Seroquel is an increasingly popular prescription drug for treating schizophrenia and bipolar disorder. According to a 2013 Intercontinental Medical Statistics (IMS) Health report, doctors wrote over 14 million prescriptions in 2013.1
It’s been about two decades since the abuse potential of Seroquel started to appear in case reports. People most commonly abuse drugs to get high. Seroquel does not produce any such effects. Thus, it is not generally considered a drug of abuse that would require treatment in a rehab facility. Nonetheless, people may use it to enhance or counter the effects of marijuana and cocaine.
Seroquel is the brand name of a drug used to treat mental disorders. The US Food and Drug Administration (FDA) has approved the drug to treat schizophrenia, bipolar disorder, and (when combined with antidepressants) severe depression. It is available in the form of conventional and slow-release tablets.
Besides, a doctor may prescribe Seroquel for disorders other than those for which it is approved by the FDA. The practice of prescribing an approved drug for non-approved conditions is called off-label use. In the US, Seroquel is widely prescribed for several non-approved conditions, such as:2
Psychosis in people who have Parkinson’s disease
The active drug in Seroquel is quetiapine. Quetiapine prevents a chemical – dopamine – from binding to its receptors in the brain. Dopamine is a neurotransmitter, a chemical that helps brain cells communicate with each other. A healthy balance of dopamine is critical to mental and physical health. Too much dopamine is associated with schizophrenia, and too little dopamine can cause depression.
Q-ball (Seroquel with heroin or cocaine)
Maq-ball (Seroquel with marijuana)
The rising number of abuse reports suggest that Seroquel may be addictive. That said, abuse and addiction are not the same.
Drug abuse refers to any use other than that which is recommended by a physician. Addiction is a long-term brain disease that causes compulsive use of a drug despite the known harms. Long-term abuse may lead to an addiction. However, a person may abuse a substance and still not be addicted to it.
Researchers are studying how Seroquel may cause addiction. To date, they have not reached a conclusion. Interestingly, quetiapine does not fit into any specific theory of addiction. Unlike cocaine, it does not cause a rush of dopamine in the brain’s reward system. In fact, it decreases the levels of dopamine in the brain.
Some researchers propose that Seroquel’s sedative and calming effects may lead to an addiction. Nonetheless, this theory has not been widely accepted in the medical community.
A majority of people who abuse quetiapine have a history of benzodiazepine use. Yet quetiapine and benzos do not act in the same way.
Seroquel may cause psychological dependence. In addition, a few animal studies suggest that it may cause physical dependence. However, more studies are needed to establish the findings.
No human studies have found that Seroquel is physically addictive. Nonetheless, some studies on rats suggest that the drug may cause physical dependence. According to drug experts, Seroquel may cause psychological dependence. This might be the cause behind the purported addiction risk.
Seroquel belongs to a class of medications known as atypical antipsychotics (AAs). AAs are also known as second-generation antipsychotics. Unlike typical antipsychotics, AAs carry a lower risk of side effects, such as movement disorders of the face and body.
Drugs in this class are used to treat hallucinations, paranoia, and delusions. These symptoms are the hallmarks of mental disorders like schizophrenia and bipolar disorder.
Some atypical antipsychotics available in the US are:
No, Seroquel is not narcotic or opioid. It is a member of a class of medications called atypical antipsychotics. Narcotics act on opioid receptors. They are commonly used to treat severe-to-moderate pain. Seroquel works by altering the levels of neurotransmitters, most notably dopamine.
Seroquel is not a controlled substance. The DEA categorizes substances into one of five schedules based on their abuse potential and risk of causing dependence. Because Seroquel is not generally considered a substance of abuse, it is not included in any of the schedules.
Any FDA-approved drug is typically safe when it is used as recommended. That said, some medications carry more severe health risks than others. The safety of a drug depends on several factors, including how it is used, what precautions are taken, and inherent drug factors. Some drugs have a lower safety margin than other drugs.
