Is quetiapine abuse a growing concern in addiction treatment. How does recreational use of Seroquel compare to other antipsychotics. What are the risks and benefits of prescribing quetiapine for sleep and anxiety disorders.

The Rise of Quetiapine Use in Addiction Treatment

Quetiapine, sold under the brand name Seroquel, has seen a significant increase in off-label prescriptions, particularly for treating sleep and anxiety disorders in patients with addiction issues. This trend has sparked debate in the medical community about its appropriateness and potential for abuse.

Why has quetiapine become a popular choice for addiction treatment? There are several factors at play:

• It has fewer parkinsonian side effects compared to first-generation antipsychotics
• Patients tend to accept it more readily than other medications
• It can address common comorbidities like insomnia, anxiety, and depression
• It’s perceived as having a lower abuse potential than benzodiazepines or z-drugs

Examining the Evidence: Is Quetiapine Abuse a Reality?

Despite growing concerns about recreational use, the evidence for widespread quetiapine abuse remains limited. Reports of abuse often lack clear definitions or diagnostic criteria for addiction. Most cases involve individuals with pre-existing substance use disorders experimenting with various drugs.

Key points to consider:

• Terms like “abuse” and “misuse” are often used without standardized definitions in the literature
• Reports of recreational use rarely describe euphoric effects
• Quetiapine’s pharmacological profile makes it unlikely to produce a “high”
• Difficulties with dose tapering are common with many psychotropic medications and don’t necessarily indicate addiction

Quetiapine vs. Other Second-Generation Antipsychotics

How does quetiapine compare to other atypical antipsychotics in terms of abuse potential and therapeutic use? While quetiapine has gained attention for off-label prescribing, it’s important to consider its profile alongside other medications in its class.

Comparative Abuse Potential

Studies examining the relative abuse potential of second-generation antipsychotics are limited. However, some observations can be made:

• Quetiapine is more commonly reported in abuse-related events compared to other atypicals
• This may be due to its more widespread use rather than inherently higher abuse potential
• Olanzapine and risperidone are occasionally mentioned in abuse reports, but less frequently
• The sedative effects of quetiapine may contribute to its popularity among some users

Therapeutic Considerations

When comparing quetiapine to other second-generation antipsychotics for off-label use in addiction treatment, several factors come into play:

1. Sedation: Quetiapine tends to be more sedating, which can be beneficial for sleep disorders
2. Anxiolytic effects: It may have stronger anti-anxiety properties compared to some other atypicals
3. Weight gain: Quetiapine has a moderate risk of weight gain, while some others (e.g., olanzapine) carry a higher risk
4. Dosing flexibility: Lower doses can be used for sleep/anxiety, while higher doses treat psychotic symptoms

Balancing Benefits and Risks in Clinical Practice

Given the complex nature of addiction treatment, how should clinicians approach the use of quetiapine? A nuanced understanding of its benefits and potential drawbacks is essential.

Potential Benefits

• Addresses multiple symptoms common in addiction (insomnia, anxiety, mood instability)
• May reduce cravings for some substances
• Lower risk of respiratory depression compared to benzodiazepines
• Can be used in patients with a history of substance abuse

Potential Risks

• Metabolic side effects (weight gain, diabetes risk)
• Potential for misuse, especially in vulnerable populations
• Risk of overdose, particularly when combined with other CNS depressants
• Long-term effects of off-label use are not well-studied

Clinicians must carefully weigh these factors for each patient, considering their individual needs, history, and risk profile.

Understanding Quetiapine’s Pharmacology and Abuse Potential

To better grasp why quetiapine might be sought after recreationally, it’s important to examine its pharmacological profile. Unlike drugs of abuse that typically target dopamine systems directly, quetiapine’s effects are more complex.

Receptor Binding Profile

Quetiapine interacts with multiple neurotransmitter systems:

• Serotonin (5-HT2A) antagonism: Contributes to antipsychotic and antidepressant effects
• Dopamine (D2) antagonism: Antipsychotic action, but with lower affinity than other antipsychotics
• Histamine (H1) antagonism: Responsible for sedative effects
• Alpha-1 adrenergic antagonism: May contribute to anxiolytic properties

This diverse binding profile explains quetiapine’s broad therapeutic effects but also complicates the understanding of its abuse potential.

Theories on Recreational Appeal

Several hypotheses have been proposed to explain why some individuals might seek quetiapine for non-medical use:

1. Sedation seeking: The rapid onset of sleepiness may be desirable for some users
2. Anxiolysis: Its calming effects could be appealing, especially to stimulant users
3. Self-medication: Individuals may use it to manage withdrawal symptoms or sleep disturbances
4. Potentiation: Some may believe it enhances the effects of other substances

It’s crucial to note that these theories do not equate to evidence of addictive properties comparable to traditional drugs of abuse.

Navigating Off-Label Prescribing: Ethical and Legal Considerations

The increasing off-label use of quetiapine raises important ethical and legal questions for healthcare providers. How can clinicians balance patient needs with responsible prescribing practices?

