I believe you may be speculating about some of this stuff. Doctors in USA can prescribe drugs for conditions that are not officially approved by the FDA. Prescribing antipsychotics, tricyclic antidepressants, benzodiazepines, or any other drugs with a sedative effect could be used to treat insomnia regardless to what the drugs official use is. Its not malpractice, its normal practice and happens everyday.

Doctors do not directly profit from any drugs they prescribe. Also quetiapine has a generic versions since 2012, and you can be sure her insurance company is going to only approve the cheaper version now since it saves them money. Its probably really inexpensive.

You said her dopamine and serotonin levels are permanently affected? What evidence do you have to support this claim? I'm no expert on quetiapine, but I've not read anything that indicates it can cause permanent changes outside of a few very rare (<1% incidences) side effects. And since we are on the subject of altered brain chemistry, have you thought about what permanent or temporary chemical changes cannabis causes to the brain? The long term effects of cannabis use has not had much research. The short/medium effects have at least been shown to unbalance the endocannabinoid system (a neuromodulator effecting many parts of the brain) As such, it can cause dependency and withdraw symptoms. Cannabis has over 400 different chemical compounds, 61 of which are unique to cannabis. Do you know how all of them effect the brain?

And yeah the dopamine/serotonin levels are permanently affected by SSRI's and other atypical antipsychotics and mood stabilizers.
Depression is caused by a decrease in circulating 5HT/NE in the synaptic cleft.
SSRI's affect the 5HT1A downregulation mechanism, SERT transporter becomes blocked with SSRI's preventing reuptake pre-synaptically therefore rebound effects are present because 5HT is not processed pre-synaptically at the efficacy that it usually is processed at. So yes, there is a permanent effect with SSRI's, and other TCA's and anti-depressants and anti-psychotics.

Cannabis binds to the CB1/CB2 receptors, and THC has a chemically similar counterpart in our brain as a neurotransmitter, there are 2 active chemicals in cannabis which is THC/CBD, CBD has anti-inflammatory effects amongst other miraculous effects that this herb provides. Cannabis is definitely safer than SSRI's/antidepressants.

This post was edited by ViviLOL on Sep 3 2014 05:35am

no solution to insomnia except medications

First point: but it's still negligent. Esp considering some of the deleterious ramifications of their use on sleep quality.. for instance, benzos increase time in stage 2 sleep and when coming off of them REM rebound is experienced which denotes the shortage of REM.

Second point: false.. pharmaceutical companies will pay big money to doctors to prescribe their medications. This is one of the reasons adderall/ADHD meds are so ubiquitous now

Third point: wrong lol. Cannabis will not cause dependency or withdrawal symptoms. Period. It can be habit forming, sure, but literally any activity or regimen of activity can and will be habit forming. That's basic neural plasticity. As for long term effects, they are more known actually. Only in chronic & heavy users, there'll be a decreased responsiveness to dopamine in the prefrontal cortex and an increase in alpha wave power in a resting state. These changes manifest as decreasing your ability to focus.. so essentially ADHD-esque symptoms. These changes are reversible though, again a basic neural plasticity response. Cannabis has been more extensively studied than you think.. I can even outline the effects it has on various neurotransmitters if you want? Or the effect on AMPA & NMDA receptors via COX2 signaling? And memory deficits are mainly based around impaired working memory WHILE high.. LTP can and will still occur readily once the depol threshold fires, par usual.
There's only one singular nuance of long term use that can be quite noxious. The anterior cingulate cortex can actually shrink.. but that's after several yearss.. and upward of 5+ joints/blunts a day. That's a ton of weed lol.. most people won't come close to having that risk. Stop talking about things you don't know about.

The whole prescribing drugs for unlisted conditions is not malpractice if done with a reasonable approach. It usually occurs when the first line drugs prove to be ineffective, not suitable for long term use, or when the patient experiences too many negative side effects. I assure you it happens quite often with severe psychological conditions that don't have good drug options.

@ Vivi: Yes SSRI's prevent reuptake, thats what they are supposed to do. But when you discontinue the drug, eventually the brain will go back to how it was before - That is, after all withdrawal symptoms subside. This is what every source I have found suggests. What reputable source do you have that indicates permanent changes do in fact occur?

Just look at this logically for moment and there is probably no need to review the supporting scientific evidence. When somebody is consuming cannabis cannabinoids such as THC, it overloads the CB1/CB2 receptors to the point that the person literally feels high. The brains natural response is to try to rebalance the chemical flow and it does this by producing less endocannabinoids (N-arachidonoylethanolamine, 2-Arachidonoylglycerol, etc) because its getting more than enough stimulation from the THC. When a regular cannabis user suddenly stops use, whats left is a brain producing fewer endocannabinoids than it normally needs. The result is withdraw symptoms that can last anywhere from a couple days to a few weeks while the brain rebuilds its endocannabinoid levels. Common cannabis withdrawal symptoms are irritability, anxiety, depressed mood, restlessness, insomnia, nightmares, reduced appetite, gastrointestinal symptoms, and others. Its usually not severe enough to require medical attention, but it occurs none the less.

