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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by afatchic on May 5, 2001, at 18:31:15
Hello All, This is my first post in many months. I suffer from dysthimia (a chronic form of depression) and have been on ADs since 1989. Most of the time, I took Prozac and Trazodone, which are a wonderful combination for me except for the sexual side effects. I tried augmenting with Buspar for a few weeks and had zero results. Now I'm on Serzone. I've been taking it for about a month. I started at 75mg twice a day and am now up to 150mg twice daily. I barely have the energy to work and have started sleeping through my alarm and being late to work. I'm normally very punctual. Anyone have any advice? I've asked my doctor to reduce my dose and let me gradually increase the dose. So far she hasn't responded to my message (and no, I'm not one of those annoying patients who monopolizes a doc's time). Should I be considering augmenting with something more activating? Thanks for your responses
Posted by JohnX on May 5, 2001, at 22:18:56
In reply to Serzone Sedation, posted by afatchic on May 5, 2001, at 18:31:15
> Hello All, This is my first post in many months. I suffer from dysthimia (a chronic form of depression) and have been on ADs since 1989. Most of the time, I took Prozac and Trazodone, which are a wonderful combination for me except for the sexual side effects. I tried augmenting with Buspar for a few weeks and had zero results. Now I'm on Serzone. I've been taking it for about a month. I started at 75mg twice a day and am now up to 150mg twice daily. I barely have the energy to work and have started sleeping through my alarm and being late to work. I'm normally very punctual. Anyone have any advice? I've asked my doctor to reduce my dose and let me gradually increase the dose. So far she hasn't responded to my message (and no, I'm not one of those annoying patients who monopolizes a doc's time). Should I be considering augmenting with something more activating? Thanks for your responses
Serzone sedation can be a toughie (it was a problem for me). I took Serzone for 2 months and unfortunately the sedation didn't wear off. But it did do wonders for my sleep,anxiety,and dysthymia. I didn't try an augmentation strategy, but usually noradrenergic meds are best bets to help with sedation.
You could try to augment it with a mid dose of Wellbutrin. Wellbutrin is generally activating plus is more likely to increase libido than kill it (like the SSRI's such as Prozac do). Also it can cause weight loss (Serzone may cause weight gain). The side effects of Wellbutrin are in many ways opposite of Serzone (except for the sexual stuff).
You could also add in a low dose stimulant. Check with your doctor.
BTW, Buspar generally takes longer than most meds to achieve its goal.
good luck,
john
Posted by SalArmy4me on May 5, 2001, at 23:06:45
In reply to Serzone Sedation, posted by afatchic on May 5, 2001, at 18:31:15
I postulate that nefazodone can be taken all at bedtime, due to the fact that its Triazole-dione metabolite has a half-life of 18 hours, and the the mean half-life of total label ranged between 11 and 24 hours. Taking it all at bedtime would minimize daytime sedation.
> Hello All, This is my first post in many months. I suffer from dysthimia (a chronic form of depression) and have been on ADs since 1989. Most of the time, I took Prozac and Trazodone, which are a wonderful combination for me except for the sexual side effects. I tried augmenting with Buspar for a few weeks and had zero results. Now I'm on Serzone. I've been taking it for about a month. I started at 75mg twice a day and am now up to 150mg twice daily. I barely have the energy to work and have started sleeping through my alarm and being late to work. I'm normally very punctual. Anyone have any advice? I've asked my doctor to reduce my dose and let me gradually increase the dose. So far she hasn't responded to my message (and no, I'm not one of those annoying patients who monopolizes a doc's time). Should I be considering augmenting with something more activating? Thanks for your responses
Posted by Sunnely on May 6, 2001, at 1:31:19
In reply to Serzone Sedation, posted by afatchic on May 5, 2001, at 18:31:15
Indeed, nefazodone (Serzone) is a sedating antidepressant. The recommended antidepressant dose of Serzone is between 300-600 mg/day. Unfortunately, the sedation from Serzone is dose-related, that is, increase in dose leads to increase sedation. A couple ways to deal with Serzone-, and other antidepressant-induced sedation, are:
1. Start the antidepressant drug at a lower dose and increase it slowly.
2. Take the bulk of the antidepressant dose at bedtime and less during daytime. (Note: Norman Sussman, MD from NY University, Department of Psychiatry, suggests that Serzone can be given as a once-a-day dosing at bedtime. One caution with this dosing is that, giving all the daily dose of Serzone as a single dose also increases the risk of a marked drop in blood pressure with accompanying dizziness (orthostatic hypotension) and could possibly lead to fall and head injury. If you and your doctor decide to dose it this way, it will be clinically prudent to slowly transition your morning dose with the evening dose, taking into account your ability to tolerate the transition.)
3. Add a stimulant to alleviate the antidepressant-induced daytime sedation. Modafinil (Provigil), a drug approved for narcolepsy, seems to be gaining popularity in this regard. The usual dose is between 100 to 200 mg/day in the morning (max of 400 mg). Caution, however, as there may be some drug-drug interactions between Serzone and Provigil. It appears that based on in vitro study, Provigil may induce the liver enzyme (CYP3A4), which Serzone depends on for metabolism. Theoretically, this may lower the blood level of nefazodone but probably clinically insignificant since Serzone is converted into 3 active metabolites, anyway. One caveat, however. One of Serzone's active metabolites called mCPP (meta-chlorophenylpiperazine) have anxiety-provoking effects hence, rapid conversion and excess amount of this compound may provoke anxiety episodes. Provigil has less abuse potential than the other psychostimulants.