Ethical Considerations

• Beneficence: Providing effective treatment for complex symptoms
• Non-maleficence: Avoiding potential harm from inappropriate use
• Autonomy: Respecting patient preferences while ensuring informed consent
• Justice: Equitable access to treatment options

Legal and Regulatory Issues

Off-label prescribing is legal in many countries but comes with responsibilities:

• Ensuring evidence-based practice and documenting rationale
• Obtaining informed consent, including discussion of off-label status
• Monitoring for adverse effects and reporting as required
• Staying informed about evolving guidelines and recommendations

Clinicians should familiarize themselves with local regulations and institutional policies regarding off-label prescribing of antipsychotics.

Quetiapine in Vulnerable Populations: Special Considerations

The use of quetiapine in certain patient groups requires additional scrutiny due to potential risks and unique considerations. Let’s examine some of these populations:

Elderly Patients

Older adults may be particularly vulnerable to the side effects of quetiapine:

• Increased risk of falls due to sedation
• Potential for cognitive impairment
• Higher susceptibility to anticholinergic effects
• Interactions with other medications commonly used in this age group

Clinicians should use caution and consider starting with lower doses in elderly patients.

Adolescents and Young Adults

The use of quetiapine in younger populations raises several concerns:

• Limited long-term safety data in this age group
• Potential impact on developing brains
• Risk of metabolic side effects during critical growth periods
• Possibility of misuse or diversion in school/college settings

Careful monitoring and consideration of alternative treatments are essential when prescribing to younger patients.

Pregnant and Breastfeeding Women

The risks and benefits of quetiapine use during pregnancy and lactation must be carefully weighed:

• Potential for fetal exposure and associated risks
• Limited data on long-term outcomes for exposed infants
• Passage of the drug into breast milk
• Balancing maternal mental health needs with fetal/infant safety

Close collaboration between psychiatrists and obstetricians is crucial for managing these cases.

Future Directions: Research Needs and Policy Implications

As the debate around quetiapine use in addiction treatment continues, several key areas require further investigation and policy consideration:

Research Priorities

1. Long-term studies on the safety and efficacy of low-dose quetiapine for sleep/anxiety
2. Comparative effectiveness trials against other pharmacological and non-pharmacological interventions
3. Neuroimaging studies to better understand quetiapine’s effects on reward pathways
4. Population-level analyses of prescribing patterns and associated outcomes
5. Qualitative research exploring patient perspectives on quetiapine use

Policy Considerations

Policymakers and regulatory bodies may need to address several issues:

• Developing clear guidelines for off-label prescribing of antipsychotics
• Implementing monitoring systems to track potential misuse or diversion
• Ensuring appropriate education for healthcare providers on the risks and benefits
• Balancing access for patients who benefit with measures to prevent inappropriate use
• Considering the economic implications of widespread off-label prescribing

By addressing these research gaps and policy challenges, the medical community can work towards more informed and responsible use of quetiapine in addiction treatment.

Alternatives to Quetiapine: Exploring Other Treatment Options

While quetiapine has gained popularity for off-label use in addiction treatment, it’s essential to consider alternative approaches that may be equally effective and potentially carry fewer risks.

Non-Pharmacological Interventions

Several evidence-based non-drug treatments can address sleep and anxiety issues in addiction:

• Cognitive Behavioral Therapy for Insomnia (CBT-I)
• Mindfulness-based stress reduction
• Sleep hygiene education
• Relaxation techniques (e.g., progressive muscle relaxation)
• Exercise and physical activity interventions

Alternative Pharmacological Options

When medication is necessary, several alternatives to quetiapine may be considered:

1. Trazodone: An antidepressant commonly used off-label for insomnia
2. Gabapentin: Shows promise for both sleep and anxiety in addiction
3. Prazosin: May be helpful for sleep disturbances, especially in PTSD
4. Melatonin: A safer option for circadian rhythm regulation
5. Other antidepressants: SSRIs or SNRIs for comorbid anxiety/depression

The choice of treatment should be individualized based on the patient’s specific symptoms, medical history, and preferences.

Integrated Treatment Approaches

Combining multiple modalities often yields the best results in addiction treatment:

• Psychosocial interventions (e.g., motivational interviewing, contingency management)
• Peer support and 12-step programs
• Family therapy and social support enhancement
• Occupational therapy and vocational rehabilitation
• Nutritional counseling and lifestyle modifications

By considering these alternatives and adopting a holistic approach, clinicians can expand their toolkit beyond reliance on quetiapine or other antipsychotics.

Quetiapine abuse – myth or reality?

Helge Waal, Jørn Henrik Vold, Svetlana Ondrasova Skurtveit

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Helge Waal

E-mail: [email protected]

Helge Waal, professor emeritus at the Norwegian Centre for Addiction Research, University of Oslo, and adviser at the National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital

The author has completed the ICMJE form and declares no conflicts of interest.