@ Bella: I would love to see the study that provided the information about the anterior cingulate cortex. Do you by chance have a link or a name of the study?

I cant say for sure that doctors are not directly profiting from drug makers, but i'd like to see concrete evidence that its actually occurring on the scale you guys are suggesting. Because without evidence, its just speculation. It was well known to have occurred in the 80s and early 90s but much of it has ceased due to the Stark Law. While the Stark law only applies to Medicare/Medicaid patients, they have become the ethical standard for all doctors. Especially considering that now days in US, its pretty hard to be a regular doctor without taking on some medicare patients. Most hospitals and clinics now have policies that limit or eliminate gifts from pharmacy reps. If your clinic doesn't have this policy, its time to find a new doctor.

I hope that we can all be humble enough to treat this thread as a learning experience, and not as an ego boost or ego bash. Anybody is welcome to share constructive criticism or any other relevant information.

This post was edited by NatureNames on Sep 3 2014 11:48pm

Sure: http://bjp.rcpsych.org/content/190/3/230.long
it's because over a chronic and heavy bout, blood flow is attenuated to the ACC causing hypoactivity and possible atrophy.

Btw your knowledge of neurochemistry is wrong. The brain won't decrease prod of the endocannabinoids as those are dependent on post synaptic depolarization for retrograde signaling anyway. It will decrease CB1/2 receptor density though. There are no withdrawal symptoms as you suggest. Nightmares? No. An increase in dreaming perhaps, as THC inhibits NE-dependent melatonin synthesis in the pineal, which can mitigate REM some. Insomnia I could give you, but that's not a withdrawal symptom, that's bc the person probably used the cannabis to sleep aka a habit forming drug, that's it. It's well known it doesn't cause withdrawal symptoms and most of that is predicated on lack of robust mesolimbic DA signaling + the actual elimination/excretion rate of the drug itself is slow.

If she has a choice she could try Trazodone. It's a non-habit forming SARI.

Marijuana+alcohol.

Wish I could still smoke. I need to find a job that doesn't test.

Everything on this thread is going to be speculation because we don't have the significant medical history of your mother. I can tell you that no doctor in the US will prescribe quetiapine as a first choice for basic insomnia. He must think there is a psychological explanation for your mom's insomnia, like a bipolar spectrum illness for example. I'm assuming numerous CBCs and endocrine studies were performed because some very common causes of insomnia can be ruled in/out by them. Also assuming she's had sleep studies with EEGs to confirm it is true insomnia. What other medications has your mother received prior to this? If your mom went to the doctor with complaints of insomnia only (no manic episodes) and immediately received this drug before anything else was tried, that shouldn't have happened.

Nevertheless, at this point it's very difficult to gauge what further medications will do for your mom because she is on a high dose d2/5ht2 antag. Anti-depressants can be used for sleep but they influence the neurotransmitters which are already influenced by the drug she is taking so it can very quickly turn into a mess. You would NEED to look at what else she has taken and how she responded to them to continue with a plan (along with reviewing every lab she has had to rule out medical cause of insomnia). If you have only ever been to one doctor for this it wouldn't be a bad idea to see another. Like I said, a lot of work would have had to be done before your mom should have been started on quetiapine. It is likely it happened, but you haven't mentioned anything of that sort. if you are unsure you should look into the train of thought that led the doctor prescribing this (by directly asking him, requesting your moms medical records and seeking alternate opinion).

A lot of stuff out there can temporarily help with sleep issues, like cannabis, but there are clearly bigger issues that should be dealt with that can't be sorted out here. Believe it or not and it has been clinically documented, behavioral adjustments are the best treatments to insomnia. There are lots of people who have horrible sleep habits and don't even realize it. In their younger years it doesn't affect their sleep much but as they age the poor habits catch up with them. This may not help your personal situation because there are other problems involved, but it can't hurt

http://umm.edu/programs/sleep/patients/sleep-hygiene

This post was edited by iMMze on Sep 25 2014 02:09pm

Ok the link I posted on sleep hygiene there is pretty generalized. There is another link somewhere which gives a lot more specifics, like ideal sleeping environment temperature. This can can vary person to person but I believe there was a study that looked at around 5000 participants which concluded 63F was the best temperature with easy access to a cover. Just an example demonstrating some things aren't always what you expect.