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Seroquel Tapering

This entry was posted in Antipsychotic on by .
Medically Reviewed Fact Checked

Last Updated on August 4, 2021 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Before beginning Seroquel tapering, weaning or titration, we recommend starting by first finding out as much as possible about the mechanisms and effects of this drug. This atypical antipsychotic drug carries not one, but TWO “black box” warnings due to its extremely dangerous side effects.7 It is imperative that anyone seeking to get off this drug seeks professionally managed Seroquel tapering, titration, and weaning help.

Even if the drug was prescribed during a time of extreme crisis, that does not necessarily mean that a person is destined to remain medicated for life. For many, we KNOW there are effective alternatives.

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Seroquel Tapering Guidelines and Schedule

Methods described below need to be talked about with a prescriber who is knowledgeable and willing to help a person taper. Unsupported Seroquel tapering is difficult and the health consequences of miss-steps can be dangerous. Inpatient help is the best recommendation, but if that is not possible, seek help and guidance from a trusted medical professional.

Seroquel Tapering Guidelines Summary:

  • seroquel tapering guidelinesBegin your taper from Seroquel only when you are stable. Inpatient care is strongly indicated for persons not eating and sleeping well, and who are experiencing extreme drug side effects such as suicidality, feeling aggressive, impulsive, etc.
  • Put an agreement in place with a trusted friend, family member, or caregiver that you will follow directions given by your prescribing doctor during the taper, and if you revoke the agreement, you will go to the hospital or the police may have to get involved. This formal pact is called contracting for safety, or the “Ulysses contract.” 10
  • Select a prescribing physician who understands and supports your tapering goals.
  • Stimulants are best entirely avoided, including coffee or energy drinks.14,15
  • Recreational marijuana or other drug use should be suspended.16,17
  • Adhere to dietary restrictions that will allow for blood sugar stabilization: Avoid sugar. Eat breakfast.18,19,20
  • Oxygen is a co-factor in breaking down excess dopamine.12,13 Cardio exercise is recommended to assist with controlling excess dopamine.
  • Ask your prescriber to obtain the lowest dose available for configuring dosage correctly during the taper. (orange round 25 mg)
  • If you are taking other medications discuss the best sequence for reduction with your prescriber.21,22 (read more below)
  • Expect the taper to be gradual. Months is a more realistic estimate than weeks.23
  • Slow reduction is generally recommended, and the intensity of symptoms will help determine what percentage to cut at each step-down, and how long to wait for the next cut.
  • Learn what withdrawal symptoms may be expected and discuss these with your doctor as the taper progresses, as they can help gauge whether the pace of the taper should be modified.
  • If you stop eating or sleeping well, these can be red flags your doctor needs to know about.
  • Don’t be dismayed if the last cuts seem to take the longest time. This is not unusual because the CNS and body need time, nutrition, rest, and other assistance to normalize.25
  • Speak to your prescriber if bridge medications, such as Depakote, could help in some cases.
  • Avoid repetitive stimulating music, video games, TV, internet surfing, etc. Choose calming, relaxing activities that you enjoy like outdoor walks, gardening, crafts, hobbies, etc. to offset the undesirable stimulation that can occur with antipsychotic tapering.25
  • Your physician will need to convert liquid form to Seroquel in oral form.
  • More guidelines can be found on our antipsychotic alternatives page.

Stabilize before beginning Seroquel tapering

The best time to start Seroquel tapering is when you are eating well, sleeping well, and are reasonably tolerating the medication. You will want to begin regular exercise and arrange your medical and peer support systems with a contract for safety in place. Consider arranging your daily schedule to consist of not overly demanding work or other activities that are not stressful. Other changes include optimizing the diet (more below on diet and options for supplementation) and cutting out caffeine or other stimulants. Avoid recreational drug use including alcohol. Some persons may struggle with sleep issues, and if this is the case, ask your doctor or a holistic practitioner for suggestions. There are holistic solutions you can explore as well on our antipsychotic alternatives page. For unresolving sleep issues, your doctor may suggest the temporary use of a non-antipsychotic medication to get sleep under control. Discuss all of these options with your prescribing physician to find the right solution for your situation.

