are all antipsychotics similar

[adel_ezz]

Many sites tells you information about the equivalence of antipsychotics. For instance 100 seroquel = 1 risperidone = 3 zyprexa. My information is that all are given to prevent mania and reduce dopamine responsible for psychosis. Yet seroquel especially is given for depression too this is why it works as a mood stabilizer. Some say all atypical are the same but seroquel seems to be different from readings and at least it works for me. My combo is 75 seroquel + 1 risperidone + 1 stelazin (typical AP). It's weird and crazy usually one AP is enough.

Anyway, can someone help me in this: After my last mania for which I used to take 300 seroquel to calm down I start reducing it until 75. Although my energy kept fluctuating in between, nowadays my energy is low. Usually when this happens I reduce my antipsychotics to boost my energy. But reducing seroquel too much could this cause depression ?. For I read that below 100 seroquel doesn't help in depression. Is this true ? I can't rely on pdocs, in my country they are worse than shoemakers. They believe in trial and error, which makes me think that psychiatry is fraud. OF COURSE I can take an AD, but this is committing suicide because I shall plunge into a manic phase. I want to cut this loop of mania - depression - mania etc...so to relieve this symptom of lack of energy (mood is not bad) CAN I KEEP REDUCING the seroquel, will it increase depression based on the assumption that seroquel is also good for depression. I fear of reducing the risperidone although there exists 0.5 mg in the market.
thanks  

[adel_ezz]

Thank you for your reply and for raising the following:

1. never changing one's dosage of medications without the approval of one's doctor. But as psychiatry is trial and error this statement is not necessarily true and you have to rely on your judgement

2. One thing you might ask your doctor if you can try is stopping the seroquel and starting abilify in its place. But Abilify causes anxiety again what you know is better than what you don't know. It takes years to adjust your dose and you can't lose few more years of trial and error  

3. You could also try other mood stabilizers like depakote, which has pretty good antimanic effects, or tegretol, or lamictal if you mainly get depression.  Also, have you ever tried lithium?  It's the gold standard for BP treatment for a reason. Whether tegretol, lamictal, depakote all anticonvulsants are not better than AP's. Depakote is bad for weight gain

Really my question was WHETHER reducing the seroquel combat depression or increasing it combat depression. This is my REAL question.
thanks

[Anonymouse88]

As a disclaimer, we recommend never changing one's dosage of medications without the approval of one's doctor.

That being said, many doctors can be talked into med changes that make some sense/might be a good trial and error trial to make.  Seroquel at lower doses mainly binds to histamine receptors, which is why it gets used off label as a sleep aid at low doses.  Sleepiness *might* be from lowering your seroquel dose to 75 mg from 300 mg.  While seroquel is known for being one of the best atypicals for the depression phase of bipolar, many atypicals are mood stabilizing and cover both mania and depression.

One thing you might ask your doctor if you can try is stopping the seroquel and starting abilify in its place.  Abilify is approved as a monotherapy or adjunct treatment for BP I, and is also approved as an antidepressant add-on, so if depression is your problem, it might work.  

You could also try other mood stabilizers like depakote, which has pretty good antimanic effects, or tegretol, or lamictal if you mainly get depression.  Also, have you ever tried lithium?  It's the gold standard for BP treatment for a reason.

Finally, I have some bad news for you (or good, depending on how you look at it): everyone reacts differently to different medications, and the difference can be huge.  It's also extremely unpredictable.  In your case, antidepressants are pretty clearly out if they've caused you to go manic (this is a known possible response in bipolar people), but as for what else will or won't work, we simply don't know enough (and maybe never will) to be able to make a good prediction beforehand.  And the treatments DO work, just not for all of the people all of the time.  So the trial and error approach (with some deductive reasoning added in from the patient's reactions along the way), sucky as it is, is the best psychiatrists can do, and it does not make them frauds (some are horrible, but not because of that approach).