What precautions can you take for use of Seroquel for depression?

Before starting treatment, you should have a fasting blood- sugar and lipid profile, and your doctor should record your weight. "Establishing that baseline is the standard of practice for using atypical antipsychotics," says Michael E. Thase, M.D., professor of psychiatry at the University of Pennsylvania School of Medicine. You should be monitored regularly for changes during treatment. CU medical advisers also suggest having a blood count and thyroid function test before starting treatment.

• Call your doctor immediately if you develop diabetic symptoms such as extreme thirst or hunger, frequent urination, blurred vision, or weakness.
• Discontinue the medication and see a doctor if you experience high fever, sweating, unstable blood pressure, or muscle rigidity, which may signal a rare but potentially fatal reaction.
• Have your eyes checked for cataracts before and periodically during treatment.
• Use the drug with caution if you have cardiovascular disease or a history of heart attack or seizures.
• Don't drive or operate machinery until you know how the medication affects you.
• Men who experience a prolonged, painful, or unwanted erection should discontinue the drug and contact their physician.
• Antipsychotic drugs can affect your body's ability to regulate temperature, so use care during vigorous exercise or exposure to extreme heat.
• Tell your doctor if you are pregnant or planning to become pregnant. Don't breast-feed while taking quetiapine.
• Tell your doctor what prescription and nonprescription drugs or supplements you take.
• Avoid long-term use of antipsychotics as add-ons for depression. "I would try to wean patients off in six to 12 months," Goodman says.

What other options can you try?

Most people who need an antidepressant should start with a selective serotonin reuptake inhibitor (SSRI) or another type of "second- generation" antidepressant. If that doesn't provide adequate benefit after four to eight weeks, your doctor will likely increase the dosage or switch you to another SSRI or a different type of antidepressant. Studies suggest that about 30 percent to 40 percent of people don't respond fully to treatment with an initial antidepressant, so it's not uncommon to try three or even four different medicines before finding one that works. Also, some studies have found—and many experts believe—that antidepressants often work best in combination with talk therapy lasting at least several months.

If those measures don't provide relief, adding another drug, such as a second antidepressant, is often the next step.

If depression remains even after those treatments, an atypical antipsychotic may be considered, but we recommend it only as a last resort, given its potential for serious side effects. However, if you have severe symptoms, your physician may suggest it earlier in the process. One thing to note is that many people who begin taking these types of medications stop using them because of the unpleasant or bothersome side effects. If you reach the point of considering Seroquel XR or any other atypical antipsychotic to treat your depression, Consumer Reports medical advisers suggest that you consult with a psychiatrist to help manage these medications.

Bottom line

Quetiapine and other atypical antipsychotics may complement the effects of antidepressants, but they're expensive and can cause significant side effects that require careful monitoring. Our advice: Talk with your doctor about all available treatments for your depression. If first-line medications aren't effective or you can't tolerate them, consider quetiapine only after its risks and benefits have been thoroughly explained to you.