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Jørn Henrik Vold

Jørn Henrik Vold, PhD fellow at the department of Global Public Health and Primary Care, University of Bergen. He is affiliated with the Bergen Addiction Research (BAR) group at the Department of Addiction Medicine, Haukeland University Hospital.

The author has completed the ICMJE form and declares no conflicts of interest.

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Svetlana Ondrasova Skurtveit

Svetlana Ondrasova Skurtveit, senior advisor at the Department of Mental Health, Norwegian Institute of Public Health, and professor at the Norwegian Centre for Addiction Research, University of Oslo.

The author has completed the ICMJE form and declares no conflicts of interest.

Article

Quetiapine is increasingly being used as a sedative and hypnotic drug, especially in the treatment of addiction disorders. Some have warned against this practice. However, a review of the research literature lends little support to these warnings.

The risk of dependency limits the use of sedatives and hypnotics, especially in vulnerable patients. Antihistamines, antidepressants and antipsychotics are therefore often prescribed instead, but adverse effects limit their utility. Second-generation antipsychotics have significantly fewer parkinsonian adverse effects and are increasingly used. This applies to quetiapine in particular. A number of articles in the Journal of the Norwegian Medical Association are warning against this increase (1, 2). These drugs have been approved for treatment of mood disorders and psychoses, but the dosages indicate its use for insomnia and other sleep disorders (2). In spite of a call for a reduction in the prescribing of antipsychotics, especially to older people, the prescribing of quetiapine is increasing (3). Some recent reports have given rise to the suspicion that this increase may be due to patients who actively want such a prescription (4).

Quetiapine in the treatment of addiction

Quetiapine in the treatment of addiction

Patients with addiction disorders frequently suffer from agitation, anxiety, depression and not least insomnia. Comorbid afflictions such as anxiety disorder and depression are common, due to genetic issues as well as various stresses. However, benzodiazepines and z-hypnotics reinforce the intoxicant effects and can trigger as well as reinforce the tendency to use intoxicants. Furthermore, they increase the risk of complications, including the risk of a fatal overdose. Many patients refuse to use pharmaceutical drugs that have no potential for abuse, for reasons including adverse effects. Second generation antipsychotics are generally better accepted by the patients, and in recent years quetiapine has in particular been prescribed.

Risk of abuse?

Risk of abuse?

Reports from a number of countries show that the use of quetiapine is increasing and that a considerable proportion of the prescribing is off-label (5–8). The question is what this trend reflects and how it should be assessed. The terms abuse and misuse are often used in this literature. One report uses the term recreational abuse (5). Evoy and colleagues use the term abuse-related events (7). However, these terms are not defined in terms of diagnostic criteria for addiction disorder, but are based either on their use outside the approved indication or on various criteria for hospitalisation due to poisonings or other crises. Intoxication and detoxification problems are barely described, if at all. Individual reports describe pills being crushed for inhalation or injection, and some case histories describe dosage escalation and problems with dosage tapering, but it is difficult to ascertain whether this is due to an increase in problem intensity or insufficient effect. The evidence for risk of abuse of quetiapine is generally rather weak, given that heavily addicted substance abusers tend to try out many different drugs. Moreover, problems with dosage tapering are common in the use of all types of psychotropic drugs such as antidepressants and antipsychotics.

The key question is therefore whether atypical antipsychotics are sought after because of their euphoriant effects. This is rarely, if ever, clinically described, and the pharmacological profile of quetiapine renders it unlikely. The reports discuss possible mechanisms with reference to the mechanisms of action and metabolisation of quetiapine. This gives an impression of theorising that has not been confirmed by animal or clinical studies. These are therefore assumptions that in reality appear to be based on concerns over increased use. The articles do not sufficiently distinguish between use outside the approved indication on the one hand and abuse on the other. If the use and dosage increases are justified by a reduction in difficulties and symptoms, this alone does not constitute abuse.

Increased mortality from the use of quetiapine?

Increased mortality from the use of quetiapine?

A number of studies refer to increased mortality from the use of atypical antipsychotics, particularly quetiapine. A large Finnish registry study of mortality during long-term treatment of patients with schizophrenia with eleven years of follow-up is frequently cited. This study found that quetiapine was associated with slightly elevated mortality when compared to other atypical antipsychotics (9). The increase in mortality was due to an increased risk of suicide with the use of quetiapine, while cardiovascular mortality was the second lowest in this group. It is uncertain whether the increased incidence of suicide can be linked to the drug-based therapy, and in our opinion this study cannot be taken as evidence that quetiapine is associated with a higher mortality risk. The article’s message is also another, namely a recommendation to use clozapine as less problematic than other relevant drugs. In a recent study from Finland (10), with overlapping study populations and 20 years of follow-up, the ranking of quetiapine among the other antipsychotics changes in terms of both cardiovascular and total mortality. In this study there was no difference in suicide risk among users of quetiapine and patients who were not undergoing drug-based therapy.

More adverse effects?

More adverse effects?