Important note on rapid withdrawal:

In some cases, there may be an urgent need to transition off Seroquel due to complications such as emerging tardive dyskinesia or other movement disorders, akathisia, or other extremes as a result of the medication. We are not able to provide rapid withdrawal at Alternative to Meds Center and would suggest consulting your prescriber without delay for the best direction.

Contracting for safety — the “Ulysses contract”

Reducing a drug that has locked down the expression of dopamine may generate some mania symptoms. This is not unusual and somewhat expected. In a manic state, a person may find it difficult to impossible to follow the tapering directions that have been put in place. To counteract this situation before it happens, it is suggested that you and a trusted friend or family member draw up a contract or commitment saying that you will follow the directions of the prescribing physician. And, if you decide to revoke this agreement, that it will likely mean the police or hospitalization will have to become involved. Put your commitment to this person in writing so that they may present it to you later should you become unwilling to continue to follow directions and so that you will listen to them. It is not safe to abruptly halt an antipsychotic taper and you are putting this “Ulysses contract” in place for your own safety and the safety of those around you as well.10 This is a safety precaution that we highly recommend. Please also refer to our page Seroquel withdrawal psychosis.

Medical support needed for Seroquel tapering

Finding medical support can be difficult but we recommend taking the time to find it for antipsychotic tapering. Inpatient treatment is the most preferred approach, if possible. When you find your ideal practitioner, share the information from our site and begin the discussion and planning for a safe taper.

No caffeine or other stimulants

The importance of this cannot be over-emphasized. Where antipsychotic use has caused supersensitive dopamine receptors you do not want to add any potential for going off the rails because of adding more fuel to the fire.14,15 Even other prescribed medications may trigger this reaction and will be discussed below.

Stop marijuana use

seroquel thc adverse effectsThough the subject is not new, since the legalization of marijuana products containing THC, a tsunami of research has occurred on THC-induced psychosis. However, it has been known for some time that THC can affect some people more adversely than others. For example, according to Henquet et al in their 2008 study published in the Schizophrenia Bulletin, genetics likely play a role in determining who could be most at risk for THC-induced psychosis or schizophrenia.16 Of course people experiencing this phenomenon could have very likely ended up on a prescription of Seroquel and due to sensitivity should have been directed to cease using THC products. But in any case, a person should stop marijuana use before attempting to taper. For some, using THC products may have not been problematic while taking Seroquel and may have been somewhat useful to offset some of the emotional numbness or other Seroquel-induced side effects. But it is a different story when tapering Seroquel, as marijuana use here could introduce the very real risk of drug-induced psychosis.17

Eating breakfast and maintaining blood sugar

Maintaining equilibrium in blood sugar levels is extremely helpful during antipsychotic tapering. Both hypoglycemia and hyperglycemic conditions can have disastrous effects on mental health, including delirium, psychosis, and confused states. These types of symptoms can derail a Seroquel taper faster than you can order an apple-cherry strudel at an Austrian bakery. There are low-glycemic alternative sweeteners that are chemical-free that can be used in baking. Otherwise, skip the sweet stuff.18,19

Eating breakfast is another simple and effective strategy for maintaining level blood sugar. An interesting study authored by Betts et al and published in the American Journal of Clinical Nutrition showed that habitual breakfast skipping led to fluctuations in glucose levels over the later part of the day, whereas breakfast eaters showed no such fluctuations.20 A bag of sliced cucumber or celery is a viable snack. Coconut slices dipped in peanut butter are amazing. Hard-boiled eggs or ham roll-ups are portable and filling especially if you are on the go. The important point here is all about balance. Don’t binge on sugar and refined carbs, and don’t go into hunger states. Keep yourself satisfied with low-glycemic delicious snacks and several small to moderate-sized protein-based meals during the taper.

