Psycho-Babble Medication Thread 16019

Shown: posts 1 to 17 of 17. This is the beginning of the thread.

 

Serzone effect for Social Phobia?

Posted by Missy on November 30, 1999, at 22:12:23

Hello, everyone. I think I've seen a few posts touting Serzone's effectiveness for social phobia. I was also able to find one or two articles in PubMed which suggested it was quite effective. In fact, one study indicated a "70% marked or moderate" effectiveness. I realize that's difficult to interpret, as most other studies only used the % citing "marked" improvement. Additionally, I suppose the thinking is that with Serzone not being an SSRI, but instead showing 5HT antagonism as well as an epinephrine effect, it is thought to have some potential benefit over SSRI's.

Any experiences with Serzone being used to treat social phobia would be very much appreciated. Also, would you mind providing (1) dosage, (2) side effects, and (3) augmentation or potentiation, including either a benzodiazepine, Buspar, Pindolol, or other.

Thanks so much.

Warmest regards,


Missy

 

Re: Serzone effect for Social Phobia?

Posted by CraigF on November 30, 1999, at 22:39:52

In reply to Serzone effect for Social Phobia?, posted by Missy on November 30, 1999, at 22:12:23

Serzone is becoming my strong point...

I suffer from Dysthymia, social and general anxiety, possible ADD, and obsessive tend. (not OCD)

They switched me to Serzone after one day of Remeron. It seemed more a decision based upon side effects than efficacy.

Doc told me to go to 300 and hold, but I moved to 400 on my own, as the benefits faded after a few days (and maybe two drinks).

I may augment with WB for ADD and/or Buspar for added social anxiety (general anxiety is much better). A caution, however, that someone posted earlier: Buspar and Serzone are contraindicated, but some doctors perscribe the mix

 

Re: Serzone effect for Social Phobia?

Posted by Louise on November 30, 1999, at 22:43:39

In reply to Serzone effect for Social Phobia?, posted by Missy on November 30, 1999, at 22:12:23

Good question, and I have heard about similar results from Effexor XR. If you've tried both, which is better for social anxiety?

Thanks,

Louise

 

Re: Serzone effect for Social Phobia?

Posted by JohnL on December 1, 1999, at 2:36:15

In reply to Serzone effect for Social Phobia?, posted by Missy on November 30, 1999, at 22:12:23

Hi there Missy. I took Serzone initially for depression. I had an instant hypomanic reaction which was real nice actually, but then I just got more and more depressed as I got higher and higher in dose. That happens with me sometimes. But back to the subject...I have always been the shy guy in the corner, not really socially phobic, but definitely withdrawn and not confident. I noticed on Serzone I was very confident, not at all shy, very comfortable in a crowd, and able to venture effortlessly out of my shell. I think it would be a great med for social phobias.

I went up to 550mg before throwing in the towel (I have actually gotten worse on some meds, not just Serzone). I remember a narrow therapeutic windown in the 275mg to 375mg range that was a nice sweet spot. Going higher at my doc's urging ruined it. Side effects were mild daytime sedation, mild dizziness when getting up, and that's about it. Good sleep, good sex, slight hangover feeling upon waking in A.M. Side effects can be managed by taking most or all of the day's dose at once in late afternoon.

The trick with Serzone I believe is slow titration. That is, increase dose no faster than 25mg every four days. I don't know why, but it seems to work better that way with fewer adverse reactions. And you are more likely to find that "sweet spot" without blowing right past it. I remember seeing a clinical study where Serzone+Pindolol was 90% effective. I have heard of it being used in combination with various meds, but it doesn't mix well at all with Prozac (anxiety, headaches, flu-like symptoms).

Hope all goes well with you. JohnL

 

Re: Serzone effect for Social Phobia?

Posted by Cindy on December 1, 1999, at 8:34:59

In reply to Re: Serzone effect for Social Phobia?, posted by JohnL on December 1, 1999, at 2:36:15


Missy, I took Serzone up to 450 mg/day...and found that it definitely helped with social anxiety. I was much more able to speak to groups of people without being as afraid. I'd still be taking it (instead of Effexor) if it helped with OCD as much as it helped me with depression.--Cindy

 

Re: Serzone effect for Social Phobia?JohnL.

Posted by MA on December 1, 1999, at 9:01:01

In reply to Re: Serzone effect for Social Phobia?, posted by JohnL on December 1, 1999, at 2:36:15

JohnL.

It sounds as though Serzone worked for you at a certain dose, yet once you were beyond that, it didn't.

