Quetiapine (often branded as Seroquel) is an antipsychotic drug used for schizophrenia and bipolar disorder. It’s also prescribed off-license in the UK for anxiety. That means that a fair few people with alcohol and other drug dependence end up on it. Recent experience makes me wonder if prescribers are as aware of the risks as they might be.
The National Institute for Health and Care Excellence (NICE) says that although there is some evidence that quetiapine can reduce anxiety, it’s not any better at this than antidepressants are. On the other hand, quetiapine can cause problems in the long term including parkinson’s like symptoms, severe reduction in white cells, neuroleptic malignant syndrome (albeit rarely) and has been associated with withdrawal symptoms.
Quetiapine makes number nine on Listverse’s top ten abused prescription drugs. Called ‘Suzy-Q’ they say the drug has a ‘huge recreational value in prison.’
…the tranquilizer has earned the name “Jailhouse Heroin” among our citizens who are paying their debts to society. Abusers seek its anxiolytic (anxiety reducing) effects, as well as its tendency to reduce feelings and provide a careless state of mind. Prisoners commonly trade their meals and money for these pills…
Sansone and Sansone flagged up the risk in 2010:
Quetiapine, an atypical antipsychotic, has been the subject of a series of case reports that suggest a potential for misuse/abuse. The available cases indicate a male predominance; oral, intranasal, or intravenous routes of administration; misuse/abuse in jail or inpatient psychiatric settings; and subjects with extensive histories of polysubstance abuse.
This year Polish researchers looked at 25 case reports of quetiapine abuse. What did they find?
Higher frequency of abuse/dependence was observed in men and people being in their mid-thirties. Only half of the cases reported a positive history of substance abuse. The most prominent phenomenon associated with quetiapine abuse/dependence was marked withdrawal symptoms.
They advised caution when prescribing to patients with a history of addiction.
Research presented last year examined over 400 patients going through a treatment centre in New York and found that 17% were abusing new antipsychotics (89% of these were quetiapine). They were mostly used in combination with other drugs and most were obtained illicitly. The reasons for quetiapine abuse? ‘Coming down’ from other drugs or enhancing the effect of other drugs. For those who were prescribed them legitimately the indications were for sleep, anxiety and mood symptoms, not psychosis. But ‘the risk for misuse may override any therapeutic benefit in these cases.’
So why take the risk at all?