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Seroquel vs Ativan
Introduction
For patients suffering from conditions such as schizophrenia, bipolar disorder or anxiety disorders, certain medications that modify the balance of specific neurotransmitters in the brain can help manage symptoms and improve quality of life. Seroquel and Ativan are two such drugs often prescribed for these conditions. They each impact different neurotransmitters in the brain, but both have a calming effect on patients with psychiatric or anxiety disorders. Seroquel is an atypical antipsychotic medication that works by affecting levels of dopamine and serotonin in the brain. On the other hand, Ativan belongs to a class of medications called benzodiazepines which work primarily by enhancing the effects of GABA, a naturally occurring chemical in the brain known for its calming properties.
Seroquel vs Ativan Side By Side
| Attribute | Seroquel | Ativan |
|---|---|---|
| Brand Name | Seroquel | Ativan |
| Contraindications | Worsening symptoms of depression, suicidal thoughts or behavior, CNS depressants, certain antifungal treatments (ketoconazole, fluconazole), HIV protease inhibitors (ritonavir), hepatitis C virus protease inhibitors (boceprevir, telaprevir), antibiotics (erythromycin, clarithromycin). | Worsening symptoms of depression, suicidal thoughts or behavior, CNS depressants, barbiturates (phenobarbital), sedatives (diazepam), narcotic analgesics, antidepressants, sedative antihistamines. |
| Cost | For brand name: around $600 for 60 tablets of 100 mg. For generic (quetiapine): as low as $0.15 to around $2 per day depending on dosage. | For brand name: approximately $220 for 30 tablets of 1mg. For generic (lorazepam): typically not exceeding about $0.50–$1.00 per day for usual daily doses of 2–3 mg. |
| Generic Name | Quetiapine | Lorazepam |
| Most Serious Side Effect | Suicidal thoughts or actions, allergic reactions, changes in vision, rapid heartbeat, chest discomfort, hyponatremia, Neuroleptic Malignant Syndrome (NMS), signs of serotonin syndrome. | Allergic reactions, severe skin reactions, changes in mood or behavior, unusual dizziness and lightheadedness, sudden restless feeling or excitement, confusion, aggression, hallucinations. |
| Severe Drug Interactions | Clozapine, antifungal treatments, HIV protease inhibitors, hepatitis C virus protease inhibitors, antibiotics. | Barbiturates, sedatives, narcotic analgesics, antidepressants, sedative antihistamines. |
| Typical Dose | 25-800 mg/day, with 300-400 mg/day being sufficient for most adults for treating schizophrenia. | 2–3 mg/day, taken orally in divided doses, with a daily dose varying from 1 to 10 mg. |
What is Seroquel?
Quetiapine (the generic name for Seroquel) is a second-generation antipsychotic medication, representing significant progress from the first generation of these drugs. Quetiapine was given FDA approval in 1997. It works by adjusting levels of dopamine and serotonin in the brain, effectively prolonging their presence and effect. This makes it useful in treating various forms of mental health disorders such as schizophrenia, bipolar disorder, and depression when used with antidepressants. On the other hand, Lorazepam (Ativan) is a benzodiazepine class drug that primarily affects GABA neurotransmitters to induce sedation and reduce anxiety symptoms - it has less influence on dopamine or serotonin systems. Hence, Ativan tends to have fewer side effects related to mood alterations compared to Seroquel but may bear a higher risk for dependency due its tranquilizing effects.
What conditions is Seroquel approved to treat?
Seroquel is approved for the treatment of several mental health conditions:
- Schizophrenia, a chronic and severe mental disorder affecting how a person thinks, feels, and behaves
- Bipolar disorder (both manic and depressive episodes)
- Major depressive disorder as an add-on treatment when initial antidepressant therapy has not worked sufficiently
- Acute treatment of manic episodes associated with bipolar I disorder in pediatric patients aged 10 to 17 years.
How does Seroquel help with these illnesses?
