[tellak]

Propofol is an anesthetic, seroquel is not... it’s an antipsychotic. The thing with antipsychotics is they’re shit or “dirty” drugs... seroquel is not even indicated for insomnia (and depending on who you ask is a terrible choice.. a lot of family med/internists use it, psychiatrists often cringe). It works because it has a strong antihistamine side effect, so it’s basically a very potent Benadryl.

The point being, you’re still arousable. A vigorous rub of the sternum will likely wake you up. Not so much on propofol.

[ineedasername]

I'm not sure what your point here is. I made no claim of 1-to-1 parity with propofol, the various uses of seroquel, it's efficacy for a given purpose, etc. Seroquel is however in the class of drugs "major tranquilizers" and my claim was simply that it can have a similar "time warp" effect. It's a claim based on my experience with it, and it is not an uncommon one. (And I do have experience with propofol through a single surgery to compare)

I will address some of the other details of your comment though. First, the statement that someone on seroquel is "arousable": Compared to propofol, sure. But a vigorous rub of the sternum will absolutely not do it for many people, myself included. My wife can attest to the difficulty. And if aroused before time, the state can be likened to severe drunkenness in terms of ability to function.

Also, your are right, there are arguably better sleep aid options. But it's arguable because individuals react so differently to different medications. Seroquel was not a first choice for the task, or the third. A doctor likely would be negligent in prescribing it for that sole purpose on a first consultation without exploration of other options.

As for it being a shit or "dirty" drug, there aren't particularly good options within this class of drugs. We can argue about whether these are over-prescribed, but for people who truly do need them, it is something of a devil's bargain where the benefits can be suspect relative to the costs. For the fortunate that response to them, newer medicines like latuda offer a much lower side-effect profile for similar benefits. Absent very good insurance though, that is financial hit of roughly $15,000 per year that few can afford out of pocket. This leaves the "dirty" drugs.

I won't put words into your mouth with this next part, but there are some that would then argue that these sorts of drugs are universally unsuited for any use, and that people suffering from their targeted disorders might better control their symptoms with diet, exercise, and supplements. Having seen many people attempt such and fail, I regard this point of view as a sort of survivors bias. The people that argue this point of view tend to be the very rare people for whom it works, but just as with any particular medication, the efficacy of any treatment regime varies greatly with the individual.

[tellak]

I tried to keep my statements factual and my own opinion out of it.

While “shit” was a bit tongue in cheeky the term “dirty” is used among practitioners because of the wide range of metabolic side effects that the atypical psychotics have. Seroquel is a metabolically “dirty” drug. Taken in therapeutic doses long term a high percentage of people will end up with metabolic syndrome derangements.

Likewise, in the US and Canada, is not indicated for sleep disorder/insomnia use either. In Lexicomp it’s not even listed for off-label use. That’s just a fact, I don’t know what you’re trying to convince me of. In the US there is also a storied history with Astra-Zeneca and a lawsuit due to their practices of pushing off-label use resulting in a $.5 billion settlement.

Another fact is that Seroquel was one of the most heavily marketed drugs ever to primary care providers. As my 100s of dollars of Seroquel branded swag my office accumulated 15 or so years ago will attest to (I am not a psychiatrist).

My own personal experience has been that most psychiatrists I’ve spoken to at a large academic center, are appalled at the idea of using seroquel for insomnia long term due to serious side effects and the consensus is that it’s MOA is mostly due to its antihistamine property. That’s really all I was saying.

Also most atypicals are not highly sedating, lurasidone especially so. I have not heard of it seriously being mentioned likely for primary insomnia.

[ineedasername]

You seem to have an axe to grind against Seroquel. I don't fault you for it. I hate it. I wouldn't take it if I hadn't explored other options to their exclusion. In my case I take it both for sleep issues and because it's on-label and effective as an adjunctive treatment for other health issues.

Otherwise I wasn't referencing lurasidone for it's sedative properties (it can have the opposite effect) but in comparison with Seroquel for it's use on-label as an antpsychotic. Sorry if there was confusion there. It's a much better option than Seroquel, if it happens to work for you. It doesn't always.