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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by Dreya on July 29, 1998, at 22:11:11
I am a 29 y.o. woman taking 10-20 mg Paxil on alternating
days. This is my third round of experience with this med,
and for the first time I am experiencing sleep disturbance,
sexual dysfunction, along with neck and jaw tension. My
depression has been alleviated, but find myself frustrated
daily by the side effects. I would like to ask my Dr. for
a switch to Serzone...What is the smallest effective/recommended dosage? I am a
firm believer in taking as little of a drug as possible.Also, how successful is Serzone at reducing sexual dysfunction
and restoring disturbed sleep?
Posted by Matt on July 30, 1998, at 17:53:46
In reply to Paxil vs. Serzone, posted by Dreya on July 29, 1998, at 22:11:11
> I am a 29 y.o. woman taking 10-20 mg Paxil on alternating
> days. This is my third round of experience with this med,
> and for the first time I am experiencing sleep disturbance,
> sexual dysfunction, along with neck and jaw tension. My
> depression has been alleviated, but find myself frustrated
> daily by the side effects. I would like to ask my Dr. for
> a switch to Serzone...> What is the smallest effective/recommended dosage? I am a
> firm believer in taking as little of a drug as possible.The smallest "therapeutic" dosage is 200mg/day (usually bid), though YMMV.
> Also, how successful is Serzone at reducing sexual dysfunction
> and restoring disturbed sleep?It is very good in both of these regards. It causes far fewer sexual side effects than does Paxil, and it causes most people to sleep very soundly and fall asleep quickly.
Best,Matt
Posted by Erik on August 26, 1998, at 18:37:33
In reply to Re: Paxil vs. Serzone, posted by Matt on July 30, 1998, at 17:53:46
> > I am a 29 y.o. woman taking 10-20 mg Paxil on alternating
> > days. This is my third round of experience with this med,
> > and for the first time I am experiencing sleep disturbance,
> > sexual dysfunction, along with neck and jaw tension. My
> > depression has been alleviated, but find myself frustrated
> > daily by the side effects. I would like to ask my Dr. for
> > a switch to Serzone...> > What is the smallest effective/recommended dosage? I am a
> > firm believer in taking as little of a drug as possible.> The smallest "therapeutic" dosage is 200mg/day (usually bid), though YMMV.
> > Also, how successful is Serzone at reducing sexual dysfunction
> > and restoring disturbed sleep?> It is very good in both of these regards. It causes far fewer sexual side effects than does Paxil, and it causes most people to sleep very soundly and fall asleep quickly.
>
> Best,> Matt
I have tried Prozac,Zoloft,Paxil,Wellbutrin,Norpramin and now just started Serzone.
The worst of the bunch by far for me was the Paxil, it caused me to constantly grind my teeth
and I had severe sexual dysfunction. As soon as I quit the paxil, I experienced the worst
dizzy spells. My doctor started me on a low dose of Serzone (100mg/day) and I am looking forward
to evaluating the effectiveness of this drug. My problems arent with depression so much as acute
anxiety attacks that has hospitalized me in the past. I would be interested in seeing any more
feedback regarding this drug (Serzone).
Posted by David Bailey on August 27, 1998, at 8:15:07
In reply to Re: Paxil vs. Serzone, posted by Erik on August 26, 1998, at 18:37:33
I have been taking Serzone for the past 3 months. I to have tried MANY different
types of medicines. And I finally feel like I am on my way to
recovery. Please feel free to ask any question.
Posted by Maree on August 27, 1998, at 22:41:12
In reply to Paxil vs. Serzone, posted by Dreya on July 29, 1998, at 22:11:11
I have been on Zoloft, Paxil, Effexor and Wellbutrin.
I have had too many side effects from each one of
then that has caused me to stop them. I am going to
start Serzone next week. I really hope it's as good as
everyone claims. I would also like to know why it is not
one of the first recommended antisepressants if
there are so few side effects?
Posted by Depressed in San Jose on August 31, 1998, at 16:54:07
In reply to Re: Paxil vs. Serzone, posted by David Bailey on August 27, 1998, at 8:15:07
> I have been taking Serzone for the past 3 months. I to have tried MANY different
> types of medicines. And I finally feel like I am on my way to
> recovery. Please feel free to ask any question.Hi David.