The most common adverse effects from the use of atypical antipsychotics are weight gain, increased triglyceride level and possibly a higher prevalence of diabetes, endocrine disturbance and cardiac complications with effects on cardiac rhythm and blood pressure. The adverse effects are primarily associated with high dosages, and are common in antipsychotic therapy. When used off-label, dosages are normally low (25–100 mg/day) for some days or weeks. There is less evidence of difficulties from such use. Cates et al. found an average weight gain of 4.2 pounds (1.9 kg) in psychiatric patients who were prescribed an average of 109. 3 mg of quetiapine for insomnia in addition to other antipsychotic treatment (11). A similar study showed a weight gain of 11 pounds (approximately 5 kg) after the use of up to 100 mg of quetiapine per day for one year (12). This may indicate that quetiapine accounts for a certain tendency towards weight gain, which is also found in the use of other antipsychotics. A comprehensive study comparing the problems inherent in the use of various types of atypical antipsychotics, based on a database of poisonings in the United States, gives little indication of specific risks (5). There was a somewhat increased tendency towards reduced alertness and a somewhat reduced tendency towards dystonia in connection with quetiapine intoxication when compared to other antipsychotic drugs. However, the similarities predominate. Nor was the severity of the intoxication any worse in case of quetiapine: 73.4 % of the intoxications were deemed to carry little medical risk and 24.6 % were considered moderately hazardous. Hazardous conditions were identified in 2 % of the cases of quetiapine intoxication. This is somewhat below the average for all antipsychotic drugs.

How useful is quetiapine in the treatment of sleep disorders?

How useful is quetiapine in the treatment of sleep disorders?

Debernard et al. state that quetiapine is not a sleeping pill (2). As a first-line treatment for primary insomnia, this is undoubtedly correct. A large-scale review of the benefit of quetiapine for insomnia concludes that in light of the adverse effects, such use is unwarranted (13). This applies to all atypical antipsychotics (14). To be sure, some studies point out desirable effects for certain types of sleep disorders, but these studies are methodologically weak. Studies that include placebo-controlled effect on sleep lend little support to the use of quetiapine for insomnia, but suggest an effect in those who also suffer from obsessive-compulsive disorder and generalised anxiety (15).

The neurobiology behind sleep and sleep mechanisms is complex, and mental disorders affect sleep in various ways. The effect of drugs, e.g. quetiapine, can vary from one patient to another. The benefit for primary insomnia can be real in cases of complex conditions. For example, quetiapine has a separate indication as supplementary treatment for depressive disorders (16). A comprehensive review of the benefits and difficulties associated with the use of all registered atypical antipsychotics showed that their benefit varied somewhat between the different formulations (17). Quetiapine was found to be more useful than the others for generalised anxiety, but not for other conditions. Our assessment is that quetiapine might be attempted for sleep disorders or agitation when the use of benzodiazepines and z-hypnotics is undesirable.

Norwegian experiences

Norwegian experiences

Data from the Norwegian Prescription Registry show that 5 183 persons were prescribed with quetiapine in 2005. In 2018, this number had risen to 63 125 persons (18). Thereby, the one-year prevalence had increased to 1. 2 %. These figures also include treatment of psychoses and affective disorders, but the increase is nevertheless considerable. However, no reports of usage problems have been submitted by the departments for addiction treatment. The medical advisor at the Emergency Addiction Services and Detoxification, Oslo University Hospital, has on request reviewed the department’s clinical experience and concluded that the department has not registered any increased prescribing of or demand for quetiapine. In exceptional cases the department has encountered patients who have been prescribed with, or despite regular prescribing have used ‘supratherapeutic’ doses, but they have no information on patients having obtained quetiapine from others (P. Krajci, personal communication).

The heads of units that provide drug-assisted rehabilitation convene twice annually to discuss experiences. At the last session (2–3 December 2019) only one of a total of twenty units reported having encountered a wish for increased dosage. All the others reported exclusively problem-free, though often moderately beneficial use. The LASSO programme (drug-assisted harm-reducing substitution treatment in Oslo), which provides a low-threshold option for persons with addiction disorder in central Oslo, does not know of any patients who have requested this drug. This suggests that there is little demand for it in the central Oslo drug scene.

Norway has relatively high overdose mortality. 95 % of the autopsies after such deaths take place at the Department of Forensic Medicine, Oslo University Hospital. Its annual statistics provide information about the findings (19). The number of deaths where antipsychotics were detected increased considerably from 2009 to 2015, but not in subsequent years. In 2018 a little more than 2 000 investigations were carried out, and intoxicants or pharmaceutical drugs were detected in somewhat more than 1 500 of these. Olanzapine was found in 3 % and quetiapine in 4 % of the examinations (H.M. Edvardsen, Department of Forensic Pathology and Clinical Forensic Medicine, Oslo University Hospital, personal communication). In a large-scale Nordic study from 2012, quetiapine was not deemed to be the man intoxicant in any of 194 cases of overdose deaths in Norway. The substance was later detected in seven persons (3.6 %), but it was not known whether this was due to prescribed treatment (20).

