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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Terry on May 16, 2000, at 23:08:00
My doctor is starting me on Serzone tomorrow morning. If anyone has any experiences with Serzone would you please let me know. Thank you Terry
Posted by JohnL on May 17, 2000, at 5:04:18
In reply to Serzone, posted by Terry on May 16, 2000, at 23:08:00
> My doctor is starting me on Serzone tomorrow morning. If anyone has any experiences with Serzone would you please let me know. Thank you Terry
Terry,
We hear all kinds of stories about Serzone. Some people do very well with it. They say Serzone has freed them from depression. The most appreciated things about Serzone are its characteristics of good sleep and good sex. But we also hear of people getting worse on Serzone, or agitated, fogheaded, couch potatoed. It's impossible to predict your response. It has the potential to be fantastic or miserable. Only a personal trial will tell.
Having said that, I do know one doctor who is having unusual success with Serzone. He claims it is his dosing schedule to credit the good results. His dosing schedule is this...start with 50mg a day for 4 to 7 days, usually at dinnertime. Then increase dose by 25mg to 50mg, but 25mg steps is better. Continue increasing dose on this schedule of every 4 to 7 days up to 300mg. If a higher dose is needed, then begin twice-daily dosing. This whole process will take longer than the textbook dosing schedule, but according to this one doctor the wait is well worth it. If your doctor suggests starting at 100mg or 200mg a day, I personally would disregard and go with a lower dose. At such an aggressive starting dose I would almost guarantee you bad results. Not for sure, but it wouldn't surprise me.
There are two reasons he does this. First, the body adjusts to side effects much more smoothly. Second, Serzone can have a rather narrow and sensitive therapeutic window. Either too little or too much can be counterproductive. Increasing dose in small steps helps the patient discover where their therapeutic range is, so they don't accidentally blow right past it. Once the general range is discovered--it will be obvious--then fine tuning can narrow it down further. Sometimes a dose adjustment of a mere 12.5mg can make all the difference. Serzone is finicky and sensitive from what I've seen and experienced myself with it.
JohnL
Posted by dove on May 17, 2000, at 8:54:11
In reply to Re: Serzone, posted by JohnL on May 17, 2000, at 5:04:18
Could anyone explain explicitly why Serzone (nefazodone) is b.i.d (twice daily)dosing? My p-doc has me taking 400mgs in dosages of 100mgs four times a day. What is the significance of this? I miss doses because I'm busy with my five kids, and would really enjoy being free of that med schedule if possible.
Any thoughts are welcome and appreciated :-)
dove
Posted by Cindy W on May 17, 2000, at 9:21:16
In reply to Re: Serzone, posted by JohnL on May 17, 2000, at 5:04:18
> > My doctor is starting me on Serzone tomorrow morning. If anyone has any experiences with Serzone would you please let me know. Thank you Terry
>
> Terry,
>
> We hear all kinds of stories about Serzone. Some people do very well with it. They say Serzone has freed them from depression. The most appreciated things about Serzone are its characteristics of good sleep and good sex. But we also hear of people getting worse on Serzone, or agitated, fogheaded, couch potatoed. It's impossible to predict your response. It has the potential to be fantastic or miserable. Only a personal trial will tell.
>
> Having said that, I do know one doctor who is having unusual success with Serzone. He claims it is his dosing schedule to credit the good results. His dosing schedule is this...start with 50mg a day for 4 to 7 days, usually at dinnertime. Then increase dose by 25mg to 50mg, but 25mg steps is better. Continue increasing dose on this schedule of every 4 to 7 days up to 300mg. If a higher dose is needed, then begin twice-daily dosing. This whole process will take longer than the textbook dosing schedule, but according to this one doctor the wait is well worth it. If your doctor suggests starting at 100mg or 200mg a day, I personally would disregard and go with a lower dose. At such an aggressive starting dose I would almost guarantee you bad results. Not for sure, but it wouldn't surprise me.
>
> There are two reasons he does this. First, the body adjusts to side effects much more smoothly. Second, Serzone can have a rather narrow and sensitive therapeutic window. Either too little or too much can be counterproductive. Increasing dose in small steps helps the patient discover where their therapeutic range is, so they don't accidentally blow right past it. Once the general range is discovered--it will be obvious--then fine tuning can narrow it down further. Sometimes a dose adjustment of a mere 12.5mg can make all the difference. Serzone is finicky and sensitive from what I've seen and experienced myself with it.
