![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 49. Go back in thread:
Posted by JohnB on November 5, 1999, at 15:57:10
In reply to Neurontin, posted by DL on November 5, 1999, at 11:16:34
> Neurontin, (one of the anticonvulsants used now as mood stabilizers)is very helpful for social phobia.
Hi, DL. I've heard of Neurontin (Gabapentin) being helpful for SP. I tried it for a limited time at 1800mg/day. I now understand from a search of PubMed that it has been tried in doses up to 3600mg/day and that is where it has been found to be effective. CAN YOU TELL ME AT WHAT DOSE YOU FOUND MARKED RELIEF? HOW LONG DID IT TAKE TO "KICK-IN?"
Posted by DL on November 5, 1999, at 23:21:43
In reply to TO: DL Re: Neurontin For SP, Doage?, posted by JohnB on November 5, 1999, at 15:57:10
CAN YOU TELL ME AT WHAT DOSE YOU FOUND MARKED RELIEF? HOW LONG DID IT TAKE TO "KICK-IN?"
I have finally found a psychiatrist who is very knowledgeable and willing to work with me to find the right med (s) for me. He tried neurontin since he feels my "major depression" dx is really more like "mixed state bipolar". Neurontin is one of the mood stabilizers that seems to have less side effects and less interactions with other meds. After the first week I had no side effects. The dose was titrated up quickly and now I am on 2400mg a day. At this level I noticed that I was much more comfortable with other people and relaxed at social events. However, since we are working on lifting the long standing depression and that was not happening, the doc has added Zyprexa. This surprise me since I am not in the least psychotic and never have been that I know of. He showed me a printout of some recent studies where it was shown to be an effective antidepressant and mood stabilizer. AND, in my case it seems to be helping.
Posted by Elizabeth on November 5, 1999, at 23:35:44
In reply to To Elizabeth RE: Nardil/Marplan, posted by JohnB on November 3, 1999, at 22:10:21
> Thanks alot, Elizabeth! Really appreciate your comments!! My Nardil was 50-60 mg/day to achieve effectiveness. I undersand "maintenance" doses as low as 30 mg/day have been used with some success, but it didn't work for me.
That's an old recommendation (as are many things one hears about Nardil these days )...I think that current practice (maintenance dose = initial dose) is much likelier to prevent relapse.
> My Klonopin is 2mg/day. My psychdoc says he thinks this has the least negative effect on memory and cognition as it has the longest half-live of the benzos, and therefore maintains relatively contast plasma levels. I didn't follow his thinking completely, but i like the twice a day dosing, on a maintenance basis. Just wish I could eliminate the benzodiazepine completely.
That's true...Ativan and Xanax need to be dosed at least t.i.d. (3x/day), and I've heard of people needing to take Xanax every 4 hours. (How do they sleep, one wonders.) (I'm not sure I follow your doctor's thinking either in saying that Klonopin would cause the least impairment, for whatever that's worth! As far as I can tell, benzodiazepine side effects are pretty individualized.)
Posted by SJ on November 5, 1999, at 23:42:20
In reply to Re: Neurontin, posted by Rick on November 5, 1999, at 11:47:10
I'm not sure what a diagnosis of social phobia involves. I started with Neurontin last spring for a bipolar II disorder, and have had very good results with it. I discontinued it briefly a few months ago, in favor of Topamax (because it can cause weight loss, but decided to stick with the Neurontin.
For me, the side effects are more troublesome when I increase the dose too quickly, or take a dose in the morning. Sleepiness is the main problem for me, although it's very manageable if I avoid a morning dose.
I wish the manufacturer would come up with a timed-release version, because it's such a hassle to have to remember to take a mid-day dose.
I've not experienced too much general anxiety while taking Neurontin, something which was a problem before. When I first started with it, I remember thinking that it felt like my brain felt "soothed". Must be why it is more commonly used by GP's for pain.
SJ
> From what I've heard, Neurontin does great things for Social Phobia for 1/3-1/2 of people who try it for a reasonable length of time, and is a complete bust for others. Also, for some it causes a lot of sedation, dizziness and/or cognition problems, while for others it's virtually side-effect free after the first week or two.
