Quetiapine withdrawal
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Quetiapine Withdrawal: Symptoms, Effects, and Clinical Implications
Introduction to Quetiapine Withdrawal
Quetiapine, an atypical antipsychotic, is widely used to treat conditions such as schizophrenia, bipolar disorder, and major depressive disorder. However, discontinuation of quetiapine can lead to withdrawal symptoms, which are an important consideration for both patients and clinicians.
Common Symptoms of Quetiapine Withdrawal
Somatic Symptoms
Withdrawal from quetiapine can result in a range of somatic symptoms. These include nausea, vomiting, agitation, restlessness, diaphoresis (excessive sweating), irritability, anxiety, dysphoria, sleep disturbances, insomnia, tachycardia (rapid heart rate), hypertension, and dizziness2 7. These symptoms can significantly impact the quality of life and may require medical intervention to manage effectively.
Withdrawal Dyskinesia
In some cases, withdrawal from quetiapine has been associated with the onset of withdrawal dyskinesia, characterized by abnormal choreiform movements, confusion, and speech disturbances2. This highlights the need for careful monitoring during the discontinuation process.
Clinical Studies on Quetiapine Withdrawal
Case Reports and Systematic Reviews
A systematic review of the literature, which included 13 case reports, found that rapid cessation of quetiapine is often linked to the onset of the aforementioned somatic symptoms and withdrawal dyskinesia2. Although the quality of these case reports was sub-optimal, the findings suggest that clinicians should be vigilant for withdrawal symptoms in patients discontinuing quetiapine.
Human Laboratory Studies
A human laboratory study investigating the effects of quetiapine on marijuana withdrawal found that while quetiapine improved sleep quality and increased caloric intake, it also increased marijuana craving and self-administration during the relapse phase1. This indicates that quetiapine may not be effective in reducing withdrawal symptoms for all substances and could potentially exacerbate cravings.
Quetiapine in Substance Withdrawal Management
Opioid Withdrawal
Quetiapine has been studied for its potential to alleviate symptoms of opioid withdrawal. In an outpatient clinic setting, quetiapine was found to help reduce cravings, anxiety, somatic pain, and insomnia in patients undergoing opioid detoxification3. This suggests that quetiapine may have utility in managing withdrawal symptoms for certain substances.
Methamphetamine and Cannabis Use Disorders
In a randomized, double-blind, placebo-controlled trial, quetiapine significantly decreased craving and withdrawal symptoms in individuals with methamphetamine abuse5. Similarly, a study on cannabis use disorder found that quetiapine was associated with a transition from heavy to moderate use, although it did not significantly reduce the frequency of light use10. These findings indicate that quetiapine may be beneficial in reducing withdrawal symptoms and cravings for some substances, but its effectiveness can vary.
Mechanisms Behind Quetiapine Withdrawal
Dopamine D2 Receptor Occupancy
Research suggests that the rapid release of quetiapine from dopamine D2 receptors may contribute to early clinical relapse upon withdrawal. Quetiapine is loosely bound to D2 receptors, and endogenous dopamine can displace quetiapine quickly, leading to low receptor occupancy and potential relapse8. This mechanism underscores the importance of gradual tapering to mitigate withdrawal symptoms.
Conclusion
Quetiapine withdrawal can lead to a range of somatic symptoms and, in some cases, withdrawal dyskinesia. While quetiapine may help manage withdrawal symptoms for certain substances like opioids and methamphetamine, its effectiveness can vary, and it may exacerbate cravings in some cases. Clinicians should be aware of the potential for withdrawal symptoms and consider gradual tapering to minimize adverse effects. Further research is needed to fully understand the mechanisms and best practices for managing quetiapine withdrawal.
Sources and full results
Most relevant research papers on this topic
A human laboratory study investigating the effects of quetiapine on marijuana withdrawal and relapse in daily marijuana smokers
Quetiapine improved sleep quality and caloric intake in daily marijuana smokers, but increased cravings and self-administration during relapse.
RCTQuetiapine withdrawal: A systematic review
Quetiapine discontinuation can cause uncommon somatic symptoms and choreiform movements, requiring clinicians to be alert for these potential side effects.
Systematic ReviewReduction of opioid-withdrawal symptoms with quetiapine.
Quetiapine effectively reduces opioid withdrawal symptoms and is generally well-tolerated in patients undergoing opioid cessation.
Observational StudyQuetiapine Dependence and Withdrawal: A Case Report
Quetiapine dependence and withdrawal can occur in patients with drug or alcohol dependence, highlighting the need for caution when using this medication for these patients.
Case ReportThe Effects of Quetiapine on Craving and Withdrawal Symptoms in Methamphetamine Abuse: A Randomized, Double-Blind, Placebo-Controlled Trial
Quetiapine supplements for 2 months significantly reduced craving and withdrawal symptoms in individuals with methamphetamine abuse compared to placebo.
RCTAcute quetiapine dose-dependently exacerbates anhedonia induced by withdrawal from escalating doses of d-amphetamine
Acute quetiapine treatment at moderate doses may exacerbate anhedonia induced by amphetamine withdrawal in rats.
Non-RCT
Animal StudySevere Quetiapine Withdrawal Syndrome with Nausea and Vomiting in a 65-year-old Patient with Psychotic Depression.
Pretreatment with domperidone effectively prevented severe quetiapine withdrawal symptoms, allowing the patient to successfully discontinue the medication.
Case ReportRapid release of antipsychotic drugs from dopamine D2 receptors: an explanation for low receptor occupancy and early clinical relapse upon withdrawal of clozapine or quetiapine.
Rapid release of clozapine and quetiapine from dopamine D2 receptors by endogenous dopamine may contribute to low receptor occupancy and early clinical relapse upon withdrawal of these medications.
In Vitro Study
Highly CitedQuetiapine in relapse prevention in alcoholics suffering from craving and affective symptoms: a case series
Quetiapine shows potential in preventing alcohol relapse in alcoholics with craving and affective symptoms, with good tolerability and a short duration of abstinence.
Case ReportQuetiapine treatment for cannabis use disorder.
Quetiapine treatment for cannabis use disorder increases the likelihood of heavy frequency use transitioning to moderate use, but not light use, but does not significantly affect light use.
RCT