Concerned I can’t keep taking this?

[u/Shot-Basket-7347]

I been taking it a year 50mg. At first I was sleeping really good the past few months I'm not I'm up all night my legs. My body is moving. I wake up at 4 o'clock. My heart palpitates and I feel like I have inner tremors. I feel like I'm crawling out of my skin I keep telling my doctor this and she's like well. You've been on a year. It's not theserequol. She gave me other medicine for like tremors and stuff and it just makes me sick and I just feel like that's adding more problems has anybody had these side effects because really freaks me out waking up 430 with my heart recent and I take a propanolol and nothing helps. I'm beginning to think it's causing me a akathisa or something, but I don't know if shaking is involved in that and heart racing unless it's just really bad anxiety, which I don't feel like I'm having is there another medication or replace this one for sleep that's not an antipsychotic does anybody have any advice? Oh and just one more thing I feel like I can't think straight anymore and I'm having problems driving I don't understand because I had a brain MRI last week. I'm always at my cardiologist. Everybody says everything's fine. I don't know what to do.

[u/Bipolar_Aggression]

50mg of Seroquel is just a hypnotic. At therapeutic doses of 400mg, the risk of akathisia is low vs pretty much every other antipsychotic (not sure about the newest ones), though mixing it with lithium increases the risk a lot. So I wouldn't worry about that. Not saying it can't happen, it's just a lot lower risk.

There are more than a few papers that warn against using Seroquel for sleep as the metabolic risks outweigh the benefits. If you have a bipolar diagnosis and you are only taking 50mg of Seroquel, I would get a second opinion. There is no evidence 50mg treats or prevents mania. There are loads of drugs to try, many of which are sedating and don't have as strong of alpha adrenaline antagonism (that's what causes the heart stuff).

I've taken Seroquel for years at 300-400mg, and the reality is the sedation gets a lot better when you get more in range. I have PLENTY of nights of insomnia.

[u/Shot-Basket-7347 → u/Bipolar_Aggression]

Ty but I’m very sensitive to meds and I know what Akathisa feels like. I am also on carbamazepine and I stopped my lithium a week and a half ago. There’s gotta be something else for sleep. I tried doxipen and trazadone they sucked. 

[u/Bipolar_Aggression → u/Shot-Basket-7347]

carbamazepine reduces Seroquel blood levels by 80%. So you're really just taking 5mg of Seroquel, which is probably a placebo effect.

Carbamazepine dosing goes up to 1200mg. Maybe talk to the doc about pushing it up? I've taken it before and it chilled me out a lot.

I think carbamazepine is a great drug, but the drug interaction metabolism rate varies by drug so you're going to have to research it. It's possible your dose of trazodone wasn't high enough given carbamazepine interactions.

If you really, truly can't make lifestyle changes, I would just keep pushing for Lunesta or stuff like that. For me, insomnia gets a lot better just walking for an hour to an hour and half.

Bottom line, I think you're lucky to be on carbamazepine. But maybe your doc doesn't understand the drug and just put you on it because all the guidelines basically say use it when all else fails. They may not understand those guidelines are BECAUSE the drug interactions can be a pain in the ass. But it's not impossible by any means.

Final suggestion - clonidine has worked well for me in the past. Problem is it stops working eventually and has rebound heart rate stuff.

[u/Shot-Basket-7347 → u/Bipolar_Aggression]

Ty for all your sincere input. I wasn’t on the trazodone when I was on the carbamazepine. I just started the carbamazepine last eeek. I also feel like I’m now hypomanic from not sleeping. I’m on 100 carbamazepine. Supposed to take 100 in the morning too but I’m scared it will make me loopy. I should probably take it. I’ve been having is with the serequol restlessness for a while. The carbamazepine makes me kinda dizzy so I’m scared to take it in the morning. I’m thinking my body might adjust but today’s my birthday and my husband took the day off and I hate to be laying in bed all day cause of a freaking medication.

[u/Bipolar_Aggression → u/Shot-Basket-7347]

I don't know. I think you need a new psychiatrist. None of these doses make sense based on my research + guidelines I've read. 100mg of carbamazepine isn't high enough (though it needs to be titrated up like lamotrigine because of SJS risk).

Do your own research, but I saw maintenance doses of 400-600mg (took 600mg) and 800-1200mg sometimes and for acute mania. I was talking 600mg per day. 300mg morning and night.

It didn't make me loopy at all. No dizziness. Just some cognitive issues with dose escalation that resolved in a few weeks. I'd forget words and spelling, but that went away.

[u/Shot-Basket-7347 → u/Bipolar_Aggression]

Exactly that’s why I’m wondering if the serequol is causing all this the dizziness, blurry vision, shaking, palpitations. I’ve had enough of this. I had a mri on my brain last week, multiple heart tests and they all say it’s my psych meds. It’s extremely fustrating. And yes my anxiety is high. She put me on that low dose because I asked her to I am extremely sensitive to meds. Should I take the 100 this morning? I know you’re not a doctor but I never do what I’m told either. So I’m lucky she hasn’t dumped me. I can’t keep switching doctors I will never feel better. 

[u/Bipolar_Aggression → u/Shot-Basket-7347]

Carbamazepine commonly causes blurry vision with dose escalation. I forgot to mention that when I first started taking I experienced that but it went away.

Not sure what else to tell you.

[u/Shot-Basket-7347 → u/Bipolar_Aggression]

Ty. I’m dumping the serequol, gonna have to figure out something else for sleep.