Why didn't you go back to it at the dose at which it worked? If you miss the window can't you regain the feeling again on that same dose? I've missed the window many times from going up too quickly. This was in one of my deepest depressions and I think the pdoc thought a higher dose was needed.

I think you responded to one or more of my posts and commented that you and I had similar symptoms of depression. Social phobia, dysthymic, etc.

Serzone is one of the only meds I haven't tried. Right now I'm on Celexa 40 mg, Wellbutrin 200 mg and Neurontin 200-300 mg. The Neurontin was just added, but I don't think I'm bipolar, although I have commented to my pdoc that when I went off AD's entirely, my inital sx of depression were agitation, hyperness, etc. I felt like I was handling things beautifully until I crashed big time. Did you ever try Neurontin? Effects?

So many times I'm not sure how to classify my depression and my doc isn't either. We just keep trying different mixes, but never seem to hit the right combination.

What are you taking now and how is it working? My combo is OK, but I 'm still trying for the right mix. Unfortunately my insurance runs out the end of this month and I won't have the luxury of continual trials. I was hoping to find a better mix this month.

Send me your list of best and worst combos. That might be a good category for everyone. Thanks

MA

 

Re: Serzone effect for Social Phobia?MA

Posted by JohnL on December 1, 1999, at 16:39:45

In reply to Re: Serzone effect for Social Phobia?JohnL., posted by MA on December 1, 1999, at 9:01:01

> JohnL.
>
> It sounds as though Serzone worked for you at a certain dose, yet once you were beyond that, it didn't.
>
> Why didn't you go back to it at the dose at which it worked? If you miss the window can't you regain the feeling again on that same dose?

You know, I was so suicidally depressed and so distraught with my new pdoc who was doing this to me that I couldn't have been paid a million dollars to stay with Serzone or the pdoc. I couldn't get away fast enough. In hindsight, that was probably a mistake, because I don't know whether I would have regained a good effect by lowering the dose and staying with it longer. That's the problem with a lousy doc...we get lousy management.


>
> I think you responded to one or more of my posts and commented that you and I had similar symptoms of depression. Social phobia, dysthymic, etc.

Yep. I've come to know my depression as the melancholic type. Characterized by anhedonia, low energy, withdrawn. Melancholic dysthymia with some suicidal bouts mixed in from time to time.
>
> Serzone is one of the only meds I haven't tried. Right now I'm on Celexa 40 mg, Wellbutrin 200 mg and Neurontin 200-300 mg. The Neurontin was just added, but I don't think I'm bipolar, although I have commented to my pdoc that when I went off AD's entirely, my inital sx of depression were agitation, hyperness, etc. I felt like I was handling things beautifully until I crashed big time. Did you ever try Neurontin? Effects?

No. Haven't tried Neurontin. I did try Lamictal. It was worth about a point on a ten point scale. Definitely helpful, but no miracle.
>
> So many times I'm not sure how to classify my depression and my doc isn't either. We just keep trying different mixes, but never seem to hit the right combination.

I sure hear ya. I've frustrated all my docs so far. To make it even worse, my current pdoc is retiring in a few weeks...I have to start the hunt from scratch again! And I'm not in any good shape to do that.
>
> What are you taking now and how is it working?

Prozac + Remeron. No it's not working. I feel like I'm teetering on the edge. I'm on a thin line between dysthymia and major depression.

>
> Send me your list of best and worst combos. That might be a good category for everyone. Thanks
>
> MA

For me the best SSRI was Zoloft, and for a short time I was actually totally euthymic after adding Nortriptyline to it. But that faded, and even though I wasn't depressed, I was totally incapacitated by anhedonia (talk about major apathy) and total destruction of sex. With the benefit of hindsight, I should have stayed with it and added a dopamine agonist like amantadine or bromocriptine for the apathy and the sex. That would have been a wise thing to try, had I known at the time, before dumping the whole thing and starting over.

The worst ones were Paxil (hair loss and sex loss), Serzone (worsened depression), Moclobemide (worsened depression), Wellbutrin (very loud tinnitus), Buspar (very loud tinnitus), Pindolol (very tiring). Buspar+Pindolol is supposed to be great, but it caused me such dizziness and confusion I couldn't function. I was immediately scared away on short trials of Effexor and then Vivactil, but they are still both on my radar screen. It seems I've tried so many things I have forgotten some.

