Quetiapine: Why the Form Matters for Depression

What quetiapine is

Quetiapine is a tablet in a class of medicines called atypical antipsychotics. There are two forms: immediate-release tablets (Seroquel) and extended-release tablets (Seroquel XR), plus generic versions of each. Both are on current FDA labels.

The form is more than a detail, because the approved uses are not the same. It helps to check which product and which purpose your prescriber is discussing.

What each label approves

The two labels differ on depression, and the list below shows how. The extended-release label says its effectiveness as an add-on in major depressive disorder was established in two 6-week trials in adults who had an inadequate response to antidepressant treatment. It is not approved as a stand-alone treatment for major depressive disorder, and bipolar depression and major depressive disorder are different diagnoses with different approvals. MedlinePlus says quetiapine may be prescribed for other uses but names none, so we list no off-label uses here.

• Seroquel XR (extended-release): schizophrenia; manic or mixed episodes of bipolar I disorder; depressive episodes of bipolar disorder; maintenance treatment of bipolar I disorder as an add-on to lithium or divalproex; and adjunctive therapy with antidepressants for major depressive disorder.
• Seroquel (immediate-release): schizophrenia; manic episodes of bipolar I disorder; depressive episodes of bipolar disorder; and maintenance treatment of bipolar I disorder as an add-on to lithium or divalproex. Major depressive disorder is not listed.

How it is thought to work

The label says how quetiapine works in these conditions is unclear. Its effect could come from blocking dopamine D2 and serotonin 5-HT2A receptors, and an active form the body makes from it, norquetiapine, acts at these receptors too. MedlinePlus says it works by changing the activity of certain natural substances in the brain.

What taking it can be like

Sleepiness is common, and the label says it is often most noticeable early on. In adults using the extended-release form as an add-on for depression, the most common side effects in the label were sleepiness, dry mouth, fatigue, constipation and weight gain. The label cautions about driving and other activities that need alertness until you know how it affects you.

Dizziness on standing can happen, particularly early on. The label also says to stay aware of overheating and dehydration, since antipsychotics can affect how the body cools itself. MedlinePlus says not to stop taking it without talking to your doctor, even if you feel well.

If you have been told an antidepressant has not helped enough, our guide to next steps can help you prepare your questions.

Boxed warnings

Both labels carry the same two boxed warnings, the FDA's strongest kind.

• Older people with dementia: older adults with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Quetiapine is not approved for this use.
• Suicidal thoughts and behaviors: antidepressants increased these risks in children, teens and young adults in short-term studies. The studies did not show an increase in people over 24, and there was a reduction in people 65 and older. People of all ages starting antidepressant treatment need close monitoring, and families should watch for changes. The labels also say it is not approved for children under 10. If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.

Other side effects and warnings

Some of these need checks your prescriber arranges, so it helps to know them in advance.

• Metabolic changes: high blood sugar, changes in blood fats and weight gain. The label calls for monitoring.
• Movement and nerve effects: tardive dyskinesia, which means uncontrollable movements, and neuroleptic malignant syndrome, a rare dangerous reaction with fever and muscle stiffness.
• Blood pressure and heart: low blood pressure and fainting, and cases of QT prolongation, a heart rhythm finding. Tell your prescriber about any heart condition, family history of QT prolongation or other medicines that affect rhythm.
• Eyes and thyroid: lens changes have been seen with long-term use, and the label recommends eye exams. It also reports lower thyroid hormone levels.
• Blood counts: low white blood cell counts. Report fever, chills or sore throat.
• Also on the label: seizures, trouble swallowing, constipation and trouble emptying the bladder. It should not be taken with a known hypersensitivity to quetiapine or the tablet's ingredients.
• Stopping suddenly: the label describes insomnia, nausea and vomiting after abrupt cessation and advises gradual dose reduction.
• Pregnancy: if you are pregnant, planning a pregnancy or breastfeeding, tell your prescriber.

Can quetiapine be managed online in Pennsylvania and New York

A video visit can cover mood, sleepiness and side effects. Blood sugar, blood fats, weight, blood pressure and eye exams have to happen outside the visit, so ask how they would be arranged. Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our medication inquiry form.

A licensed psychiatrist on our team treats depression by secure video for people physically located in Pennsylvania or New York during each visit. See online depression treatment, online psychiatry in New York and our medicines list. Our therapists do not prescribe, and they see clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York. Ask us about fees and insurance.