>
> If, for some reason, the Klonopin ever stops working wonders for my Social Phobia (and there's sure no evidence of that after months of use!), Neurontin is high on my list of alternatives to try.
>
> Serzone is another. That's one AD that seems incredibly variable in terms of reactions -- a low side-effect wonder for some, and a totally non-theraputic source of major side-effects for other (excepting sexual dysfunction). But the reported de-personalization tendency of all mood stabilizers/AD's would concern me.
>
> Rick
>
>
> > Neurontin, (one of the anticonvulsants used now as mood stabilizers)is very helpful for social phobia.
Posted by Craig on November 6, 1999, at 11:59:51
In reply to Re: Any SSRI/other? good as Nardil for Social Phobia?, posted by Adam on November 3, 1999, at 19:05:12
Adam suggested Remeron, stating the weight gain may be easier to control...I don't know. I 've always been a very disciplined person in my diet, but Remeron wiped that out. I could not stop eating...and I had problems staying awake.
As mentioned above, the SSRIs should all be helpful with social phobias. But there is the sexual dys. and I noticed the effects taper over time.
I'm taking Serzone and notice a difference in social settings after three weeks. I think quite a few people try it for social phobia, judging from earlier threads. No weight problems (actually easier to lose weight) and no sexual probs. I'd give it a whirl maybe while waiting for Reboxetine? Although I don't think Reb. would work on general anxiety/worry (I say that b.c. it sounds similar to welbutrin.
Never tried Nardil, but wouldn't considering my reaction to Remeron...
I'll be interested to know what you try.
Posted by JOHNB on November 6, 1999, at 13:46:34
In reply to Re: TO: DL Re: Neurontin For SP, Doage?, posted by DL on November 5, 1999, at 23:21:43
JUST A THOUGHT - RECENT RESEARCH (FOUND ON PUBMED) PERFORMED BY PARKE-DAVIS PHARMACEUTICALS SUGGESTS 3600 MG/DAY OF NEURONTIN FOR SOCIAL PHOBIA/.
THANKS. JOHNB :)
Posted by JOHNB on November 6, 1999, at 13:50:24
In reply to Re: Neurontin, posted by SJ on November 5, 1999, at 23:42:20
HI, SJ. THIS IS FOR WHAT IT'S WORTH - I READ A STUDY IN PUBMED SUGGESTING THAT NEURONTIN CAN BE TAKEN TWICE A DAY, AND BE JUST AS EFFECTIVE AS TID DOSING. SO,MAYBE A MID-DAY AND EVENING DOSE WOULD SOLVE THE PROBLEM OF MORNING DROWSINESS DUE TO THE MORNING DOSE.
SEE YOU. JOHNB :)
Posted by JOHNB on November 6, 1999, at 13:56:44
In reply to Re: Any SSRI/other? good as Nardil for Social Phobia?, posted by Craig on November 6, 1999, at 11:59:51
THANKS, CRAIG. I'LL BE SEEING MY PSYCHDOC IN ABOUT A WEEK TO DISCUSS A CHANGE IN MEDS. HE'S A GOOD PSYCHOPHARMACOLOGIST, AND IS WILLING TO GIVE MOST THINGS A TRY, INCLUDING BUPROPION + MAOI'S, EVEN THOUGH THIS IS CONTRAINDICATED IN THE CONSERVATIVE DRUG HANDOUT LITERATURE. THE 4 ALTERNATIVES:
(1) HIGH DOSE BUSPAR (60MG/DAY). PUB MED ARTICLE. (2) HIGH DOSE NEURONTIN (3600 MG/DAY). FOUND A PUBMED ARTICLE BY PARKE-DAVIS SUGGESTING THIS HIGH DOSE WAS EFFECTIVE FOR SP.
(3) ZOLOFT OR SERZONE IN COMBINATION WITH BUSPAR (40MG/DAY). AGAIN, RAN ACROSS PUBMED CONTROLLED STUDY IN WHICH BUSPAR ENHANCES THE ANTI-PHOBIC EFFECT OF SSRI'S AND OTHER AD'S
(4) NARDIL, PLUS SOMETHING TO COUNTERACT ITS EFFECT UPON APETITE AND SEXUAL DYSFUNCTION - MAYBE DOPAMINE AGONISTS, SUCH AS BUPROPION OR SELEGILINE.WILL POST BACK ABOUT WHAT I TRY AND IT'S EFFECT.