I just started Serzone after having been on numerous other
anti-ds. However, I feel more side effects from Serzone than I
felt from the others...urinary retention; nausea; insomnia; mental
"fuzziness". I am only taking 25mg/day (trying to tritate it into
my system). Is there a point when these side effects will go away?If so, when and once they have gone away...will I feel like I'm
"normal" and not on some medication?Thanks for any input.
D.I.S.J.
Posted by Chris Estees on September 1, 1998, at 5:27:46
In reply to Paxil vs. Serzone, posted by Dreya on July 29, 1998, at 22:11:11
> I am a 29 y.o. woman taking 10-20 mg Paxil on alternating
> days. This is my third round of experience with this med,
> and for the first time I am experiencing sleep disturbance,
> sexual dysfunction, along with neck and jaw tension. My
> depression has been alleviated, but find myself frustrated
> daily by the side effects. I would like to ask my Dr. for
> a switch to Serzone...> What is the smallest effective/recommended dosage? I am a
> firm believer in taking as little of a drug as possible.> Also, how successful is Serzone at reducing sexual dysfunction
> and restoring disturbed sleep?..................................................
I have been taking Paxil for about 3 years. I take 70mg per day.
I still couldn't sleep so the Doc put me on Serzone, now 200mg at night.
I am now sleeping. But DON"T try to get off Paxil by using Serzone--
I tried with disasterous results. I also got
an "I am sorry!" from the doctor whose care I am under!
Posted by randy on August 11, 2000, at 21:29:17
In reply to Re: Paxil vs. Serzone, posted by Maree on August 27, 1998, at 22:41:12
> I have been on Zoloft, Paxil, Effexor and Wellbutrin.
> I have had too many side effects from each one of
> then that has caused me to stop them. I am going to
> start Serzone next week. I really hope it's as good as
> everyone claims. I would also like to know why it is not
> one of the first recommended antisepressants if
> there are so few side effects?
Posted by adniL on August 22, 2000, at 20:44:32
In reply to Re: Paxil vs. Serzone, posted by Chris Estees on September 1, 1998, at 5:27:46
Serzone doesn't have sexual side effects. I've been taking it for a couple years now. I can't use it as a sole med - it doesn't take care of my anxiety at all. I have to take it at night or I feel drowsy all day. Should mee your needs, I hope.
Posted by Rick on August 26, 2000, at 16:19:40
In reply to Re: Paxil vs. Serzone, posted by adniL on August 22, 2000, at 20:44:32
> Serzone doesn't have sexual side effects. I've been taking it for a couple years now. I can't use it as a sole med - it doesn't take care of my anxiety at all. I have to take it at night or I feel drowsy all day. Should mee your needs, I hope.
I haven't read the whole thread, but your comment about anxiety effectiveness caught my eye. One of Serzone's strong points is its efficacy and quickness in helping several forms of anxiety, especially GAD and depression-related anxieties. Also, I've read that at high doses (probably a min. of 600 mg.) it CAN cause sexual dysfunction, perhaps because that's when the serotonin reuptake properties really kick it.
I've been taking 450 mg./day of Serzone for several months (300 of it in the morning, plus anxiety-fighting Klonopin and wake/alertness-inducing Provigil), and have seen some sexual *enhancement* with minimal adverse effects.
Rick
Posted by adniL on August 28, 2000, at 1:14:38
In reply to Re: Paxil vs. Serzone » adniL, posted by Rick on August 26, 2000, at 16:19:40
OK, let's just say that Serzone is nothing like Paxil, Prozac and the rest when it comes to sexual side effects. It's not something to expect. It didn't work on my anxiety, but everyone is different. Celexa causes sexual problems like the other SSRIs, but it didn't affect me (nor my depression). I wish we could all get the right med the first time, but that doesn't seem to happen too often.
Posted by Robaire on September 2, 2000, at 16:09:53
In reply to Re: Paxil vs. Serzone, posted by Matt on July 30, 1998, at 17:53:46
I tried serzone (400 mg) a couple of different times and I did not notice any side effects--sexual or otherwise. Unfortunately it did not help me with my chronic insomnia at all by itself. In order to sleep, I had to add 10mg of ambien into the mix.
