ve put feeling cold as a possible side effect of coming off Seroquel. Any feedback in the comments would be appreciated.
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First published 21 Aug 2012. Updated 5 Jan 2019.Old Wordpress Comments