I have bipolar NOS with rapid cycling and mixed state features. I do get full blown mania as well and if i am not on meds that are working for me i often switch back and forth between Mania, mixed state Mania and depression. I have been on a number of anti-psychotics both atypical and old typical anti-psychotics. The only atypicals my insurance will cover for me are seroquel and risperidone. I find that Quetiapine works much better for my symptoms with less side effects then risperidone. Olanzapine worked far better for me with no side effects but since i can't get it covered, the fact that it's so expensive (about $8 for a 10mg generic Olanzapine tablet and i would need atleast 10mg's a day) and the fact that my doctor does not like prescribing Thorazine/Largactil (which also works good for me with little side effects in the short run atleast) i am stuck with seroquel.
It definitely does help my bipolar and unlike say risperdal it also helps my depression as well as mania. It also helps stop the rapid cycling and dark racing thoughts i get and of course hypomania and mania. The biggest complaint i have about seroquel is that it takes days to really start working at all against mania or depression. It's a really sedating anti-psychotic and it can rival even alot of the really old typical's like chlorpromazine (Thorazine aka Largactil) and prochlorperazine (Compazine, Stemetil) in terms of sedation but it's not a very potent anti-psychotic. Low doses of 200mg's or less of quetiapine (everyone is different this is just a sort of average) pretty much just acts as a potent H1 antagonist and adrenergic antagonist. It's not until you get above 200mg's a day that it really starts acting as a antagonist at serotonin and dopamine receptors. I have been on up to 500mg's a day and really the biggest complaints i have of seroquel are that it won't knock mania right out in a emergency situation and that it takes far longer to work then say olanzapine or risperidone. Well that and the godawful dry mouth and even dry eyes that i get right after taking it. Fortunately since it has such a short half life the dry mouth and other anti-histaminic effects wear off fairly quickly. As far as the sedation goes i find that it loses this effect pretty quickly.
A few pluses that i found seroquel to have is that it never gave me the zombie effect that is a common complaint of anti-psychotics. I do get alot of sedation when i first start taking it unless i am manic then i often won't feel it at all. But i don't get the dumbed out zombie feeling that i often get from risperdal especially if i take over 2mg's a day. I am going to guess that this is because risperidone is a very potent D2 antagonist while quetiapine only hit's the D2 receptor in higher doses and possibly dissociates from the D2 receptor thus allowing normal transmission of dopamine. Which is why seroquel doesn't screw with your hormones nearly as much as risperdal does. Unfortunately quetiapine is not a take as needed anti-psychotic like olanzapine, risperidone or some of the older ones such as haldol are. It takes days to reach anti-psychotic doses and even when you get up to around 300mg's a day it still takes awile for it to start working fully. The good news is that almost everyone i know including myself finds that the sedation goes away pretty quickly once you reach a anti-psychotic dose. This may be due to quetiapine's active metabolite norquetiapine which acts as a norepinephrine reuptake inhibitor among other things. Or perhaps just like every other anti-histamine you become tolerant to the sedation caused by H1 antagonists.
I would say to give it a try for a week if you can hack it out. Some people find that seroquel XR which is the 24 hour release version works better as it's slow release so you don't get the knockout effect. Plus it get's around quetiapine's rather short half life of 5 hours. Though you will probably be more groggy during the day at first with the XR version. What other anti-psychotics have you tried? If you haven't tried it i would suggest olanzapine as that one knocks out mania and mixed states after half a hour for me if it's the Zyprexa zydis version which is a wafer you melt on your tongue. You can get away with taking it as needed too.
I have taken quetiapine, risperidone, olanzapine, methotrimeprazine aka levomepromazine (a old phenothiazine anti-psychotic that is related to chlorpromazine but only has half the anti-psychotic potency but is so sedating it makes quetiapine look like dextroamphetamine), chlorpromazine aka largactil aka good old Thorazine and prochlorperazine aka stemetil aka compazine. I have only taken the methotrimeprazine and compazine for sleep (just 15mg's of methotrimeprazine will knock me out for a good 12 hours), nausea and vomiting so i can't say how well they worked for bipolar. I was prescribed the Thorazine for nausea and vomiting too but i did take 100mg's of it sometimes for a manic episode and it worked quite well. Out of all of them i found zyprexa to not only work the best but with the least side effects. But everyone is different and it took me a long time to find the right combo of meds and unfortunately trial and error is the name of the game for most people with bipolar. So try and not get discouraged just because a med doesn't work for you. Right now i take 200mg's of lamotrigine as my mood stabilizer along with the quetiapine and clonazepam. Sometimes i take bupropion or trimipramine as a anti-depressant too but lately i haven't really needed it. It has been a rough winter to say the least but there is no med going to change the shitty situation i live in.
I am lucky if i get 6 hours of sleep a night and i take 4-6mg's of clonazepam, 150mg's of morphine SR (or more) and often 20mg's or more of dicyclomine (brand name bentylol) which is a strong anti-cholinergic used as a antispasmodic (it helps my IBS) a day along with the 300-400mg's of quetiapine i take every night. On bad days I'll sometimes take 100mg's during the day. Oddly enough quetiapine seems to help my attention span and motivation because i don't have all those thoughts spinning around my head so i can actually concentrate.
Good luck on finding something that works for you and don't give up trying
![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