Seroquel, also known as quetiapine, is effective in managing symptoms of psychiatric disorders by altering the activity of certain natural substances in the brain. It does this by blocking multiple neurotransmitters, namely dopamine and serotonin receptors. These chemicals are responsible for transmitting messages between nerve cells and play a vital role in regulating mood and behaviour. Lower levels or functional alterations of these neurotransmitters have been associated with conditions like schizophrenia or bipolar disorder. By inhibiting these receptors, Seroquel can balance out the neurotransmitter levels thereby reducing symptoms such as hallucinations, delusions and improving concentration.
On the other hand, Ativan (lorazepam) works on a different set of chemicals in the brain - primarily gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter that slows down brain activity to induce relaxation and reduce anxiety or panic. This makes Ativan particularly helpful for individuals dealing with anxiety disorders or those who require sedation prior to surgery.
What is Ativan?
Ativan, another name for Lorazepam is a benzodiazepine that increases the neurotransmitter GABA in the brain to exert its calming effects. This makes it effective for short-term treatment of conditions like anxiety and insomnia. Ativan was approved by the FDA in 1977 and has since been used widely as an anti-anxiety medicine due to its immediate effects.
Unlike Seroquel which is an atypical antipsychotic primarily affecting dopamine and serotonin receptors, Ativan does not act on these neurotransmitters. Its main action on GABA means that its side-effect profile differs from atypical antipsychotics such as Seroquel. Specifically, Ativan does not typically cause weight gain or increase cholesterol levels — common side effects associated with Seroquel use.
However, while both drugs can be sedating, this effect may be more pronounced with Ativan particularly when starting therapy or increasing dosage which can also impair motor function and coordination temporarily. Therefore careful monitoring is required especially if you're taking other central nervous system depressants including alcohol.
What conditions is Ativan approved to treat?
Ativan is a medication often prescribed for the management of:
- Anxiety disorders
- Short-term relief of symptoms related to anxiety or acute stress that might lead to severe impairment
- Preoperative sedation and anxiety relief before surgical procedures.
How does Ativan help with these illnesses?
Ativan (lorazepam) is a benzodiazepine, which operates in the body by magnifying the efficiency of GABA, a neurotransmitter that slows down brain activity. This results in sleepiness or calming effects, thus alleviating symptoms of anxiety and insomnia. It acts quickly and can be taken as needed rather than on an ongoing basis like Seroquel. Ativan’s action on GABA may also play roles in its efficacy as an anti-anxiety medication. Since it does not significantly impact serotonin levels, it is sometimes prescribed when a patient doesn't respond well to “typical” antipsychotics such as Seroquel; or it may be combined with these medications for more comprehensive treatment strategies.
How effective are both Seroquel and Ativan?
Both quetiapine (Seroquel) and lorazepam (Ativan) have established histories of success in treating patients with symptoms of psychiatric disorders, including anxiety and bipolar disorder. They were initially approved by the FDA several years apart, with Seroquel coming into use later. As they act on different neurotransmitters, they may be prescribed under different circumstances.
The effectiveness of quetiapine and lorazepam in managing symptoms was directly studied in a double-blind clinical trial in 2005; the two drugs exhibited similar efficacy in managing acute mania associated with bipolar disorder as well as similar safety profiles. However, weight gain was more common among those taking quetiapine.
A 2010 review reported that quetiapine is effective from the first week of treatment for alleviating manic episodes connected to bipolar disorder and it is also widely used off-label for insomnia due to its sedating effects. The same study reports that despite concerns over metabolic side-effects such as weight gain and diabetes mellitus type II risk increase, it has become one of the most commonly prescribed antipsychotics worldwide.
A 2012 review indicated that lorazepam seems to be effective at reducing acute anxiety symptoms but long-term use can lead to physical dependence and withdrawal syndrome upon discontinuation. Nonetheless, lorazepam is often considered a first-line option for short term relief of severe or disabling anxiety or panic attack due to its immediate onset action. Significant research on its use involves co-prescribing alongside an SSRI or an antipsychotic like Seroquel when rapid symptom control is required while waiting for longer acting agents' therapeutic effect onset. Nonetheless, Lorazepam's role as primary treatment remains limited because continuous usage beyond four weeks leads to tolerance development which makes this drug less effective over time.
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At what dose is Seroquel typically prescribed?
