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Re: input from Dr. Stahl » Cindy W

Posted by Cam W. on October 19, 2000, at 17:16:53

In reply to Re: input from Dr. Stahl » Cam W., posted by Cindy W on October 19, 2000, at 9:12:28

> Cam, does adding Serzone to Effexor-XR increase or interfere with Effexor's effects? And to deal with hypomanic episodes, what med would stabilize mood without interfering with antidepressive or anti-OCD effects of Effexor-XR? Thanks!--Cindy W

Cindy - As Noa said, Serzone blocks the serotonin-2 (5HT-2) receptor which corrects serotonin-induced sleep disturbances and restlessness, etc. I think (but am not sure) that the cause of some of the sexual dysfunctions (eg anorgasmia, decreased libido, etc.) are because of the stimulation of the 5HT-2 receptor (this is not the whole cause of the SRI sex-related problems). Effexor, by stimulating these receptors are also causing the insomnia and restlessness seen in some people taking SRIs.

Also, Serzone blocks serotonin-3 receptors (5HT-3). This decreases the nausea and stomach problems that can be caused by SRIs. There are also 5HT-3 receptors in the brain, but I don't know what they do.

Taking Effexor with Serzone can, in rare instances, result in serotonin syndrome (heart palpitations, swaeting, etc.). This is when the two drugs increase serotonin levels too much. This usually only happens when you use 2 antidepressants with different mechanisms of action are taken together (eg MAOIs with SSRIs). Since Serzone and Effexor increase serotonin in a very similar way, the risk of serotonin syndrome is greatly decreased.

Some people are sensitive to the side effects of some serotonergic antidepressants. Each SSRI blocks the serotonin reuptake pump, but each of these antidepressants also stimulate (or block) other receptors (eg å1- & å2-adrenergic receptors, norepinephrine reuptake pump, histamine -H1 receptor, mucarinic receptors, etc.). It is the stimulation of these different receptors that differentiates one SSRI from another. This is why each of them have slightly different side effects profiles, and perhaps slightly different efficacy in different subtypes of depression.

After saying all that; what my point was: using 2 antidepressants with fairly similar antidepressant action, but with differing side effects profiles enables you to use lower doses of each of the antidepressants separately, thus acheiving better serotonin reuptake pump blockade, while minimizing side effects.

As to your question of a mood stabilizer with these antidepressants; there are several different mood stabilizers that may work. Everything from the atypical antipsychotics (Zyprexa, Risperdal, and perhaps even Seroquel); Lamictal™ (lamotrigine) is another choice (although I don't see it used as the sole mood stabilizer; it is usually used as an adjunct to another mood stabilizer); can't forget lithium and Depakote either (Tegretol may affect the metabolism of Serzone and Effexor); Neurontin™ (gabapentin) and Topamax™ (topiramate).

Talk to your doctor about the options. See what he/she feels most comfortable prescribing (it's easier for a doc to follow your progress if he/she has an idea of what to expect from a drug combination).

Hope this helps - Cam




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