I also tried it with lithium (1500mg) and I was able to sleep better, sometimes without ambien. But of course, on lithium I had horrible acne and gained nearly 50 pounds (a lot of good that does in helping one out of depression).
The only thing positive I can say about serzone is that it didn't have any adverse effects.
Posted by Brenda Morris on September 26, 2000, at 9:12:36
In reply to Re: Paxil vs. Serzone, posted by adniL on August 22, 2000, at 20:44:32
> Serzone doesn't have sexual side effects. I've been taking it for a couple years now. I can't use it as a sole med - it doesn't take care of my anxiety at all. I have to take it at night or I feel drowsy all day. Should mee your needs, I hope.
Okay, I used Prozac for several years, then Zoloft for a while (didn't take), then Effexor for the last 2 years and now have to change as new HMO won't pay! Dr gave me Paxil samples and said to try them----do I really want this or do I want Serzone?? All I know about Serzone is what I've read right here. I definitely do NOT want less sex drive. Help?
Posted by noa on September 26, 2000, at 15:50:58
In reply to Re: Paxil vs. Serzone » adniL, posted by Brenda Morris on September 26, 2000, at 9:12:36
Do I take it effexor is working well but your insurance won't pay and that is the only reason you need to change?????
If so, your doctor should take a more active stance to advocate on your behalf. If this med is working for you, and there is no MEDICAL justification to change it, I do not think it is moral, ethical, or reasonable for an insurance company to deny coverage, esp. since this is a well accepted medication that many insurance policies cover, not some out-there experimental thing.
It is outrageous that an insurance company can come in and deny coverage for an effective treatment that has been shown to be beneficial to the patient, leaving the patient with the heartwrenching choice of bankrupcy or emotional destabilization/return to active symptoms of mental disorder.
In addition, there are so many anecdotal reports (despite the manufacturer's insistance to the contrary) of the suffering that patients experience upon withdrawalfrom effexor, esp. an abrupt withdrawal.
Get your doc involved, as he or she can advocate for you that this is a medically necessary medication, and can vouch for its effectiveness in treating your symptoms.
Posted by noa on September 26, 2000, at 16:03:13
In reply to Re: Paxil vs. Serzone » adniL, posted by Brenda Morris on September 26, 2000, at 9:12:36
The following is the site of the Physicians who Care organization. They collect anecdotes like yours---having to discontinue a good med because insurance won't pay, etc.---thought you might be interested.
Posted by stjames on September 26, 2000, at 17:04:50
In reply to Re:Paxil v Serzone--insurance (warning-rant ahead), posted by noa on September 26, 2000, at 15:50:58
> Do I take it effexor is working well but your insurance won't pay and that is the only reason you need to change?????
>
james here.....I take Effexor and my HMO does not normally cover it. All my doc had to was ask the HMO to make a special case as nothing else works.
james
Posted by ksvt on September 26, 2000, at 19:52:19
In reply to Re:Paxil v Serzone--insurance , posted by stjames on September 26, 2000, at 17:04:50
> > Do I take it effexor is working well but your insurance won't pay and that is the only reason you need to change?????
> >
>
>
> james here.....
>
> I take Effexor and my HMO does not normally cover it. All my doc had to was ask the HMO to make a special case as nothing else works.
>
> jamesjames - excuse me for being a little dense, but how did your hmo justify not covering effexor? I was under the impression that it was pretty mainstream stuff. Is it that much more expensive than the SSRIs? ksvt
Posted by stjames on September 26, 2000, at 23:51:24
In reply to Re:Paxil v Serzone--insurance , posted by ksvt on September 26, 2000, at 19:52:19
>
> james - excuse me for being a little dense, but how did your hmo justify not covering effexor? I was under the impression that it was pretty mainstream stuff. Is it that much more expensive than the SSRIs? ksvtJames here....
HMO's, as a cost containment procedure, have what they call "formalary". This is a list for meds they will pay for. In general this is not a bad idea, doc's do not need acess to evey antibiotic to treat people. It is different for things like the psuco meds. Both the AD's I take are non-formalary and are the olny (and when I say only I mean EVERY AD out there, excet MAOI;s) It has been a tap dance with the HMO to get these meds. The %(&%(& HMO pays a 3d party to process Rx approlals. The HMO does not have a problem letting me get these meds, it is getting this info to the 3d party so i do not have to pay retail for 60 150 mg Effexor and 15 30mg Remeron and wait 3 months for the HMO to pay me back.