> JohnLTerry, JohnL's comments are really great, about Serzone. The only other thing I would add is to give it a fair trial. The first couple of weeks, a lot of people feel kind of moody, angry, labile in moods, or strange...or you may not feel any of this at all. If you feel any of this, try to let at least two weeks go by before you make up your mind about Serzone. I felt weird for about two weeks (mood changes without apparent reason, dizziness, tired), then I felt just great on Serzone. JohnL is especially right about great sleep and great sex on Serzone. (Unfortunately, I didn't help with OCD.)--Cindy W
Posted by Aylese on May 17, 2000, at 9:44:28
In reply to ? for JohnL serzone dosing, posted by dove on May 17, 2000, at 8:54:11
Dove, Your Doctor is indeed knowledgeable if he is prescribing Serzone 4 times a day. It has a very short half-life of only 2-4 hours. ( It is very short-acting.) General directions are for dosing twice a day, which leaves a huge gap when you aren't being helped. Four times a day keeps your Serzone level more steady. It is a terrible nusience four times a day, but I bought an alarm wrist watch to remind myself that another dose is due. I try to take it every 6 hours. (Much better than every 12.) I have lost nearly 12 pounds since Christmas with out dieting and it has helped quite a bit with intense sleep problems. If I can't sleep well, I will take 1/2 an antihistamine tablet (chlortrimeton) and sleep like a baby. I am at the maximum dose of 600mg per day. I wonder if it wouldn't work better with a mood stabilizer, but the Doc won't give me the chance to try and find out. I know tricyclics and SSRI's worked much better than Serzone does but I had gained 60 pounds over the last 15 or so years so the Doctor wanted to see if Serzone would normalize my appetite and metabalism. So far, it IS working. My appetite has really decreased. I certainly wish it was a more effective antidepressant, but it helps some in that regard. Good Luck, Aylese
Posted by Noa on May 17, 2000, at 10:51:20
In reply to Re: Serzone, posted by Cindy W on May 17, 2000, at 9:21:16
One thing Serzone does well for me is to block the so-called "bad" serotonin receptors, ie, the ones that seem to be related to being agitated, antsy, twitchy, fidgety, and sleepless.
I find serzone to be slower/longer acting than trazodone was for me. With trazodone, I would take 25 mg and within an hour couldn't keep my eyes open. With serzone, I take 300 mg at around 6 pm or so, and am ready to sleep at 10. When I take it later than early evening , I am still fidgety when I get into bed and getting up in the morning is hell.
I still feel too much of the activating serotonin, and am thinking of shifting the effexor:serzone ratio even more. It had been 375:225 for a long time. Lately it has been 300:300. I can't tell how much antidepressent power the serzone has for me, because I did the impatient thing of increasing serzone and decreasing effexor at the same time. I am tempted to give a trial of adding up to 150 mg serzone in the morning.
Dove, I think the four times a day dose is inconvenient, but it might help in not knocking you out.The higher dose of serzone (300) does cause me more drowsiness about one hour after taking it than with the smaller dose. But it seems to even out after a while and not conk me out. Does anyone know if the sedation effects start to wear off at all after a while? Are they the same for morning doses as evening doses?
Posted by JohnL on May 18, 2000, at 2:55:45
In reply to ? for JohnL serzone dosing, posted by dove on May 17, 2000, at 8:54:11
> Could anyone explain explicitly why Serzone (nefazodone) is b.i.d (twice daily)dosing? My p-doc has me taking 400mgs in dosages of 100mgs four times a day. What is the significance of this? I miss doses because I'm busy with my five kids, and would really enjoy being free of that med schedule if possible.
>
> Any thoughts are welcome and appreciated :-)
>
> doveDove,
Maybe the doctor has a couple things in mind. Serzone's halflife is very short. Maybe that's a consideration. Or maybe he's trying to smooth out any side effects. Clinical trials have shown interestingly that q.i.d. dosing vs b.i.d. dosing showed no difference in therapeutic response. So I don't think multiple dosing has much to do with response, but probably more to do with managing side effects. Just a guess. Next time you see the doc, ask him. I would be interested to know.
JohnL
Posted by dove on May 18, 2000, at 11:38:33
In reply to Re: ? for JohnL serzone dosing, posted by JohnL on May 18, 2000, at 2:55:45
Well, I talked to my p-doc, and he is a hoot! Here my p-doc is all worried about the Serzone making me stupid and drowsy, while he started my first week on Prozac at 20 mgs, to be raised to 40 mgs by week #2. What strange things people do. Where do these protocols originate from? I mean, he threw a big whopping dose of Prozac at me, along with a newly initiated wellbutrin, raise in Adderall and doubling the amount of Amitriptyline, all in the same week.
Anyway, yes the p-doc was trying to minimize any unwanted side-effects. Thanks everybody for your thoughts, I really appreciate it!
dove
Posted by JennyR on May 20, 2000, at 21:40:52
In reply to Re: Serzone, posted by JohnL on May 17, 2000, at 5:04:18
I was on 300 mg, all at night for a few months. Then I started waking up a lot and I was increased to 400 mg at night. That was good for a while, then I started waking up again. Now I've been upped to 600mg - the max. It's been about a week and the sleep is just starting to improve somewhat. I'm concerned because I'm at the max and if it isn't effective for me at this level, or is but only for a while, I'll probably have to deal what so many other people have been dealing with - all the trial and error and all the various side effects. I'm concerned about that. Hope it works for you.