The safety concerns often involve the effects of abuse, overdose cases, and potentially life-threatening side effects. There have been reports of death related to quetiapine use in the past. In 2008, the drug was involved in 25 deaths among children 16 years and younger.4
Seroquel may increase the risk of death in older adults who have dementia. Dementia causes memory loss and reduced focus. Seroquel may also make a person more likely to have suicidal thoughts.
Antidepressants are known to increase suicide risk in young adults, especially during the initial phase of treatment. Therefore, combining an antidepressant with Seroquel may increase the risk further. Notably, the risk may be higher in people with a history of depression and other mood disorders.
A doctor should be called immediately if a patient taking Seroquel has one or more of the following symptoms:5
Suicidal thoughts or attempts
Development of new depression
Worsening of depression
Anxiety (may be new or worse than before)
Extreme agitation or restlessness
Problems falling or staying asleep
Aggressive and violent behavior
Abnormal mood or behavioral changes
Quetiapine can harm the fetus. The American College of Obstetricians and Gynecologists does not recommend long-term or routine use of Seroquel during pregnancy.
Nonetheless, a doctor may prescribe the drug if the benefits outweigh the potential risks. In such a case, they may recommend folic acid to prevent damage to the structure that forms the brain and spinal cord in the infant.
Higher doses may pass into breast milk. However, doses under 400 mg cause a minimal increase in the levels of the drug in milk. There have been no reports of severe outcomes in breastfed infants. People who want to use Seroquel while breastfeeding should consult their doctors about the potential risks.
Quetiapine tablets may be taken with or without food. The usual dose of conventional tablets is one to three times per day. Slow-release (long-acting) tablets should be taken once daily, usually in the evening. Medication should always be taken at the same time each day. Doing so helps reduce the odds of missing doses.
Patients should read the prescription label carefully, follow the instructions, and never take the drug in higher doses or at a higher frequency than has been recommended by a doctor.
The long-acting tablets should be swallowed whole. Chewing or crushing them can cause a rapid release of quetiapine into the bloodstream. This is not desirable and may make the side effects worse.
Quetiapine is the most commonly abused second-generation antipsychotic, accounting for over 60% of all cases of abuse. There were 2,118 cases of abuse between September 2003 and September 2013.1
Abuse can lead to serious outcomes that may require hospitalization. Hospitalization may be necessary for over half of the people who abuse/misuse quetiapine.6
Case reports suggest that abuse is most prevalent in correctional facilities, community, hospitals, and inpatient psychiatric facilities. Data about abuse in the general population are not available. Yet the emergence of street names and street prices show the drug has reached far beyond hospitals.
People may abuse Seroquel by:
Swallowing the pills
Snorting crushed tablets
Injecting the solution made from powdered drug
The following behavioral and physical changes may help to identify Seroquel abuse:
Stealing the drug or buying it from friends or family members
Constant or frequent nasal congestion (can indicate snorting)
Track marks (if the drug is injected)
Uncontrollable movements of the jaw, lips, and tongue
Changes in sleep schedule
Problems with focus
Following oral use, Seroquel reaches peak blood concentration in about 1.5 hours. The long-acting forms usually take up to 6 hours.
The side effects of short-term Seroquel use can include:
A drop in blood pressure, especially when changing position
Using Seroquel for 4 weeks or more can cause movement disorders known as extrapyramidal side effects (EPS).7 The longer the duration of use, the higher the risk of EPS. The most common symptoms of EPS are:
Uncontrollable muscle contractions that can cause tilted neck, lockjaw, and slurred speech
Increased internal restlessness
Problems with using or understanding words
Intense urges to move
Abnormally fast or slow movements of the fingers
Enlarged breasts in men
Long-term use of Seroquel may cause:
Cataracts. A cataract causes an opaque area in the lens of the eyes. It affects vision, especially night vision. People taking Seroquel should get their lenses tested before beginning treatment and again every six months.