THANKS, CRAIG. JOHNB :)
Posted by Rick on November 7, 1999, at 21:13:22
In reply to Re: Any SSRI/other? good as Nardil for Social Phobia?, posted by JOHNB on November 6, 1999, at 13:56:44
JohnB, be v-e-r-y careful if you try idea #4 with Nardil+Selegiline. It turns out the warnings about mixing MAOI's can be true! While I was still on Nardil for Social Phobia, my pdoc added a small dose (5 mg) of Selegiline.
Not only did this NOT help sexual function return, but I also found that about a half hour after taking the two meds together, my blood pressure would rise to DANGEROUSLY high levels (e.g. I'd jump from 110/75 to 200/110). I was totally asymptomatic (perhaps because I've had high BP in the past), but for others this kind of jump could result in a hypertensive crisis with serious consequences. The BP would go back down to normal levels within another 30-60 mins., but this is NOT something to fool around with!!! I was stupid to keep taking the combo, even for just a week.
After this we dumped the Nardil completely and went a little higher on the Selegiline. Eventually, we moved (thank God) to Klonopin.
BTW, for Social Phobia NO MED has EVER shown as great an effect vs. placebo (double-blind, controlled, large sample) as Klonopin did in Dr. Davidson's landmark 12/93 study at Duke. The results were 78% significant improvement for Klonopin (clonazepam) vs. 20% for placebo. The Medline (Pub Med) abstract is at the url below. I urge you to order the complete article.
Regardless, BE WARY OF A NARDIL+SELEGILINE COMBO!!!!
Rick
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8120156&form=6&db=m&Dopt=b
> THANKS, CRAIG. I'LL BE SEEING MY PSYCHDOC IN ABOUT A WEEK TO DISCUSS A CHANGE IN MEDS. HE'S A GOOD PSYCHOPHARMACOLOGIST, AND IS WILLING TO GIVE MOST THINGS A TRY, INCLUDING BUPROPION + MAOI'S, EVEN THOUGH THIS IS CONTRAINDICATED IN THE CONSERVATIVE DRUG HANDOUT LITERATURE. THE 4 ALTERNATIVES:
> (1) HIGH DOSE BUSPAR (60MG/DAY). PUB MED ARTICLE. (2) HIGH DOSE NEURONTIN (3600 MG/DAY). FOUND A PUBMED ARTICLE BY PARKE-DAVIS SUGGESTING THIS HIGH DOSE WAS EFFECTIVE FOR SP.
> (3) ZOLOFT OR SERZONE IN COMBINATION WITH BUSPAR (40MG/DAY). AGAIN, RAN ACROSS PUBMED CONTROLLED STUDY IN WHICH BUSPAR ENHANCES THE ANTI-PHOBIC EFFECT OF SSRI'S AND OTHER AD'S
> (4) NARDIL, PLUS SOMETHING TO COUNTERACT ITS EFFECT UPON APETITE AND SEXUAL DYSFUNCTION - MAYBE DOPAMINE AGONISTS, SUCH AS BUPROPION OR SELEGILINE.
>
> WILL POST BACK ABOUT WHAT I TRY AND IT'S EFFECT.
>
> THANKS, CRAIG. JOHNB :)
Posted by Milena on January 5, 2002, at 11:18:09
In reply to Re: Any SSRI/other? good as Nardil for Social Phobia?, posted by JOHNB on November 6, 1999, at 13:56:44
Has anyone ever been on Celexa at one time and Serzone another? I'm on 60mg of celexa now and I'm gaining weight, and have sexual side effects as well. I heard that with Serzone there is no weight gain and no sexual side effects, but how is it compared to celexa for social phobia? Is it better/worse??
Thanx,
Milena
Posted by Rick on January 5, 2002, at 14:40:49
In reply to How would you compare CELEXA to SERZONE... ????, posted by Milena on January 5, 2002, at 11:18:09
I've taken each, and even took them together for awhile. Celexa had modest benefit for my social phobia at up to 40 mg. Actually, it seems the main way it helped was by making me more apathetic. Not exactly the best route to recovery. That said, its efficacy could vary a lot by person. I infer from your question that it's helped you more than it helped me, but with difficult side effects.