Conclusion and recommendations

Conclusion and recommendations

We cannot see any evidence that the increased use of quetiapine is due to increased abuse or addiction to this drug in Norway. However, like other atypical antipsychotics, the drug can cause serious intoxication, and it has metabolically adverse effects indicating that its use should be restricted to necessary and useful treatment. Quetiapine is approved for treatment of schizophrenia and bipolar disorders, but its use outside the approved indications has increased, for example in treatment of addiction, sleep disorders and agitation when the use of benzodiazepines and z-hypnotics should be avoided or restricted. Quetiapine is also used to support tapering and withdrawal from benzodiazepine addiction. Such treatment should be undertaken over a shorter period of time and with lower dosages, and its use should be assessed against its clinical benefit and in light of the problem that even lower dosages can result in weight gain and elevated triglyceride levels.

Literature

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   Gjerden P, Bramness JG, Slørdal L. Kvetiapin brukes for mye. Tidsskr Nor Legeforen 2018; 138. doi: 10.4045/tidsskr.18.0535. [PubMed][CrossRef]

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   Debernard KAB, Frost J, Roland PH. Kvetiapin er ikke en sovemedisin. Tidsskr Nor Legeforen 2019; 139. doi: 10.4045/tidsskr.19.0205. [PubMed][CrossRef]

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   Tveito M, Handal M, Engedal K et al. Forskrivning av antipsykotika til hjemmeboende eldre 2006–18. Tidsskr Nor Legeforen 2019; 139. doi: 10.4045/tidsskr.19.0233. [PubMed][CrossRef]

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   Aa E, Helland A, Spigset O. Kvetiapin kan ha misbrukspotensial. Tidsskr Nor Legeforen 2012; 132: 1619–20. [PubMed][CrossRef]

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   Klein L, Bangh S, Cole JB. Intentional recreational abuse of quetiapine compared to other second-generation antipsychotics. West J Emerg Med 2017; 18: 243–50. [PubMed][CrossRef]

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   Chiappini S, Schifano F. Is there a potential of misuse for quetiapine? Litterature reviews and analyses of the European Medicines Agency/European Agency Adverse Drug Reactions’ Database. J Clin Psychopharmacol 2018; 38: 72–9. [PubMed][CrossRef]

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   Evoy KE, Teng C, Encarnacion VG et al. Comparison of abuse and misuse reports to the fda adverse event reporting system with other second-generation antipsychotics. Subst Abuse 2019; 13: 1178221819844205. [PubMed][CrossRef]

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   Osborne V, Davies M, Layton D et al. Utilisation of extended release quetiapine (Seroquel XL™): Results from an observational cohort study in England. Eur Psychiatry 2016; 33: 61–7. [PubMed][CrossRef]

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   Tiihonen J, Lönnqvist J, Wahlbeck K et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009; 374: 620–7. [PubMed][CrossRef]

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    Taipale H, Tanskanen A, Mehtälä J et al. 20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry 2020; 19: 61–8. [PubMed][CrossRef]

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    Cates ME, Jackson CW, Feldman JM et al. Metabolic consequences of using low-dose quetiapine for insomnia in psychiatric patients. Community Ment Health J 2009; 45: 251–4. [PubMed][CrossRef]

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    Williams SG, Alinejad NA, Williams JA et al. Statistically significant increase in weight caused by low-dose quetiapine. Pharmacotherapy 2010; 30: 1011–5. [PubMed][CrossRef]

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    Anderson SL, Vande Griend JP. Quetiapine for insomnia: A review of the literature. Am J Health Syst Pharm 2014; 71: 394–402. [PubMed][CrossRef]

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    Thompson W, Quay TAW, Rojas-Fernandez C et al. Atypical antipsychotics for insomnia: a systematic review. Sleep Med 2016; 22: 13–7. [PubMed][CrossRef]

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    Atkin T, Comai S, Gobbi G. Drugs for insomnia beyond benzodiazepines: pharmacology, clinical applications, and discovery. Pharmacol Rev 2018; 70: 197–245. [PubMed][CrossRef]

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    Zhornitsky S, Potvin S, Moteshafi H et al. Dose-response and comparative efficacy and tolerability of quetiapine across psychiatric disorders: a systematic review of the placebo-controlled monotherapy and add-on trials. Int Clin Psychopharmacol 2011; 26: 183–92. [PubMed][CrossRef]

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    Maglione M, Maher AR, Hu J et al. Off-Label use of atypical antipsychotics: An update. Rockville, MD: Agency for Healthcare Research and Quality, 2011.

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Signs of Seroquel Abuse – Greenhouse Treatment Center

Edited by: Brittany Tackett

Updated: May 06, 2022

There are many psychiatric drugs prescribed to treat numerous mental and behavioral health conditions.

These drugs may be therapeutic for people when used as directed. However, many psychiatric medications have a strong potential for abuse or addiction.