Cardio Exercise

There are obvious and universal health advantages to exercise.12 There is an additional benefit for someone tapering Seroquel. The taper may induce an excess of dopamine that exercise can help to metabolize. This is because oxygen is a cofactor in breaking down excess dopamine. 13 Getting the heart rate up by running, brisk walking or other activities can be very effective therapeutically during antipsychotic tapering. Always work gradually towards a realistic goal and don’t overdo it but aim for increasing endurance and strength over time, along a safe trajectory.

Use the smallest mg dose available for the taper

Have your doctor prescribe the smallest dose to make configuring dosage amounts more easily. In this case, it is the round orange 25 mg. Please note — this doesn’t mean to drop to the lowest dose. As an example, For example, to go from 200 mg down to 175 mg, you could cut the 200 mg pill in half (for 100 mg) and then add 3 x 25 to total 175 mg.

Other medications you are on

This is not often a perfect world. A person may end up on a puzzling and imperfect array of medications along with Seroquel (quetiapine). Some depressant-type medications would be better to taper off last to give an added buffer to the Seroquel withdrawal. On the other hand, stimulants like Provigil, SSRIs, or SNRIs would be best gently tapered off first to avoid excess dopamine levels that would be counterproductive during Seroquel tapering. Work out a proper and logical plan with your prescriber that will make your Seroquel taper process as safe and efficient as possible. 21,22

How long is my Seroquel taper going to last?

There is no “one-size-fits-all” for antipsychotic tapering. Studies show that gradual reduction is more effective for preventing relapse of original symptoms.23,25 We have found a good starting range to consider would be one month to prepare and get stable, and one month for every year a person has taken Seroquel or similar drugs. Factors that will help determine the schedule are the amount of support you have in place, the severity of symptoms as well as withdrawal effects, and how long the drug was taken. This will naturally be different for each individual.

Symptoms during the withdrawal

Withdrawal symptoms can newly emerge, as well as overlap original symptoms and side effects. The wide range of withdrawals is attributed, at least in part, to the upregulation of dopamine receptors as a result of treatment with Seroquel. Starvation makes hunger, and that is what happens with the (starved) dopamine receptors and (created hypersensitivity to) dopamine. As a result, when the drug is withdrawn, dopamine begins to flow again, and withdrawals can occur. If these are overwhelming or extreme, that would mean the taper is too fast and might even signal going back up on the drug and then when stable, resuming the taper at a slower pace.244 Time is needed for these hypersensitive receptors to downregulate again, and this is one reason why antipsychotic tapering has to be slow and gradual. You can read more on our page about Seroquel withdrawal symptoms.

Red Flags of Seroquel Tapering

During Seroquel tapering, if a person starts not eating or sleeping well, these can be critical red flags to look further into and remedy. It may mean that the person needs to increase their dosage and stabilize before further dosage reduction. Be aware of these types of signs and signals, and do speak to your prescribing doctor so that they can be attended to without delay.25

Bridge medications such as Depakote

Near the end of a taper, there could be complications due to a dopamine-glutamate surge 27 that could be mitigated through the use of a bridge medication. At Alternative to Meds Center, we have found using Depakote as a Seroquel bridge medication can be useful in these cases. Please find more information on bridge medications on our webpage and speak to your doctor about this topic.

Limiting stimulating media

Antipsychotic drugs hold back the “reward” neurochemical, dopamine. Therefore a person will often engage in activities that are extreme or tend to be overly stimulating, to try and recapture that sense of reward. However, while tapering off antipsychotic drugs, avoid such activities. Heady religious materials, being consumed by video games, loud, driving music, or diving into exhilarating other subjects should best be reserved for AFTER your taper is complete and your neurochemistry has normalized so that day-to-day life itself has begun to offer its own remarkable rewards.26

Outdoor walks, gardening, creative pursuits, yoga, relaxing hobbies, and exercise are some examples of grounding activities that could engage and support you through Seroquel weaning.

Antipsychotic Alternatives and Antipsychotic Withdrawal

The pages on our site address antipsychotic alternatives that can be used during the tapering process. We strongly recommend you review these pages. Suggested links to review are Antipsychotic Alternatives and Seroquel Alternatives. You may also want to consider reading the Seroquel withdrawal page for more information on topics not extensively covered here, such as nutrition and supplementation.