Things I've found either neutral or mildly helpful are St Johnswort, SAMe, Lamictal, Naltrexone. Actually the best I ever felt was on 200mg/day of 5HTP. But it had a strange urination burning kind of side effect that was scary and intolerable and unexplained by anyone. Don't know where to go from here, but I'm down in the dark dumps and need to find a way out. Nice talking with you MA. JohnL

 

Re: Serzone effect for Social Phobia?JohnL again

Posted by MA on December 2, 1999, at 7:07:18

In reply to Re: Serzone effect for Social Phobia?MA, posted by JohnL on December 1, 1999, at 16:39:45

JohnL.,

Hi again. Boy you sure do know alot about depression. I thought I was educated until I found this Psycho Babble site. It's like getting alot of very scientific and really personal input about people's struggles.

Afew questions if you don't mind...

What does euthymic mean?

When you say....I should have stayed with it and added a dopamine agonist like amantadine or bromocriptine for the apathy and the sex.

How do you know what to add? I keep trying to tell my doctor I need something with dopamine or norephinephrine. Even though I'm not really sure what the drugs will do. I just feel that SSRI's aren't enough on their own. Shouldn't he know these things???

Briefly, what symptoms do serotonin, norepinephrine and dopamine target? I know it probably is not a simple thing to explain but the residual symptoms of depression for me have always been apathy, loss of focus, problem with memory...Vague, but very real, as you know.

The depression goes away but I'm left with a feeling of not really being connected to the world. I function but don't enjoy things. Also I have trouble reading and understanding simple things. Come to think of it, I have always had to read things over and over before I get it. I seem to miss something in the process between reading and understanding.

Thanks for all your insight and experience. I see my doctor tomorrow. Today and the past few days I've hada whopper of a headache. Another thing to keep me from having a good day.

MA

 

Re: Serzone effect for Social Phobia?JohnL again

Posted by noa on December 2, 1999, at 8:21:57

In reply to Re: Serzone effect for Social Phobia?JohnL again, posted by MA on December 2, 1999, at 7:07:18

John, Can your retiring pdoc recommend another pdoc to you?

MA, Your question about what euthymic means struck me as possibly being two questions: what is the literal meaning of the word, and a more philosophical question, how can we possible know how it feels to be euthymic? Euthymia is the state of mood that is not depressed and not manic or elated. Just a good solid mood. I am not sure I have had much of that in my life, that is, good mood with out anxiety.
BTW, I was in Barnes and Noble and was reading from a reference book on childhood disorders, and one of the authors' first names is Euthymia! She is a doc at NIH, I think.

 

Recommendations for getting another good PsychDoc

Posted by Michael on December 2, 1999, at 8:47:25

In reply to Re: Serzone effect for Social Phobia?JohnL again, posted by noa on December 2, 1999, at 8:21:57

I had horrible experiences with my family physician and one psychiatrist. I eventually called a university medical center and made an appointment with their anxiety disorder's clinic. There are other clinics for depressions and other conditions. I met with a very, very experienced psychopharmacologist. He very thoroughly diagnosed my disorder and prescribed the right meds. I later switched from the university anxiety disorder's clinic to a private psychopharmacologist, just because my HMO didn't cover the university. However, I did get their recommendation and referral to my new, and very experienced private practice psychopharmacologist. Bottom line, I would either go to a university medical center clinic or get their recommendation of a good psychopharmacologist who works outside of the university medical center.

Good luck,

Michael

 

Re: Recommendations for getting another good PsychDoc

Posted by Kevin on December 2, 1999, at 10:44:36

In reply to Recommendations for getting another good PsychDoc, posted by Michael on December 2, 1999, at 8:47:25

This raises a real good point- just how DO you distinguish between good and bad psy-docs? I am starting to realize that I have neither the inclination nor the wherewithal to take the do-it-yourself armchair-neurology course (indeed, the chief problems that have led me to seek help are problems with memory, concentration, and cognition; also, I am supposed to be doing Ph.D level work [in an unrelated field] and not spending my time musing about the effects of blocking the 5HT2A receptor, etc.). The reason we have a professional division of labour in our societies- and, a fortiori, the reason doctors take home enough money to choke a horse- is so that the layman doesn't HAVE to worry about acquiring expertise in areas which aren't his job. Rather, this befalls the professional, and there are (or are supposed to be) mechanisms for weeding out the incompetent practitioner (so that, once again, I DON'T have to take it upon myself to make that judgement call). I think this situation suxxx- comments?

-Kevin

 

Re: Serzone effect for Social Phobia? MA

Posted by JohnL on December 3, 1999, at 3:17:31

In reply to Re: Serzone effect for Social Phobia?JohnL again, posted by MA on December 2, 1999, at 7:07:18


>
> Afew questions if you don't mind...
>
> What does euthymic mean?