So the first time I the I went without meds and sleep for a week and the HMO customer service was no help I called my doc and asked to be admitted as a danger to myself. I got my meds. I also got the special phone # for overrides on Rx's that only the doc were to use. next time it happened I used the "special number" and they were real pissy till I told them I was a crazy person and
b4 i blew my brains out becuse of no meds i would come over to their office and mow them down. One can be very convincing with no sleep for a week, crashing off Effexor. Cilck...I had a manager on the phone. Meds...no problem ! I told them in the future I would just admit myself, at a cost of $2,000 and hold them resopnsible for all mental trauma, anyone I killed, ect. For about a year I would call them a week b4 I refilled and I had no problems. Then they said they fixed it so I did not have to warn them. I have had no problems for a year now.It is sad that I pay $420/mo and have to resort to these tatics.
james
Posted by Noa on September 27, 2000, at 11:33:54
In reply to Re:Paxil v Serzone--insurance , posted by stjames on September 26, 2000, at 23:51:24
James, yes 420 is expensive insurance--at that premium, you shouldn't have to fight for coverage.
Posted by Noa on September 27, 2000, at 11:34:54
In reply to Re:Paxil v Serzone--insurance , posted by stjames on September 26, 2000, at 23:51:24
My insurance used to deny coverage for ritalin for anyone over age 19, but my doc wrote to them and they authorized it.
Posted by Noa on September 27, 2000, at 11:37:08
In reply to Re:Paxil v Serzone--insurance , posted by stjames on September 26, 2000, at 23:51:24
This is the kind of thing that you should submit to the site I mentioned above. Also, the Coalition of Mental Health Consumers and Professionals (nomanagedcare.com) is advocating for changes in the health care system because experiences like yours are all too common.
Posted by shar on September 27, 2000, at 14:08:56
In reply to Re:Paxil v Serzone--insurance » stjames, posted by Noa on September 27, 2000, at 11:37:08
When I go to get my Effexor XR refilled, the ins co. won't pay because they say my dosage is too high. I'm on 300 mg. per day which is up there, but not excessive. So, I now always tell the pharmacy they will have to call the ins. co. and get an override so they'll pay.
The first time it happened, the Effexor was going to be $180. It really made me think about people without insurance, or those with crappy policies who end up suffering because some business person(s) decide to 2nd guess the doc.
This is not an HMO. It is good old Blue Cross/Blue Shield here in Texas for State gov. employees.
Another of their antics was AFTER the sign up period was over, they DOUBLED the deductible for MH services (counseling type things). From $250 to $500. So, I could get IN-PATIENT care for $1,000 a day, for up to ??60 days I think. But, to get $200/mo for counseling....forget it.
And, this is a rip-off for my counselor too. I really regret that because she will lower my fee when I have to pay it all. We both deserve better.
Ah, that felt good to get off my chest.
Noa, thanks for those web sites. I am going to write to them.
Shar
Posted by ksvt on September 27, 2000, at 20:02:11
In reply to Effexor -- insurance co. doesn't like dosage, posted by shar on September 27, 2000, at 14:08:56
> When I go to get my Effexor XR refilled, the ins co. won't pay because they say my dosage is too high. I'm on 300 mg. per day which is up there, but not excessive. So, I now always tell the pharmacy they will have to call the ins. co. and get an override so they'll pay.
>
> The first time it happened, the Effexor was going to be $180. It really made me think about people without insurance, or those with crappy policies who end up suffering because some business person(s) decide to 2nd guess the doc.
>
> This is not an HMO. It is good old Blue Cross/Blue Shield here in Texas for State gov. employees.
>
> Another of their antics was AFTER the sign up period was over, they DOUBLED the deductible for MH services (counseling type things). From $250 to $500. So, I could get IN-PATIENT care for $1,000 a day, for up to ??60 days I think. But, to get $200/mo for counseling....forget it.
>
> And, this is a rip-off for my counselor too. I really regret that because she will lower my fee when I have to pay it all. We both deserve better.
