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Daniel Sheibley, MD
Daniel Sheibley, MD, Doctor
Category: Medical
Satisfied Customers: 1834
Experience:  MD Grad Jefferson Medical College 2009. Internal Med intern 2010 & Radiology residency 2011. Husband & father of two.
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I am worrying about my medication but my psychiatrist and GP

Resolved Question:

I am worrying about my medication but my psychiatrist and GP keep shunting me from one to the other and I'm not getting any answers.
I take Escitalopram, Mirtazapine, Depakote and Seroquel for Bipolar II - they work well for me.
I have been reading about the medications and hear that patients on medications such as these tend to end up with heart disease. I know there has to be a balance between pros and cons, but now I am paranoid about dropping dead prematurely!! Is this a valid concern, and do I need to try to get my meds changed, or is it just an unfortunate cost of taking something that stops be being suicidally depressed?? It looks likely that I will be taking these meds long term.
Submitted: 3 years ago.
Category: Medical
Expert:  Daniel Sheibley, MD replied 3 years ago.
Daniel Sheibley, MD :

Hello. Yes notably seroquel plus escitalopram can place you at higher risk for long QT syndrome (the heart disease problem you are worried about)

Daniel Sheibley, MD :

It is that combination of the medications you are on that is most worrisome for that problem, not that the medication along can't cause or exacerbate that problem, the combination of the two is an interaction that makes it more likely

Daniel Sheibley, MD :

As long as you continue to be aware of your cardiac health and have an EKG routinely, you'll be able to follow and catch any changes before they become critical.

Daniel Sheibley, MD :

If that is not enough of a solace for you, you can discuss a different atypical antispychotic other than seroquel such as latuda which has less effects on Long QT syndrome (the heart issue) than many of the other atypical antipsychotic class of medications

Customer:

Ok, thanks for clarifying that. I have been making sure I eat right and exercise regularly to try to keep in good physical health. Both my paternal grandparents died of heart attacks (aged 36 and 56) so I am a bit paranoid!

Daniel Sheibley, MD :

It is in the same family but a slightly different side effect profile.

Customer:

Ok, so maybe I will ask about Latuda then, that might be a good alternative

Daniel Sheibley, MD :

There are 15 medications in that class.

Daniel Sheibley, MD :

If one doesn't work for you there are many others that may work (regarding intolerable side effects)

Daniel Sheibley, MD :

Latuda may be a better option (not that one of the other 15 might not be better than seroquel regarding long qt)

Daniel Sheibley, MD :

Geodon is one of the worser ones for long qt

Daniel Sheibley, MD :

I suggest you have a meeting with your psychiatrist about your atypical antipsychotic medication (Seroquel) and see if there is one they feel will fit you well and minimize the risk you are concerned about regarding the cardiac side effects.

Daniel Sheibley, MD :

Again, not knowing all details of your history, Latuda would be my first recommendation.

Daniel Sheibley, MD :

Lurasidone is the generic name

Customer:

Ok, thank you for your advice - at least I can go into a meeting with them being confident in what I am asking for. I really appreciate your help.

Daniel Sheibley, MD :

but i believe it is only brand name available

Daniel Sheibley, MD :

Glad to help. Did I provide good service?

Customer:

Really good service; thank you for being straight with me and for giving me some really solid information to work with. I appreciate it a lot

Daniel Sheibley, MD :

You can find detailed lists of that class of medications online (wikipedia is amazing)

Daniel Sheibley, MD :

they should have a page devoted to each of those medications in the class

Daniel Sheibley, MD :

The class is "atypical antipsychotics"

Customer:

I will go and look into that now

Daniel Sheibley, MD :

for some of them they give a ranking as in "this one is 8th least likely to cause motor symptoms" or this is 2nd most common to produce long qt symptoms

Daniel Sheibley, MD :

or metabolic symptoms

Daniel Sheibley, MD :

those are the three main classes of side effects from this group of medications

Daniel Sheibley, MD :

find what fits your concerns and preexisting health problems the best

Daniel Sheibley, MD :

and take your physician's suggestions because they will have their preference and reasons for choosing between one or two that fit you best

Daniel Sheibley, MD :

and there isn't much difference between 2nd and 3rd least likely to cause certain problems out of a group of 15, just keep that in mind. that is splitting hairs.

Customer:

Honestly, I am so grateful for your answers - I am so glad I came onto this site. You've really given me a lot to work with! Thank you!

Daniel Sheibley, MD :

If you ever want to discuss things further you can always personally request me. Best wishes to you.

Customer:

Oh that's good to know. I may just do that. Again, you've really helped me today - I know I'm just another online patient but your time and insight has helped me a lot.

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