****Euthymic is a word that describes feeling perfectly normal. Not high, not depressed, just normal. So many clinical studies measure success as 50% improvement on symptoms. To me, that's not success. That should not be the goal. The goal should be euthymia, normalcy, absence of any residual symptoms.
>
> When you say....I should have stayed with it and added a dopamine agonist like amantadine or bromocriptine for the apathy and the sex.
>
> How do you know what to add? I keep trying to tell my doctor I need something with dopamine or norephinephrine. Even though I'm not really sure what the drugs will do. I just feel that SSRI's aren't enough on their own. Shouldn't he know these things???

****I think only a small percentage of doctors are truly pasionate about their work. They are the ones that seem enthused and up-to-date with all the tricks of the trade. Those are the kinds of doctors that show up at Dr Bob's Pharmacology Tips. That's where I have learned a majority of information, including uses of amantadine, bromocriptine, theories of causes of apathy, etc. I suspect most doctors have very limited psychopharmacology skills. Dr Bob's Tips really highlights doctors who seem to be in love with their work and therefore remain on the cutting edge.
>
> Briefly, what symptoms do serotonin, norepinephrine and dopamine target? I know it probably is not a simple thing to explain but the residual symptoms of depression for me have always been apathy, loss of focus, problem with memory...Vague, but very real, as you know.
>
> The depression goes away but I'm left with a feeling of not really being connected to the world. I function but don't enjoy things. Also I have trouble reading and understanding simple things. Come to think of it, I have always had to read things over and over before I get it. I seem to miss something in the process between reading and understanding.

****I'm not real knowledgable about the roles of serotonin, NE, and dompamine. But as I understand it, serotonin is generally involved with overall well-being, NE is involved with energy and reward, and dopamine is involved with pleasure and reward. However, they are all probably intriquately intertwined in mysterious ways we may never understand. For example, I felt awesome on 5HTP. That was mostly a serotonin thing. You would think a dopamine thing would work better on anhedonia. But it was a serotonin thing that worked. So why don't SSRIs do the same? They work on serotonin too, right? I don't get it. ??? Perhaps it's as basic as they say...a chemical imbalance between the three...and each of us has a unique balance of our own. But I suspect it's a whole lot more complex than that.

Hope your appointment went well. I would like to hear about it when you get a chance. Mine is in 4 hours. Fingers crossed for some kind of hope. Have a smooth day. JohnL


 

Serzone and Buspar are not contraindicated

Posted by Jane on December 3, 1999, at 16:41:06

In reply to Re: Serzone effect for Social Phobia?, posted by CraigF on November 30, 1999, at 22:39:52

i read here that someone posted (although havent seen it) that buspar and serzone are contraindicated - i went to look up the PDR for the package inserts and serzone is NOT contraindicated with buspar. in fact, craig (i think) is right : many pdocs prescribe the mix. anyone know the reason why these may be contraindicated?
jane

 

Re: Serzone and Buspar are not contraindicated

Posted by Dee on December 9, 1999, at 13:35:51

In reply to Serzone and Buspar are not contraindicated, posted by Jane on December 3, 1999, at 16:41:06

I been taking serzone and started w/ buspar last week. I asked my p-doc about the counterindication that I've seen mentioned here. He didn't know of any, and also he checked with two databases none of which mentioned it.
(I think it had something to do with a liver enzyme...) If anyone knows the source of this information, please let us know.
Dee

 

Re: Dee

Posted by Noa on December 9, 1999, at 22:10:12

In reply to Re: Serzone and Buspar are not contraindicated, posted by Dee on December 9, 1999, at 13:35:51

Hi, Dee! How are you?

 

Re: Dee

Posted by Dee on December 11, 1999, at 13:41:27

In reply to Re: Dee, posted by Noa on December 9, 1999, at 22:10:12

Hi, Noa...
I'm fairly good, I think... Been like a sparrow in a storm for a couple of months, and really canot tell. I am hoping that adding buspar would do the trick.

Yet I have accomplished lots of things: Bills are getting paid, I moved to a new place that I like a lot more than the one I used to live in. This is QUIET, you all know how much that meand to someone with my condition. This moving thing's the reason I haven't had much time to hang around online, then I had togo a week w/o telephone when Bell Atlantic run out of lines. I'll keep yall posted.
Dee

 

Re: Dee

Posted by Noa on December 11, 1999, at 15:23:09

In reply to Re: Dee, posted by Dee on December 11, 1999, at 13:41:27

Wow, Dee. Moving is really hard, so I am impressed that you were able to do that. I hope your new place is homey and comfortable for you. I miss having you around, but it sounds like you were off getting done some things you needed to do. Good luck.


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org

Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.