What Is Seroquel Used For?

There are numerous reasons one may be prescribed an antipsychotic including psychosis, schizophrenia, hallucination, mania, and bipolar maintenance. Statistics show rising numbers of “off-label” uses of Seroquel.6 The manufacturer of the drug has been sued for $hundreds of millions in fines because of misleading off-label marketing for insomnia, for example, so we hope this trend is on the decline.

Seroquel, or the generic quetiapine, has consistently come up as the antipsychotic medication most often linked to abuse and street presence when compared to all other antipsychotics.2 Why this is, is not entirely clear. It may be that the calming effects of Seroquel, intensified when smoked, snorted, or injected, have contributed to this scenario.9 Plus the fact that the drug is listed as a non-controlled substance, potentially making it easier to procure in drug and alcohol rehabs, or diverted to non-prescribed settings or street use. In any case, once Seroquel addiction or dependence has developed, Alternative to Meds Center knows that tapering from Seroquel can be difficult and arduous, and needs proper medical care and oversight for safety and for success.

Seroquel and Serotonin

seroquel serotonin deficiencyThe experts don’t really know exactly how antipsychotic drugs work, but there have been rat and other animal studies to try and find out.1 Seroquel blocks dopamine. However, Seroquel, as the name might suggest, also alters the transport of serotonin. These alterations of natural neurochemicals are thought responsible for the drug’s dampening effects on mood, emotions, and sensitivity to stimulation from the environment. On the street, Seroquel has earned the name “baby heroin,” a term that reflects such characteristics and can be purchased cheaply on the street.2 The drug is also thought to alter a wide range of natural neurotransmitters in varying degrees including dopamine, serotonin, adrenaline, histamine, and possibly others. The drug is thought to have a marked effect on these normally stimulant-respondent receptors, resulting in its powerful sedative effect. However, when compared to other antipsychotic drugs, there are fewer reports of drowsiness connected with Seroquel than with other drugs in its class.27 In the treatment of psychosis where hallucinations or mania are present, Seroquel can be effective as a dampener of these unwanted symptoms, at least for a time. There is much to be discovered about the mechanisms of not only antipsychotic medications, but how the beautiful and intricate systems of the body and CNS interact, and how to support these through natural and drug-free means.

Tapering and Seroquel Dependence

Any psychoactive drug taken regularly or often enough can affect or disrupt natural neurochemistry. The body is designed to adapt to and overcome the presence and action of drugs. This is called tolerance. When tolerance develops, it is at this point that withdrawal or missing a dose will produce reactions that can be severe enough to create an intense need to procure more of the drug to avoid the withdrawals. This is not pleasure-seeking behavior so much as it is the downward spiral where dependence and Seroquel addiction seem to eventually merge. When Seroquel is taken for an extended period of time, developing Seroquel dependence makes the drug less able to produce the effects that it did earlier. The body’s own built-in defense mechanisms are responsible for this outcome. It is not that the drug “stops working” so much as the body begins to work very hard to overcome the intrusion.4

antipsychotic addictionHowever, this drug resistance becomes a contributing driver of continuing Seroquel dependence and in some cases, Seroquel addiction. When a person takes an antipsychotic medication for an extended period of time, the balance of desiring to quell symptoms but remain free of addiction can become overturned as the drug’s efficacy begins to decline. Now there can result in an untenable situation where taking the drug can no longer dampen undesired symptoms adequately, yet not taking the drug produces uncomfortable withdrawals. Seroquel withdrawals include nausea, insomnia, headache, irritability, other mood changes, dizziness, and others. The most usual responses to this scenario are to up the dosage, or switch to a different medication, or take additional drugs to try to neutralize emerging negative side effects. A person suffering from these reactions can be stabilized, in most cases, and the decision to begin a safe program of Seroquel tapering may provide a much better outcome.

Can Problems With Seroquel Tapering Be Avoided?