Stimulants and sedatives are common drugs of abuse.   Less commonly misused are antipsychotic drugs prescribed to treat schizophrenia and bipolar disorder, like Seroquel.

Seroquel as a Drug of Abuse

• Seroquel, the brand name for generic drug quetiapine, acts on various brain receptors to alter activity within several neurotransmitter systems, including dopamine and serotonin. This medication is considered a second-generation antipsychotic (SGA).
• The Food and Drug Administration (FDA) approved Seroquel for prescription use in 1997 and by 2010 it was the fifth largest selling pharmaceutical in the United States reaching $6.8 billion in annual sales.²
• Seroquel is FDA approved as a treatment for schizophrenia, manic-depressive episodes, and maintenance therapy for bipolar disorder.¹ However, numerous case reports have shown an increase in prescriptions for off-label use.
• In 2010, the drug’s manufacturer paid $520 million for government allegations of promoting off-label prescribing for a variety of indications including dementia, insomnia, and anger management. ²
• Seroquel is currently a non-controlled substance, but recent studies have shown a strong potential for misuse and abuse when used beyond FDA-approved indications.³ In association with illicit use, it is reportedly referred to as Suzie-Q, Q-ball, or baby heroin.¹
• Seroquel and other atypical antipsychotics have not historically been thought of as drugs of abuse as they are not strongly associated with euphoria or other reinforcing or desirable drug effects such as alertness. However, these drugs have reportedly been abused for sedative effects or a form of self-medication for anxiety or insomnia.
• Others may use these medications to enhance desirable effects or counter adverse effects of illicit drugs such as cocaine, heroin, or marijuana.³
• Seroquel is the most commonly abused atypical antipsychotic medication. A 10-year retrospective study of second-generation antipsychotic abuse using 2003-2010 data from the National Poison Data System (NPDS) reported 2,118 cases of quetiapine abuse, compromising 60. 6% of all cases.⁴ 
• It is not clear why Seroquel is abused more frequently than other antipsychotics. It could be that because it is more frequently prescribed, it is more readily available for abuse.
• Schizophrenia and bipolar disorder are relatively uncommon mental illnesses. Antipsychotics like Seroquel may therefore not be as commonly encountered in medicine cabinets as other abuse-prone prescription drugs, although it can be purchased illicitly online or through drug dealers.
• One of the most common methods of abusing prescription drugs is by stealing them, asking for them, or buying them from friends or family with legitimate prescriptions. Seroquel abuse is also particularly common in institutional settings like prisons and impatient mental health care facilities where preferred illicit drugs may not be available ^1,3

While Seroquel can trigger side effects in people who take the drug as prescribed, a person who abuses this substance may be more likely to experience side effects. ⁵

Physical side effects associated with Seroquel

^4,5

• Weight gain.
• Increased appetite.
• Indigestion.
• Nausea and vomiting.
• Constipation.
• Rapid heartbeat.
• Dry mouth.
• Dizziness.
• Sleepiness.
• Headaches.
• Body aches.
• Weakness.
• Clumsiness.
• Stuffy nose.
• Breast enlargement in men.
• Missed menstrual cycles in women.
• Nipple discharge.

Someone who abuses Seroquel may crush and snort the drug, or they may mix it with water and inject it intravenously. These are extremely dangerous practices that can quickly lead to overdose.

Signs that someone is abusing drugs in this manner include redness or dryness around the nose, constant sniffing or nasal congestion, sore throat, hoarse voice, and coughing.

Signs that someone abuses Seroquel through intravenous injection include skin infections at the site, track marks, and paraphernalia like rubber hoses, needles, and dirty spoons. ^1,4,5

Another sign that a person may be abusing Seroquel is tardive dyskinesia (TD) or extrapyramidal effects (EPS). The signs of TD are jerky, uncontrollable movements, often starting in the jaw, lips, and tongue. Someone with TD may appear to be chewing or grinding their teeth. EPS signs include restlessness, physical tremor, and stiffness.⁵

Mental side effects associated with Seroquel:

^4,5

• Irritability and mood swings.
• Foggy or unclear thinking.
• Poor judgment.
• Trouble speaking clearly.
• Unusual dreams or nightmares.
• Other sleep disturbances.

Other signs of prescription drug abuse, including abuse of Seroquel, may include needing frequent refills, stealing the drug, stealing money for the drug, or experiencing financial, legal, or social ramifications due to being intoxicated.

Substance abuse may not only harm a person’s mental and physical health, but can damage personal relationships with friends and family, make work or school more difficult, and can ultimately lower quality or enjoyment of life.

Overdose or toxicity may be more likely if the drug is taken in larger doses than prescribed.