Weight gain is generally not a problem with Serzone, although Celexa certainly doesn't have a Paxil-like reputation for that side effect, either. (I didn't have that problem with either one.)
My social phobia definitely responded better to Serzone, as part of a Klonopin/Serzone/Provigil combo. But the Klonopin is clearly the key med at alleviating the fear of social interaction, while the Provigil enhances its benefits by making me a lot more outgoing, confident and assertive.
While Serzone alone would probably be helpful (someone who used to post here a lot said it was wonderful for her social phobia but couldn't help her OCD), I think it's helped me more via beneficial interactions with the other meds.
I CAN say that I've had no adverse sexual effects whatsoever at up to 450 mg of Serzone, whereas Celexa had negative impact at 20 mg and basically ruined my sexual functioning at 30 mg. That said, everyone's different: A co-worker had wonderful results on Celexa 60 mg for depression, although it took a full eight weeks to kick in. He claims that following initial bouts of nausea and sweating, he's had no side effects at all. But one thing that seems consitent across the great majority of people is that Serzone won't cause sexual problems except perhaps at unusually high doses that go beyond the recommended range.
BTW, the poster who thought Serzone was wonderful for her social phobia replaced it with Effexor, which she said was almost as good for the SP, while also helping the OCD. Even though Effexor often causes sexual dysfunction, she said that was not a problem for her with Effexor. Also, I recently saw a friend I haven't seen for a few years and he seemed do be doing so much better than before. While his problem was depression, he's always been a rather withdrawn person, but now seemed so much more assertive and confident. Turns out he had been taking Prozac for years, but switched to Effexor a year ago after the Prozac largely pooped out. So Effexor may have distinct possibilities as an SP treatment (some open studies have suggested this, as they have for Serzone and Celexa). Of course, you always need to be wary of Effexor if you have high blood pressure or risk factors for it. It's not known for weight gain. In fact, at the higher doses where adrenergic effects kick in, it may actually have some of the opposite effect.
Sorry about rambling, but getting back to your original question, I think Serzone is definitely worth a try and it's unlikely to cause sexual or appetite problems like Celexa. But, as confirmed by placebo-controlled studies, nothing beats daily low-dose Klonopin for safe (if used responsibly) and consistent SP relief, along with minimal side effects. For non-depressive social phobia, AD's should be used as potential augmentors for Klonopin, not the more typical vice-versa. (Of course, AD *really* stands for ADvertising budget, so it's not surprising docs are always reaching for the SSRI's as first-line treatment...plus, mostly-unjustified benzophobia remains far too prevalent.)
Rick
> Has anyone ever been on Celexa at one time and Serzone another? I'm on 60mg of celexa now and I'm gaining weight, and have sexual side effects as well. I heard that with Serzone there is no weight gain and no sexual side effects, but how is it compared to celexa for social phobia? Is it better/worse??
>
> Thanx,
>
> Milena
Posted by Milena on January 5, 2002, at 17:00:43
In reply to Re: How would you compare CELEXA to SERZONE... ???? » Milena, posted by Rick on January 5, 2002, at 14:40:49
Thanx Rick, you've explained it so well. Thanx for taking the time. I am also on klonopin, I forgot to mention that one. And, yes, it's great for anxiety, but I also need a long term thing, ya know? So serzone is an SSRI, correct? An antidepressant as well? I'm definitely going to ask my psychiatrist about it. Celexa did it for me a few years ago, until I started gaining weight and got on Zoloft (which didn't work), I've tried Effexor Ex, that really didn't do all I thought it would, so now I'm back on Celexa, and this time around it's not working as well as last time, and I'm gaining weight. So Serzone will definitely be my next drug of choice. Thanx again Rick!
PS What is Provigil?
Milena
Posted by Rick on January 5, 2002, at 18:15:28
In reply to Re: Rick ---- CELEXA to SERZONE... ????, posted by Milena on January 5, 2002, at 17:00:43
> And, yes, it's great for anxiety, but I also need a long term thing, ya know?