Oral dosages of Seroquel can range from 25-800 mg/day, but studies have suggested that a dose of 300-400 mg/day is sufficient for treating schizophrenia in most adults. Children and adolescents aged 13 to 17 may be started on a dosage as low as 50 mg/day. In either population, the dosage can be gradually increased over several weeks if there are no signs of improvement. However, the maximum daily dosage should not exceed 800mg under any circumstances.
At what dose is Ativan typically prescribed?
Ativan treatment typically commences at a dosage of 2–3 mg/day, taken orally in divided doses. However, the daily dose may vary from 1 to 10 mg. For anxiety, most patients require an initial dose of 2 to 3 mg/day given two times a day or three times a day. The maximum daily total amount for anxiety is around 10 mg split into smaller doses throughout the day. If there is no adequate response to this after several weeks, your healthcare provider might consider increasing the dosage cautiously. Keep in mind that Ativan should be used for short periods only (generally up to four months), and it's important not to adjust your dosage without consulting with your doctor first.
What are the most common side effects for Seroquel?
Common side effects of Seroquel may include:
- Drowsiness or sedation
- Dry mouth
- Constipation
- Increased appetite which could lead to weight gain
- Upset stomach, nausea or vomiting
- Fatigue and lethargy
- Disturbed sleep patterns, including nightmares
- Nasal congestion (sinusitis)
Whereas Ativan's common side effects might involve:
- Sedation, dizziness and weakness
- Unsteadiness (due to impaired coordination)
- Memory impairment (especially in elderly patients) Amnesia (memory loss of varying severity)
- Dependence and tolerance after prolonged use
- Impotence, changes in sexual desire
It is crucial that these medications are taken as directed by a healthcare provider due to possible significant interactions with other drugs.
Are there any potential serious side effects for Seroquel?
Seroquel, similar to Ativan, has the potential for serious side effects, although these are relatively rare. These could include:
- Suicidal thoughts or actions
- Unusual changes in mood or behavior
- Allergic reactions: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, difficulty breathing.
- Changes in vision including eye pain and seeing halos around lights
- Rapid heartbeat, chest fluttering or discomfort; feeling like you might lose consciousness
- Hyponatremia - symptoms may include headache, confusion, slurred speech, severe weakness and unsteadiness
- Neuroleptic Malignant Syndrome (NMS) – characterized by muscle rigidity/stiffness accompanied with high fever and sweating along with rapid heartbeats and tremors
- Signs of serotonin syndrome such as restlessness/agitation/hallucinations, fever/sweating/shivering, rapid heart rate, muscle stiffness/twitching/loss of coordination, nausea/vomiting/diarrhea.
These side effects are not common but if experienced it is important to stop Seroquel immediately and seek medical attention.
What are the most common side effects for Ativan?
Ativan has been found to cause a variety of side effects, including:
- Drowsiness or dizziness
- Nausea and vomiting
- Blurred vision
- Headache
- Change in sexual interest/ability
- Constipation or heartburn
- Changes in appetite leading to weight changes (either loss or gain)
- Increased sweating Increased salivation causing potential dry mouth issues.
More serious but less common side effects may include memory problems, mental/mood changes such as hallucinations, depression, thoughts of suicide), trouble speaking/walking, muscle weakness, tremors. Ativan also tends to create dependence and withdrawal symptoms can be severe if the medication is stopped suddenly; it should always be tapered under medical supervision.
Are there any potential serious side effects for Ativan?
While Ativan is generally well-tolerated, it may cause serious side effects in rare cases. Some of these potential adverse reactions can include:
- Signs of an allergic reaction such as hives, itching, difficulty breathing or swallowing, swelling around your face or throat
- Severe skin reactions including red or purple skin rash that spreads with blistering and peeling
- Changes in mood or behavior such as new or worsened symptoms of depression, thoughts about suicide or self-harm
- Unusual dizziness and lightheadedness which could lead to falls
- Sudden restless feeling or excitement
- Confusion, aggression, hallucinations;
- Worsening sleep problems;
If any of these occur while taking Ativan please seek immediate medical attention.
Contraindications for Seroquel and Ativan?