References

1. Sansone, R. & Sansone, L. (2010). Is Seroquel Developing an Illicit Reputation for Misuse/Abuse? Psychiatry, 7(1): 13-16.
2. Brett, J. (2015). Concerns about Quetiapine. Australian Prescriber, 38(3):95-97.
3. Kim, S., Lee, G., Kim, E., Jung, H., & Chang, J. (2017).  Quetiapine Misuse and Abuse: Is It an Atypical Paradigm of Drug Seeking Behavior? Journal of Research and Pharmacy Practice, 6(1):12-15.
4. Klein, L., Bangh, S., & Cole, J. (2016). Intentional Recreational Abuse of Quetiapine Compared to Other Second-generation Antipsychotics. Western Journal of Emergency Medicine, 18(2).
5. Seroquel Medication Guide. (2013). Food and Drug Administration.

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900 14

90 015 Psychographic (film)

900 21

0021

9001 4

Psychoactive Substance	Psychoanalytic Supervision	Psychoanalyst
Psychoanalyst (film)	Psychoanalyst (disambiguation)	Psychoanalyst
Psychoanalysis	Psychobilly	Mental hospital
Crazy	Psychographic test
Libin’s psychographic test	Psychographics	Psychohygiene
Psychogymnastics	Psychogeny	Psychogenic enuresis
Psychogenic parasitosis	Psychogenic school maladjustment	Psychogenic overeating
Psychogenetics	Psychogeography	Psychospiritual practice
Psychodrama	Psychodrome	Psychodrome (film)
Psychodysleptic substances	Psychodysleptics	Psychodiagnostics
Psychodynamic direction	Psychodynamics	Psychodosis
Psyodermatology	Psychedelia	Psychedelia Tomorrow
Psychedelic therapy	Psychedelic music
Psychedelic Psychotherapy	Psychedelic	Psychedelic embossed
Psychedelic trans	Psychedelic folk	Psychedelic rock
Psychedelic experience	Psychedelic experience (guideline for taking psychedelic substances)	Psychedelic experience (guideline for taking psychedelic substances)
Psychedelic pop	Psychedelic plants	Psychedelic substances
Psychedelic drugs	Psychedelic	Psychedelic
Psychedelic rock	Psychedelic pop	Psychedelic trance
Psychedelic folk	Psychedelic rock	Psychedelic pop
Psychedelic	Psycho clothes	Psychosis
Psychosis (film)	Psychosis (film, 1960)	Psychosis (film, 1998)
Psychosis (film, 2009)	Psychosis (film, 2010)	Psychosis (novel)
Psychosis (disambiguation) )	Psychosis 2 (novel)	Hypersensitivity psychosis
Psychoses	Hypersensitivity psychoses	Psychohistory
Psychohistory (fiction)	Psychohistory (disambiguation)	Psychoimmunology
Psychocult	Psychocybernetics	Psychokinesis
Psychocorrection	Psycholyricist	Psycholinguist
Psycholinguistics	Psychologist	Psychologist of Religion
Consumption Psychologist	Psychologist Graves	Psychology
Psychology 21	Forensic psychology	Environmental psychology
Psychology of social cognition	Sports psychology	Family psychology
Management psychology	Labor psychology	Psychology of dance
Psychology of creativity	Psychology of the crowd	Psychology of development
Psychology of human development	Psychology of early youth 9001 6	Psychology of parenthood
Psychology of religion	Psychology of abnormal development	Psychology of perception
Psychology of color perception	Psychology of smell perception	Psychology of music perception
Psychology of space perception	Educational psychology	Traffic psychology
Psychology of deviant behavior	Health psychology
Psychology and Buddhism	Art psychology	Psychology art (book)
Psychology of individual differences	Psychology of corruption	Psychology of communication in an organization
Psychology of lies	Psychology of personality	Psychology of musical preferences
Mass psychology 900 16	Psychology of peace	Psychology of peaceful behavior
Psychology of science	Psychology of peoples	Psychology of peoples and masses
Psychology of peoples and masses (book)	Psychology of learning	Psychology of education
Psychology of behavior	Psychology21	Psychological compatibility
Psychological attitude 9001 6	Psychological trauma	Psychological typology
Psychological theory of law	Psychological theory of the origin of the state	Psychological intelligence
Psychological regression	Psychological resilience	Psychological resilience
Psychological autopsy	Psychological attack	Psychological anthropology
Psychological warfare	Psychological readiness for school	Psychological drama
Psychological defense	Psychological dependence	Psychological inertia
Psychological cybernetics	Psychological correction	Psychological manipulation
Psychological science and education	Psychological science and education (journal) 9 0016	Psychological preparation of football players for the game
Psychological assistance	Psychological stress	Psychological syndrome of the prelaunch state
Psychological experiment	Psychological training	Psychological type
Psychological test	Faculty of Psychology, Moscow State University MV Lomonosov
V. M. Munipova	Psychological horror	Psychological novel
Psychological journal	Psychological Institute of the Russian Academy of Education	Psychological Institute. L. G. Schukina
Psychological Institute. L.G. Shchukina	Psychological Institute. L.G.Shchukina	L.G. portrait of a criminal	Psychological gender	Psychological horrors
Psychological types	Psychological typologies	Psychological theories of emotions
Psychological boundaries	Psychological qualities	Psychological operations
Psychological testing	Psychological pricing	Psychological opinion
Psychological cliche	Psychological counseling	Psychological literary criticism
Psychological manipulation	Psychological modeling	Psychological satiety
Psychological violence	Psychological stress	Psychologist
Psychological education	Psychologism	Institute of Psychology
Psychology	Psychology psychiatric examination	Psychological and pedagogical experiment
Psychomotor stimulants	Psychomotor agitation	Psychometry
Psychometric booth	Psychometric entrance exam in Israel	Psychometrics
Psychonaut	Psychonaut (values)	Psychonauts
Psychonauts (game) )	Psychonautics	Psychoneurotic personality disorder
Psychoneurosis	Psychoneurosis	Psychoneurological dispensary
Psychoneurological institute	Psychoneurological boarding school	Psychoneuroendocrinology 900 16
Psychoneuroimmunology	Psychoorganic syndrome	Psychooncology
Psychopsides	Psychopractice	Psychoprophylaxis
Psycho-Pass	Psychopath	Psychopaths (film)
Psychopathy	Psychopathy (syndrome)	Psychopathy (meanings)
Psychopathic disorder	Psychopathology	Animal psychopathology
Psychopathology of everyday life	Psychopathological re-experiencing	Psychopathic schizophrenia
Psychopneumone	Psychopomp	Psyche
Psyche (rock band)	Psyche (asteroid)	Psyche (group)
Psyche (disambiguation)	Psyche (mythology)	Psyche (play)
Psychedelic	Psychedelics	Psyche
Psyche	Psira group)	Psyche (group)	Psiahas
Psiahas, Panagiotis	Psiax (vase painter)	Psibient
Psigmorchis tiny	Psydrina 90 016	Psidak
Psidium	Psizha	Psizha (river)
Psiy	Psiy (river)	Psikya
Psikta	Psykter	Psikose
Psila	Psilak is	Psilakis, Michael
Psilanthropism	Psilander	Psilander Waldemar Einar
Psilander, Valdemar	Psilander, Waldemar Einar	Psilander, Gustav
Psilander, Gustav von	Psili	Psyl
Psyllastearic acid	Psyllides	Psyllobora
Psilo-balm	Psylotic	Psilophytes
Psilophyte	Psilophytes	Psilocyb