Posted by Stagalee on May 15, 2001, at 15:41:23
In reply to Re: Serzone, posted by JennyR on May 20, 2000, at 21:40:52
A few folks have mentioned that twice a day or even four times a day dosing is indicated given Serzone's short half life. While the parent compound does have a short half life, it has some active metabolites that clear more slowly, and you achieve a steady state (essentially a plateau concentration, or rising and falling levels above and below a plateau) 3-4 days after starting or changing the dose. The fact that you can reach steady state even taking it once a day implies that you will not have periods with no drug on board. See:
http://www.mentalhealth.com/drug/p30-n05.html
I am taking it once a day and had a terrible reaction to 100 mg the first night, but after dropping back to 50 mg a day for 3 days was able to tolerate 100 mg just fine. Slow dose escalation is definitely a good idea, and whether you ultimately choose once or twice a day should depend on your personal reaction, e.g. people who feel fuzzy and sleepy may do better with one dose in the evening, and those who like its anxiolytic effect in the morning and can tolerate it may wish to split the dose.
Posted by Noa on May 18, 2001, at 9:33:51
In reply to Re: Serzone, posted by Stagalee on May 15, 2001, at 15:41:23
I take 500 mg once a day--at night.
Posted by PuraVida on May 18, 2001, at 19:59:31
In reply to Re: Serzone, posted by JohnL on May 17, 2000, at 5:04:18
I agree. Have been on Serzone for almost 2 1/2 years, and am wondering where to next, as I can't seem to get the "finicky" dosage right after my doctor reduced my dosage too fast and too much.
First, it has worked pretty well for me: Prozac made me too edgy and Paxil just made me sleep all day and night. I maxed out on Wellbutrin, and had trouble remembering to take it 3x a day. With the Serzone I've been upping it every 4 or 6 months, and was maxed out at 600 mgs. Told the doc I hadn't been really depressed in a year, and that my only complaint was that I was sleeping so much - I'd sleep 10 or 11 hours, and still feel the need to lie down 2-4 hours after I tool my morning dose. He reduced me from 600 mgs to 400 mgs over a two (2!) week period, and I went into a depression I'd wish on no one! Now I'm trying to stablize at 500, but still feel lethargic and am having anxity and panic more than before.
Hopefully me story doesn't scare anyone about the drug, but rather alerts you to mananging the doses in small increments, slowly. Serzone has worked for me for quite awhile, though, as with my other experiences, I had to keep upping the dose...
Posted by PuraVida on May 18, 2001, at 20:06:38
In reply to Terry and Dove...Serzone Dosing, posted by Aylese on May 17, 2000, at 9:44:28
Aylese, thanks for the advice. I lost a lot of wieght on Prozac, and have gained on Serzone, due to a lessened interet(maybe apathy?) to exercise and eating right. I was at 600, but sleeping too much and gaining weight. Perhaps 300 every 12 hours was the problem. I'm going to try the 4x a day deal - but, it is a pain! Better, I hope, than the alternatives, though!
Posted by PuraVida on May 18, 2001, at 20:12:40
In reply to Re: Serzone, posted by Noa on May 17, 2000, at 10:51:20
I often get conked out too after the morning dose. I can't find any rhyme or reason to it - I've tried taking larger evening doses and smaller AM, taking the dose with food, ect. Still, there are certain days when I look at my computer screen or read a book and it seems as my eyes are almost cross-eyed while the lids are sinking closed. I'm going to try the 4x a day thing to see if it helps, though I'm not wild about having to remember to (or sure if I can) take it.
Posted by warrior on May 20, 2001, at 0:50:33
In reply to Re: Serzone, posted by PuraVida on May 18, 2001, at 20:12:40
> I often get conked out too after the morning dose. I can't find any rhyme or reason to it - I've tried taking larger evening doses and smaller AM, taking the dose with food, ect. Still, there are certain days when I look at my computer screen or read a book and it seems as my eyes are almost cross-eyed while the lids are sinking closed. I'm going to try the 4x a day thing to see if it helps, though I'm not wild about having to remember to (or sure if I can) take it.
Pura Vida:
I like reading your posts. You have great insight and are a great supporter of those in need here.
I have taken Wellbutrin and Serzone at the same time and it seemed to be working fine. So fine in fact, that I self discontinued last July 2000. I found myself suffering from a "double depression" relapse and am currently taking Celexa. My present psychiatrist said it was probably time for me to try to go off the meds last year so who knows? Anyway, I am a strong believer that one must back up the medication regime with strong either interpersonal/support or cognitive psychotherapy-group, one-on-one, anything to keep the momentum rolling.
Take care of yourself and I hope to hear from you.
E-mail corresponding would be fabulous!
Love,
Warrior
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