Article Figures & Tables
Figures
- Figure 1:
Influences that promote off-label use of quetiapine. *Patients with complex psychosocial needs have incomplete symptom resolution with a single agent, have multiple mental health diagnoses and may live in unstable environments.
Tables
Characteristic No. (%) of participants
n = 15Male sex 8 (53) Years in practice < 5 1 (7) 5–9 4 (27) 10–14 4 (27) ≥ 15 6 (40) Practice type Community family practice (general) 6 (40) Community family practice (vulnerable/inner city population) 4 (27) Walk-in clinic 2 (13) Family doctor working in hospital (hospitalist) 3 (20) Access to extended mental health services in community or hospital 13 (87) Theme Quotation no. Illustrative quotation “Mental health plus” 1 So most of us family docs are used to using zopiclone for sleep, and so the reason, I think, I think I’m seeing so much quetiapine is because there’s another psychiatric aspect to what they’re seeing, so it’s not just sleep. … There’s either an anxiety component, an agitation component, there’s something else. It’s sleep plus. (Female part-time hospitalist, 5–9 yr in practice) 2 I would see patients who I guess were primarily coming out of jail and a lot of those patients would be on quetiapine for aggressive behaviour, for sleep, for anxiety, and some of them would even say, some of those patients would say that it helped them sort of quell their addictions, so that’s probably where I got exposed to it the most. (Male, full-time community practice, vulnerable populations, 5–9 yr in practice) 3 Mhm, so a patient comes in with, so middle-aged patient, either female or male, coming in with predominantly generalized anxiety, some depressive features, some insomnia, who is suffering most acutely from the insomnia and the fatigue as a result, which then ends up fuelling the anxiety and depressive symptoms, so would then start at a low [dosage] concurrently an antidepressant in addition to very low [dosage], say 12.5 mg, of quetiapine at night just to help with the sleep initiation. (Female, community practice, 5–9 yr in practice) 4 On the other hand, that’s one complaint that I think we struggle with addressing, because you just don’t have a lot of options that actually are reliably effective and don’t come with a host of other problems, so there’s certainly been times where I think we’ve prescribed quetiapine just as a sleeping aid simply because we don’t want to prescribe anything else and the encounter is not going to end, you know, we sort of have to give up a prescription for that in order to meet other goals, so some negotiation where, sort of, picking at a bit of a battle with the patient that might not be very therapeutic over that issue. There may be other things that we’re working on as a priority. (Male, community, ≥ 15 yr in practice) Choosing cautiously: the lesser of 2 evils 5 You need to stay away as much as possible from benzodiazepines or zopiclone or anything in that class because of the addictive properties and, well, dependence, really and the interference with sleep architecture. Now, admittedly, I don’t fully understand how quetiapine either augments or disrupts sleep architecture, so that I don’t know. I don’t know anything about the long-term effects, but as a result of us needing to move away from [benzodiazepines] etc., it seems like quetiapine has moved into that vacuum that was created. (Female, community practice, vulnerable populations, 5–9 yr in practice) 6 No. No, I think because there [are] not any alternatives, right? It’s sort of, like, what do you do with somebody who’s got a personality disorder, has impulsivity, has addictions, has anger management problems, and you don’t want to put them on a benzodiazepine, right? Like, there’s not a lot of other options. (Male, full-time community, vulnerable populations, 10–14 yr in practice) My patients are fine on low dosages 7 They seem to do fine, so I’m not very worried about 50 or 100 [mg]. I’m embarrassed to admit, I’m not even sure about the relationship between quetiapine and diabetes, so if they’ve had some blood tests, I check and see what their blood glucose is, and obviously take a look at their weight, but I don’t routinely check blood glucose after they’ve been on it for a while. (Male, full-time community practice, ≥ 15 yr in practice) Prescribing influences 8 If I were to hazard a guess, it would be, if it’s becoming more popular, that it would be just something that you’re seeing your colleagues using and you’re seeing specialists using, so you tend to use it a bit more. (Female, full-time community, 10–14 yr in practice) 9 I’ve renewed it in patients who have had it for awhile and they’re stable on their medications, I certainly renew it, though, when I do, I ask why they’re taking the medication, and oftentimes they don’t really know why they’re on it. (Male, full-time community practice, 5–9 yr in practice) 10 I do tend to just continue. I think the only time that I would necessarily reevaluate, I reevaluate their mood on a regular basis, but I think the only time that I would reevaluate their medications is if their mood was not as good as we would like it to be. I’ve had patients who have been on it a long time, and they are counselled by me on the risks of staying on it long-term, and they say, “Doctor, I want it, it helps me sleep and I feel better and my mood is better,” and I, they accept the risk and they want to stay on it. (Female, community practice, 5–9 yr in practice)
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