Cardioprogress Foundation for the Promotion of Cardiology

Innovative technologies in medicine. International Congress DATS 2023 (Baku, Azerbaijan)
The International Medical Congress DATS 2023 was held in the capital of Azerbaijan, Baku, from June 17 to 22, 2023, organized by the Tabib State Administration for Medical Territorial Services of Azerbaijan.

A new scale has been developed to predict the risk of cardiovascular disease in diabetes
Experts developed the SCORE2-Diabetes score to predict the ten-year risk of developing cardiovascular disease in people with type 2 diabetes. The tool can be used to address the need for intensive diabetes management and prescribing drugs to prevent cardiovascular complications.

WHO does not recommend the use of non-carbohydrate sweeteners for weight control
The World Health Organization (WHO) does not recommend the use of carbohydrate-free sweeteners for weight control and to reduce the risk of developing non-communicable diseases. Their long-term use may increase the likelihood of developing type 2 diabetes, cardiovascular disease and mortality.

ACC publishes expert consensus on the management of patients with heart failure
The American College of Cardiology (ACC) has published an expert consensus on the management of heart failure with preserved ejection fraction. The statement covers in detail the issues of diagnosis and therapy.

Congratulations and lecture “Medics’ contribution to the victory in the Great Patriotic War”
Dear Colleagues!

The Cardioprogress Foundation congratulates you on the occasion of the Great Victory. Doctors and physicians made a great contribution to the victory during the Great Patriotic War.

How to optimize the management of a patient with arterial hypertension
In March of this year, the XIХ All-Russian Congress “Arterial hypertension 2023: the current state of the problem” was held.

Commemoration of World Health Day 2023 and 75 years of WHO
On World Health Day, 7 April 2023, the World Health Organization celebrates its 75th anniversary. WHO was founded by a collective initiative of the nations of the world in 1948 to promote human health, keep the world safe, and serve the interests of vulnerable populations so that everyone, wherever they are, has the opportunity to achieve the highest levels of health and well-being.

In South Korea, the regulator approved the smart ring for monitoring blood pressure
South Korean medical startup Sky Labs has received national regulatory approval for a wearable blood pressure monitoring device. The cardio tracker has the shape of a ring, is worn on the finger and helps to quickly adjust the dosage of medicines for outpatients.

Spain to develop device for non-invasive monitoring of implanted stents
Nimble Diagnostics, a subsidiary of the Germans Trias i Pujol Research Institute and the Polytechnic University of Catalonia, has raised €1 million on the market to develop the first medical device to monitor patients with implanted stents. This will avoid serious complications and improve the quality of medical care.