Abnormally high blood levels of the hormone prolactin (hyperprolactinemia). Signs of hyperprolactinemia include infertility, irregular menstrual periods, decreased sex drive, and unusual discharge from the nipples.
Increased blood cholesterol levels
Changes in appetite
Increased blood glucose levels
Suicidal thoughts or behavior
Death or coma from Seroquel alone is rare. Survival in overdoses up to 30 grams of quetiapine has been documented. Nonetheless, death can occur in some cases. The risk of overdose is high in people with underlying heart disease and in those who are using multiple drugs.
Emergency department (ED) visits involving quetiapine increased by 67% from 19,195 in 2005 to 32,024 in 2011. About 75% of these visits involved a combination of quetiapine and other drugs.6
Benzodiazepines, antidepressants, and alcohol are the three most common substances involved in quetiapine suicide attempts. The other illicit substances involved in quetiapine suicide attempts are marijuana, cocaine, and heroin.6 The use of quetiapine for suicide is more common in women.
Taking too much Seroquel in a short period can cause the following signs and symptoms:
Extremely low blood pressure
Increased muscle contractions
If an overdose is suspected, a doctor or the American Association of Poison Control Centers (1-800-222-1222) should be called immediately. In the case of severe overdose symptoms, it is better to call 911 or visit the nearest emergency room immediately.
Before starting treatment, a doctor will order tests to measure electrolytes, liver function, and kidney function. Moreover, a blood test to determine whether other drugs have also been taken may be necessary. This is critical because most people visiting the ED have used other drugs with Seroquel.
No antidote for quetiapine overdose is currently available. Treatments are supportive and can include:
Patients who think they no longer need Seroquel should always talk to their doctors and should never attempt to stop taking the drug on their own. Abrupt discontinuation may cause undesirable effects called withdrawal symptoms.
The FDA states that Seroquel may increase the risk of suicide. Unsupervised discontinuation can make depression worse, which may contribute to suicidal thoughts or behavior.
Usually, withdrawal symptoms begin to appear 24 hours after the last dose. Someone who is taking the long-acting tablet may experience withdrawal 35 hours after stopping use.
Withdrawal symptoms may include:8
A drop in blood pressure when standing up from sitting or lying down
Rapid heart rate
Notably, if a person has taken low doses for less than 3 months, they may not experience withdrawal symptoms. Nonetheless, doctors recommend evaluation for at least 14 days after stopping use.
Tapering or gradual dose reduction is necessary if a person has:
Taken high doses for less than 3 months
Received Seroquel treatment for more than 3 months
Doses should be tapered under medical supervision. Unsupervised dose changes increase the risk of severe side effects, relapse, and unfavorable treatment outcomes.
Seroquel abuse is hardly severe enough to require treatment at an inpatient facility. That said, intensive treatment is necessary, especially for those who already have addictions or mental disorders.
Treating co-occurring abuse disorders or psychiatric conditions is of paramount importance. This is because Seroquel abuse is most common among people who have some forms of mental disorder or a history of drug addiction.
Detox is the first step in addiction treatment. During detox, the patient will receive medication and talk therapy to help their body eliminate Seroquel. Cravings and withdrawal symptoms are common during detox. This is also the period with the highest risk of relapse.
The duration of detox depends on the history of drug use and the amount of Seroquel abused. However, it usually lasts for about a week.
The two most frequently used talk therapies for Seroquel abuse treatment are:
CBT is perhaps the most effective nondrug treatment for addiction. It is based on the theory that our thought patterns determine our drug use behavior. CBT sessions are typically 30 to 60 minutes long. Patients will need to attend up to 20 sessions during the entire treatment.
Contingency management is another powerful tool to treat addiction. CT is based on the theory that we tend to repeat those behaviors that are rewarded. Research has shown that CT can be more effective in people who have an addiction as well as mental illness. Because many people with Seroquel abuse also have a co-occurring psychiatric disorder, CT can be effectively used to maintain sobriety.