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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by anita on April 28, 1999, at 23:37:07
Hiya. Has anyone found Serzone to be helpful for anxiety
made worse or caused by Prozac? I haven't read that much on this combo, and I'm
wondering if I should bother trying it.thanks,
anita
Posted by mendel on April 29, 1999, at 0:10:07
In reply to Serzone help Prozac anxiety???, posted by anita on April 28, 1999, at 23:37:07
. Beware of this combo! Prozac inhibits a liver enzyme system (p4502d6) which is involved in breaking down an anxiety provoking metabolite of sezone called MCPP.
Posted by Nick on April 30, 1999, at 12:03:29
In reply to Re: Serzone help Prozac anxiety???, posted by mendel on April 29, 1999, at 0:10:07
> . Beware of this combo! Prozac inhibits a liver enzyme system (p4502d6) which is involved in breaking down an anxiety provoking metabolite of sezone called MCPP.
Absolutely agree. I ran into real problems swopping patients off fluoxetine onto nefazadone, because of fluoxetine's long half life. The anxiety from fluoxetine wil usually settle with time.
Posted by Elizabeth on May 5, 1999, at 23:47:43
In reply to Re: Serzone help Prozac anxiety??? DONT DO IT, posted by Nick on April 30, 1999, at 12:03:29
Didn't know that about mCPP...that's useful! I haven't heard of the combination of Prozac and Serzone being used, I don't think, but *trazodone* (also has mCPP as a metabolite) has been used to potentiate fluoxetine (as well as for fluoxetine-induced insomnia).
Has anyone tried using nefazodone with a less enzyme-inhibiting SSRI? (Sertraline?)
Some people do have panic-like reactions to trazodone or Serzone alone, presumably due to mCPP. BTW I think that smokers taking these antidepressants will tend to have higher levels of mCPP than nonsmokers.
Posted by Mendel on May 8, 1999, at 1:20:17
In reply to Serzone and...., posted by Elizabeth on May 5, 1999, at 23:47:43
Don't mean to sound like a dr. Preskorn wanna-be but it would make sense that the small % of people who get severe anxiety with nefazodone alone are probably genetically "poor 2D6 metabolizers." One way to possibly deal with this would be to systematically administer a glass of grapefruit juice prior to each dose of serzone as by inhibiting 3A4 you could theoretically block the conversion of nefazodone to MCPP.Elizabeth, how does smoking increase MCPP and are you a psychiatrist?
Posted by paul on May 10, 1999, at 9:48:43
In reply to Re: Serzone and...- grapefruit/ anxiety/ + 2D6/3A4, posted by Mendel on May 8, 1999, at 1:20:17
This is tangentially related. As for enzyme inhibition, is sertraline the least inhibiting of the enzymes involved in the metabolism of oral opioids, i.e. codeine, hydrocodone?
I have noticed a somewhat diminished effect of hydrocodone while taking Zoloft, while a friend has noticed the same to a much greater extent with Paxil.
Are there any ways to "induce" these enzymes, or to prevent the inhibition of them while taking SSRIs?
This is the end of the thread.
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