How should I stop taking quetiapine (quetiapine) due to intolerable side effects of body dysmorphic disorder (body dysmorphia) and fatigue, after taking 25mg for under 2 weeks for bipolar disorder?

Discontinuing Quetiapine After Short-Term Use

You can safely stop taking 25mg quetiapine immediately without tapering, given your very short duration of use (under 2 weeks) and low dose. 1

Rationale for Immediate Discontinuation

At your dose and duration, withdrawal risks are minimal:

• The evidence for withdrawal syndromes with antipsychotics primarily concerns patients on higher doses for extended periods 2
• Your 25mg dose is at the very low end of the therapeutic range (quetiapine is typically dosed at 25mg twice daily for scheduled use, with therapeutic doses for bipolar disorder ranging from 300-800mg daily) 3
• Duration under 2 weeks is insufficient to establish physiological dependence in most cases 2
• The FDA label for quetiapine notes that sudden discontinuation may cause insomnia, nausea, and vomiting, but these are typically seen with longer-term use at therapeutic doses 1

What to Expect When Stopping

Possible mild discontinuation effects (lasting 1-3 days):

• Difficulty sleeping or staying asleep (insomnia) 1
• Nausea 1
• Vomiting 1

These symptoms, if they occur at all at your low dose, should be transient and self-limiting 1.

Important Considerations for Your Bipolar Disorder

Stopping quetiapine does not address your underlying bipolar disorder, which requires ongoing treatment:

• Abrupt discontinuation of mood stabilizers in bipolar disorder is associated with increased mood instability and manic relapse 2
• However, at 25mg, quetiapine was likely being used for sedation/sleep rather than mood stabilization (therapeutic doses for bipolar disorder are 300-800mg daily) 4, 5
• You should contact your prescriber immediately to discuss alternative treatment options for your bipolar disorder 3

Addressing Your Concerns

Your concerns about weight gain and fatigue are valid side effects:

• Weight gain is common with quetiapine, even at low doses 1
• Sedation/drowsiness is an expected effect, particularly at the 25mg dose which is often used specifically for its sedative properties 3
• These side effects may have been contributing to your body dysmorphia concerns 1

Alternative approaches to discuss with your provider:

• Lithium or valproate are first-line mood stabilizers for bipolar disorder with different side effect profiles 3
• If an antipsychotic is needed, aripiprazole has less sedation and lower weight gain risk 3
• Combination therapy with mood stabilizers may be more appropriate than low-dose quetiapine monotherapy 3

Critical Next Steps

Do not remain untreated for bipolar disorder:

• Contact your prescriber within 24-48 hours to discuss stopping quetiapine and establishing appropriate treatment 3
• Bipolar disorder requires ongoing mood stabilization to prevent manic and depressive episodes 3, 5
• Your concerns about side effects are legitimate and should guide selection of alternative treatments 1