The drug manufacturer states that gradual withdrawal of Seroquel is recommended over abruptly stopping Seroquel.3 This is not unlike general recommendations given for stopping most other medications safely. Unfortunately, no specific guidelines are given by either the drug maker or the FDA concerning how to accomplish safe and comfortably managed tapering from Seroquel. Most physicians, unfortunately, have received no training whatsoever that could be used to help a person who wants to come off antipsychotic medication, and this had catastrophic consequences for many patients.5

At Alternative to Meds Center, we have spent 15 years refining and developing the most reliable program for Seroquel tapering available anywhere.

Comprehensive Testing and Treatment Protocols

seroquel holistic treatment protocolsThe professionals at Alternative to Meds Center have developed and refined a set of protocols applied to Seroquel tapering that can markedly reduce the pain and suffering of trying to come off Seroquel and similar drugs.

These include counseling services, Qi Gong, orthomolecular medicine, neurotransmitter rehabilitation, and many other therapies you can read about on our services overview. We are always available to speak to you or a loved one for more information on the protocols used, the health advantages of nutritional psychiatry and other holistically based treatment, and to answer questions you may have concerning insurance coverage available for our inpatient treatment for Seroquel tapering.


1. Ichikawa J, Li Z, Dai J, Meltzer HY. Atypical antipsychotic drugs, quetiapine, iloperidone, and melperone, preferentially increase dopamine and acetylcholine release in rat medial prefrontal cortex: role of 5-HT1A receptor agonism. Brain Res. 2002 Nov 29;956(2):349-57. doi: 10.1016/s0006-8993(02)03570-9. PMID: 12445705.  [cited 2021 April 22]

2. Sansone R MD, Sansone L MD “Is Seroquel Developing an Illicit Reputation for Misuse/Abuse?” published 2010, National US Library of Medicine [cited 2021 April 22]

3. Consumer Info sheet published by Seroquel drug maker AstraZeneca last updated 2019 Dec 16 [cited 2021 April 22]

4. Merk Manual, “Tolerance and Resistance to Drugs.” Lynch S, 2019 Aug [cited 2021 April 22]

5. Wood E, et al., “Physician Education in Addiction Medicine.” JAMA. 2013 Oct 23. 310(16): 1673-1674. doi: 10.1001/jama.2013.280377 PMID 24150462 [cited 2021 April 22]

6. FDA drug label Seroquel (quetiapine fumarate) 1997 revised October 2013 [cited 2021 April 21]

7. Lee TC, Desforges P, Murray J, Saleh RR, McDonald EG. Off-label Use of Quetiapine in Medical Inpatients and Postdischarge. JAMA Intern Med. 2016;176(9):1390–1391. doi:10.1001/jamainternmed.2016.3309 [cited 2021 April 21]

8. BMJ “Astrazeneca pays $520m fine for off label marketing” 2010 340 doi: (Published 29 April 2010) BMJ 2010;340:c2380 [cited 2021 April 21]

9. Morin AK. Possible intranasal quetiapine misuse. Am J Health Syst Pharm. 2007 Apr 1;64(7):723-5. doi: 10.2146/ajhp060226. PMID: 17384357. [cited 2021 April 21]

10. Ulysses contract. Oxford Reference. Retrieved 21 Apr. 2021, from https://www.oxfordreference.com/view/10.1093/oi/authority.20110803110554741.  [cited 2021 April 21]

11. Hofmann, Stefan G., et al. “The efficacy of cognitive behavioral therapy: A review of meta-analyses.” Cognitive therapy and research 36.5 (2012): 427-440. [cited 2021 April 22]

12. Segura-Aguilar J., Paris I. (2014) Mechanisms of Dopamine Oxidation and Parkinson’s Disease. In: Kostrzewa R. (eds) Handbook of Neurotoxicity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5836-4_16 [cited 2021 April 22]

13. Herbert C, Meixner F, Wiebking C, Gilg V. Regular Physical Activity, Short-Term Exercise, Mental Health, and Well-Being Among University Students: The Results of an Online and a Laboratory StudyFront Psychol. 2020;11:509. Published 2020 May 26. doi:10.3389/fpsyg.2020.00509 [cited 2021 April 22]