4. Do nothing and let the side effect wears off (tolerance develops).
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> Hello All, This is my first post in many months. I suffer from dysthimia (a chronic form of depression) and have been on ADs since 1989. Most of the time, I took Prozac and Trazodone, which are a wonderful combination for me except for the sexual side effects. I tried augmenting with Buspar for a few weeks and had zero results. Now I'm on Serzone. I've been taking it for about a month. I started at 75mg twice a day and am now up to 150mg twice daily. I barely have the energy to work and have started sleeping through my alarm and being late to work. I'm normally very punctual. Anyone have any advice? I've asked my doctor to reduce my dose and let me gradually increase the dose. So far she hasn't responded to my message (and no, I'm not one of those annoying patients who monopolizes a doc's time). Should I be considering augmenting with something more activating? Thanks for your responses
Posted by JohnL on May 6, 2001, at 5:50:31
In reply to Serzone Sedation, posted by afatchic on May 5, 2001, at 18:31:15
> Hello All, This is my first post in many months. I suffer from dysthimia (a chronic form of depression) and have been on ADs since 1989. Most of the time, I took Prozac and Trazodone, which are a wonderful combination for me except for the sexual side effects. I tried augmenting with Buspar for a few weeks and had zero results. Now I'm on Serzone. I've been taking it for about a month. I started at 75mg twice a day and am now up to 150mg twice daily. I barely have the energy to work and have started sleeping through my alarm and being late to work. I'm normally very punctual. Anyone have any advice? I've asked my doctor to reduce my dose and let me gradually increase the dose. So far she hasn't responded to my message (and no, I'm not one of those annoying patients who monopolizes a doc's time). Should I be considering augmenting with something more activating? Thanks for your responses
I just plain don't like Serzone much because quite frankly we see few success stories with it. Sometimes it works great, but generally not very often. Usually we hear cases just like yours, where the sedation or something else just created more problems than it was worth. I wouldn't mind being a little sedated if I also felt real good, but that's usually not what happens. Instead, what happens more often than not is that sedation is a problem and the drug isn't working any miracles to make it worth it.
In your case, just based on the limited info in the post, I would consider ditching the Serzone. Instead, go back to Prozac and add Zyprexa to it. Unlike Serzone, Zyprexa sedation usually disappears fairly quickly. And Zyprexa goes wonderfully with Prozac for a whole host of reasons.
John
Posted by Noa on May 7, 2001, at 7:25:34
In reply to Serzone Sedation, posted by afatchic on May 5, 2001, at 18:31:15
I take all 500 mg. at night because of the sedation. It helps me sleep and the sedation wears off by morning.
Posted by afatchic on June 9, 2001, at 12:04:37
In reply to Re: Serzone Sedation, posted by Noa on May 7, 2001, at 7:25:34
Thank you all for your wonderful and intelligent responses. I forced myself to continue with the Serzone, taking the majority at bedtime. I've worked up to 300 mg a day and the sedation has magically disappeared. I've even had significant improvements sexually.
Now, for the down side :-( I'm having horrible short-term memory problems and some vision problems. When I scroll down on my computer screen, I have to look away because the moving words hurt to look at and my vision seems a litle blurry. To top it all off, my depressive symptoms have only resolved about 50%. Much less effective than Prozac. At this point, I'm going to continue with Serzone and hope that the remaining side effects diminish and my mood improves. I would like to hear from others who experienced memory problems with serzone. Did this side effect go away in time? Thanks again> I take all 500 mg. at night because of the sedation. It helps me sleep and the sedation wears off by morning.
Posted by danna on June 11, 2001, at 20:15:19
In reply to Re: Serzone Sedation, posted by afatchic on June 9, 2001, at 12:04:37
> Thank you all for your wonderful and intelligent responses. I forced myself to continue with the Serzone, taking the majority at bedtime. I've worked up to 300 mg a day and the sedation has magically disappeared. I've even had significant improvements ually.
> Now, for the down side :-( I'm having horrible short-term memory problems and some vision problems. When I scroll down on my computer screen, I have to look away because the moving words hurt to look at and my vision seems a litle blurry. To top it all off, my depressive symptoms have only resolved about 50%. Much less effective than Prozac. At this point, I'm going to continue with Serzone and hope that the remaining side effects diminish and my mood improves. I would like to hear from others who experienced memory problems with serzone. Did this side effect go away in time? Thanks again
>
> > I take all 500 mg. at night because of the sedation. It helps me sleep and the sedation wears off by morning.I also have terrible memory and am very sleepy. I take 500 mg.
Posted by PuraVida on June 13, 2001, at 14:02:05
In reply to Re: Serzone Sedation, posted by danna on June 11, 2001, at 20:15:19
Just added 10 mgs of Prozac to 400 mgs of Serzone (down from 500) It has helped GREATLY. Today, for the first time in what seems to be years, I actually got myself out of bed at a resonable hour! Plus, the Prozac has helped in a certain way cognitively that the serzone didn't - I feel much more positive and confident, and also mentally quicker. I like the combo. When I was on Prozac only I was a little too amped.
Posted by Joe Schmoe on June 14, 2001, at 17:19:42
In reply to Re: Serzone Sedation/Prozac, posted by PuraVida on June 13, 2001, at 14:02:05
I thought it was dangerous to take two of these drugs at the same time. Can't it result in serotonin syndrome? I am wondering if I should try starting my Paxil now instead of waiting till my Serzone tapering is finished. Do people commonly take an SSRI and Serzone at the same time?
This is the end of the thread.
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