>
Shar - I'm fortunate to live in a state which passed a law a few years ago disallowing mental health caps unless they were similar to caps for other medical services. However, in all of the time since passage of the law, blue cross blue shield has never changed its explanation of benefits, so if you're not a saavy consumer, you'd still think that the mental health care coverage limitations were still in place. When new enrollment periods came around after passage of the legislation, they sent out info to their business subscribers which woefully misrepresented the differences between a managed care option and an unmanaged care option. If you didn't go out of your way to respond very quickly, you were automatically defaulted into managed care. It's great that they even offered an unmanaged care option to some business groups, but my guess is that the vast majority ended up in managed care without even realizing that they had a real choice. Getting back to the thrust of this thread however, it's not like these ADs are all generic. Everyone reacts so idiosyncratically. The hmo certainly shouldn't be deciding what drug will work for you. ksvt
> Ah, that felt good to get off my chest.
>
> Noa, thanks for those web sites. I am going to write to them.
>
> Shar
Posted by JohnB on September 28, 2000, at 2:27:59
In reply to Re:Paxil v Serzone--insurance , posted by stjames on September 26, 2000, at 23:51:24
> James here....
>
> HMO's, as a cost containment procedure, have what they call "formalary". This is a list for meds they will pay for. In general this is not a bad idea, doc's do not need acess to evey antibiotic to treat people. It is different for things like the psuco meds. Both the AD's I take are non-formalary and are the olny (and when I say only I mean EVERY AD out there, excet MAOI;s) It has been a tap dance with the HMO to get these meds. The %(&%(& HMO pays a 3d party to process Rx approlals. The HMO does not have a problem letting me get these meds, it is getting this info to the 3d party so i do not have to pay retail for 60 150 mg Effexor and 15 30mg Remeron and wait 3 months for the HMO to pay me back.
>
> So the first time I the I went without meds and sleep for a week and the HMO customer service was no help I called my doc and asked to be admitted as a danger to myself. I got my meds. I also got the special phone # for overrides on Rx's that only the doc were to use. next time it happened I used the "special number" and they were real pissy till I told them I was a crazy person and
> b4 i blew my brains out becuse of no meds i would come over to their office and mow them down. One can be very convincing with no sleep for a week, crashing off Effexor. Cilck...I had a manager on the phone. Meds...no problem ! I told them in the future I would just admit myself, at a cost of $2,000 and hold them resopnsible for all mental trauma, anyone I killed, ect. For about a year I would call them a week b4 I refilled and I had no problems. Then they said they fixed it so I did not have to warn them. I have had no problems for a year now.
>
> It is sad that I pay $420/mo and have to resort to these tatics.
>
> jamesJames:
If for some reason they didn't allow your meds, would you try the Mexico alternative? Meds so cheap down there and you live not to far away. I think you mentioned once that you had to do that. I think I read somewhere that you can get a script from a Mexican doc and get it filled all in about half an hour. Of course in Mexico you don't need a script for a lot of meds, but to bring your 90 days supply back across to the US, you need to show some kind of script, right? Or do you need a script from a US doc? Just curious. --JB
Posted by stjames on September 28, 2000, at 11:42:44
In reply to Re:Paxil v Serzone--insurance » stjames, posted by JohnB on September 28, 2000, at 2:27:59
> James:
> If for some reason they didn't allow your meds, would you try the Mexico alternative? Meds so cheap down there and you live not to far away. I think you mentioned once that you had to do that.James here.....
Mexico is about 4 hrs one way and at least 2 yrs ago Remeron and Effexor were not on the market in
the border town I have gone to. In the past I did not have enough gas money to make it there and back, plus pay for 60 tabs. With the HMO I pay
$10/med. So I spend ~$70/mo. Even with very cheap prices in Mexico the cost alone is far cheaper with the HMO. Add a day lost and gas and it is not cost effective. Mexico is a backup, I did go there to rid myself of a nasty sinus infection when the HMO was being a pain. For 30 pills of almost everything the price was ~$10, just like my HMO. I take several meds 2X a day, 60 pills, so this would be more. 2 years ago the Rx said I could bring my pdoc's script and they could fill it, however the Rx I used did not ask for a script, I just told them what I wanted. They even showed me how to hide the meds.This $70/mo Rx bill is getting to be too much, as I pay $420/mo for the HMO. Some are land poor, I am HMO poor. I am going to go the free meds route
as it is cheaper and more legal than Mexico.james
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