14. Hedges DW, Woon FL, Hoopes SP. Caffeine-induced psychosis. CNS Spectr. 2009 Mar;14(3):127-9. doi: 10.1017/s1092852900020101. PMID: 19407709. [cited 2021 April 22]

15. Wang HR, Woo YS, Bahk WM. Caffeine-induced psychiatric manifestations: a review. Int Clin Psychopharmacol. 2015 Jul;30(4):179-82. doi: 10.1097/YIC.0000000000000076. PMID: 25856116. [cited 2021 April 22]

16. Henquet C, Di Forti M, Morrison P, Kuepper R, Murray RM. Gene-environment interplay between cannabis and psychosis. Schizophr Bull. 2008;34(6):1111-1121. doi:10.1093/schbul/sbn108. [cited 2021 April 22]

17. NIDA. 2020, May 28. Is there a link between marijuana use and psychiatric disorders? [cited 2021 April 22]

18. Sahoo S, Mehra A, Grover S. Acute Hyperglycemia Associated with Psychotic Symptoms in a Patient with Type 1 Diabetes Mellitus: A Case Report. Innov Clin Neurosci. 2016;13(11-12):25-27. Published 2016 Dec 1. [cited 2021 April 22]

19. Hormone Health Network Non-Diabetic Hypoglycemia EDITOR(S): Prof. Margaret Eckert-Norton, PHD, FNP-BC, CDE, Ramon Martinez, M.D., Susan Kirk, M.D. LAST UPDATED: July 2020. [cited 2021 April 22]

20. Betts JA, Richardson JD, Chowdhury EA, Holman GD, Tsintzas K, Thompson D. The causal role of breakfast in energy balance and health: a randomized controlled trial in lean adults. Am J Clin Nutr. 2014 Aug;100(2):539-47. doi: 10.3945/ajcn.114.083402. Epub 2014 Jun 4. PMID: 24898233; PMCID: PMC4095658. [cited 2021 April 22]

21. Safeekh AT, Pinto D. Venlafaxine-induced psychotic symptomsIndian J Psychiatry. 2009;51(4):308-309. doi:10.4103/0019-5545.58301. [cited 2021 April 22]

22. Samaha AN, Seeman P, Stewart J, Rajabi H, Kapur S. “Breakthrough” dopamine supersensitivity during ongoing antipsychotic treatment leads to treatment failure over timeJ Neurosci. 2007;27(11):2979-2986. doi:10.1523/JNEUROSCI.5416-06.2007. [cited 2021 April 22]

23. Horowitz MA, Jauhar S, Natesan S, Murray RM, Taylor D. A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse. Schizophr Bull. 2021 Mar 23:sbab017. doi: 10.1093/schbul/sbab017. Epub ahead of print. PMID: 33754644. [cited 2021 April 22]

24. Samaha AN, Seeman P, Stewart J, Rajabi H, Kapur S. “Breakthrough” dopamine supersensitivity during ongoing antipsychotic treatment leads to treatment failure over timeJ Neurosci. 2007;27(11):2979-2986. doi:10.1523/JNEUROSCI.5416-06.2007. [cited 2021 April 22]

25. Keks N, Schwartz D, Hope J. Stopping and switching antipsychotic drugsAust Prescr. 2019;42(5):152-157. doi:10.18773/austprescr.2019.052 [cited 2021 April 22]

26. Zald DH, Zatorre RJ. Music. In: Gottfried JA, editor. Neurobiology of Sensation and Reward. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 19. [cited 2021 April 22]

27. Datto C, Berggren L, Patel JB, Eriksson H. Self-reported sedation profile of immediate-release quetiapine fumarate compared with extended-release quetiapine fumarate during dose initiation: a randomized, double-blind, crossover study in healthy adult subjects. Clin Ther. 2009 Mar;31(3):492-502. doi: 10.1016/j.clinthera.2009.03.002. PMID: 19393840. [cited 2021 April 22]


Originally Published Jan 18, 2020 by Diane Ridaeus


This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Seroquel Tapering
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Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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