Both Seroquel and Ativan, along with most other psychotropic medications, may worsen symptoms of depression in some people. If you notice your depression worsening or an increase in suicidal thoughts or behavior, please seek immediate medical attention.
Neither Seroquel nor Ativan can be taken if you are taking, or have been taking drugs like clozapine that depress the central nervous system (CNS). Always tell your physician which medications you are taking; CNS depressants will require a period to clear from the system to prevent dangerous interactions with Seroquel and Ativan.
Seroquel has additional potential reactions with certain antifungal treatments such as ketoconazole and fluconazole, HIV protease inhibitors such as ritonavir, hepatitis C virus protease inhibitors including boceprevir and telaprevir, antibiotics like erythromycin and clarithromycin among others.
Ativan also reacts unfavorably with several types of medication including barbiturates such as phenobarbital; sedatives like diazepam (Valium); narcotic analgesics; antidepressants; sedative antihistamines or medicines for allergies/colds/sinus congestion containing antihistamines.
How much do Seroquel and Ativan cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Seroquel (100 mg) averages around $600, which works out to about $10 –$20/day, depending on your dose.
- The price for a pack containing 30 Ativan (1mg) tablets is approximately $220, working out to roughly $7.3/day.
Thus, if you are in the higher dosage range for Seroquel (i.e., 400 mg/day or higher), then brand-name Ativan may be less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions seroquel (quetiapine) and ativan (lorazepam), costs are significantly lower:
- Quetiapine is available in packs of 30 tablets and above with approximate costs from as low as $0.15 to around $2 per day depending on dosages ranging from 25mg up to typical doses between 150 and 300 mg.
- Lorazepam can be found in packs upto several hundred capsules with prices typically not exceeding about $.50–$1.00 per day even when considering larger usual daily doses such as 2–3 mg daily.
Popularity of Seroquel and Ativan
Quetiapine, in generic form as well as brand names such as Seroquel, was estimated to have been prescribed to about 1.8 million people in the US in 2020. Quetiapine accounted for around 2% of antipsychotic prescriptions in the US. It's an atypical antipsychotic used primarily to treat bipolar disorder and schizophrenia but also prescribed off-label for insomnia or anxiety disorders.
Lorazepam, including its brand name Ativan, is a benzodiazepine medication that had approximately 14 million prescriptions filled out across the United States within the same period. Lorazepam accounts for just under 16% of all benzodiazepine prescriptions and is commonly prescribed for treating anxiety disorders and short-term relief of symptoms related to anxiety or panic attacks. The prevalence of lorazepam has remained steady over the past decade with minor fluctuations.
Conclusion
Both Seroquel (quetiapine) and Ativan (lorazepam) have long-standing records of usage in patients with mental health disorders, and are backed by numerous clinical studies indicating their effectiveness over placebo treatments. In some cases, these drugs may be combined; however, this requires careful consideration by a physician as they also carry potential interactions. The choice between the two often comes down to the specific symptoms needing treatment: Seroquel is an atypical antipsychotic used primarily for schizophrenia, bipolar disorder, and major depressive disorder while Ativan is a benzodiazepine generally prescribed for anxiety disorders or short-term relief from severe stress and anxiety.
Both drugs are available in generic form which offers substantial cost savings especially for those paying out of pocket. Both medications require an adjustment period where benefits may not be immediately noticeable.
The side effect profile varies between the two drugs. While both can cause drowsiness or sleep-related issues, Seroquel carries unique side effects such as weight gain and increased risk of diabetes that aren't commonly associated with Ativan use. For both medications, users must closely monitor their moods and overall health status when starting therapy - immediate medical intervention should be sought if one experiences worsening mood swings or any suicidal thoughts.
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Refrences
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- Wetzel, H., Szegedi, A., Hain, C., Wiesner, J., Schlegel, S., & Benkert, O. (1995, May). Seroquel (ICI 204 636), a putative “atypical” antipsychotic, in schizophrenia with positive symptomatology: results of an open clinical trial and changes of neuroendocrinological and EEG parameters. Psychopharmacology. Springer Science and Business Media LLC.http://doi.org/10.1007/bf02246165
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