Me, too. And until something better and with a longer-term safety record comes along, I'm sticking with Klonopin as my mainstay. However, the fact that I've needed less over time, even pre-Serzone, (I'm now at 1 mg/day, morning only) suggests that Klonopin's created a partial remission of my SP symptoms...or at least allowed me to face enough anxiety-provoking situations so that I've learned to deal with them better. (See reference below.)
>So serzone is an SSRI, correct?Partially. It's more of a hybrid. Serzone produces weak serotonin reuptake inhibition (the "SRI" of "SSRI"), but it also preserves serotonin -- and to a lesser extent adrenaline -- in the brain through a different kind of mechanism that the SSRI's don't use.
>An antidepressant as well?Oficially (i.e., FDA indication) it's ONLY an antidepressant, but as I said it's known as being good for anxiety. (BTW, Klonopin's only "official" indications are as an anti-convulsant and panic disorder, but it's used for a slew of other disorders from social phobia to bipolar to chronic pain to movement disorders.)
>Thanx again Rick!
You're welcome! Let us know how it works out.
> PS What is Provigil?
Povigil (modafinil) is a fairly new, more-gentle kind of stimulant that doesn't have the side effects that traditional amphetamine-related stims like Ritalin can sometimes cause (nervousness, crashing, cardiac effects, abuse potential). I believe it's the first non-amphetamine based stimulant introduced in many, many years (along with its kin adrafinil, which is used as an AD in parts of Europe but isn't sold in the U.S.). So far Prvigil's only official indication is for excessive daytime sleepiness due to narcolepsy, but it's actually being prescribed more by pdocs for purposes such as countering AD-induced fatigue or increasing the effectiveness and/or speed of response to AD's. It's not generally thought of as an anti-anxiety med, but a low dose adds SO much to my SP treatment in terms of assertiveness and alertness. (A number of people on this board have said adrafinil -- purchased from overseas -- has been great as the primary treatment for their social phobia.)
Everyone's different, but for me the "cocktail" of Klonopin, Serzone and Provigil -- all taken first thing in the morning -- is extremely, consistently effective for SP. For me, Serzone + Klonopin is a little sedating without Provigil, but if Serzone works well for you perhaps Klonopin will be out of the picture soon.
One thing I forgot to mention about Serzone and SP: The study I read using Serzone for SP showed the greatest leap in treatment response between weeks eight and twelve. My own response seemed consistent with this. So be sure to give it time.
One more thing: If you take Serzone be sure to get a standard blood test for liver function at six and twelve months, and then yearly thereafter.
This is especially true if you take it with any other meds, since it interacts metabolically with many. For me, Serzone's probable metabolic interaction (a "stretch-it-out" effect) with both Klonopin and Provigil could be what allows me to take them in low doses, and all in the morning. But everyone's metabolic system is different, so both the theraputic reaction and liver function should be monitored carefully.
Rickhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9790154&dopt=Abstract
(Last sentence sums it up nicely.)
Posted by OldSchool on January 5, 2002, at 20:30:06
In reply to How would you compare CELEXA to SERZONE... ????, posted by Milena on January 5, 2002, at 11:18:09
> Has anyone ever been on Celexa at one time and Serzone another? I'm on 60mg of celexa now and I'm gaining weight, and have sexual side effects as well. I heard that with Serzone there is no weight gain and no sexual side effects, but how is it compared to celexa for social phobia? Is it better/worse??
>
> Thanx,
>Hi Milena, as far as antidepressants go in the end when its all said and done, one AD is as good as another. Serzone isnt really anymore effective than Celexa. However Serzone does have a good side effect profile. Serzone is a good antidepressant for agitated depression or for depression mixed with significant anxiety. Its also good for sleep. Serzone does not interfere with sleep architecture very much, whereas SSRIs like Celexa do.
And yes it is true that Serzone is free of sexual side effects and doesnt usually cause bad weight gain.
Old School
Posted by jimmygold70 on January 6, 2002, at 5:09:09
In reply to How would you compare CELEXA to SERZONE... ????, posted by Milena on January 5, 2002, at 11:18:09
Ye, but serzone has other side effects (my next post is the serzone monograph). It should be good as Celaxa for social phobia. HOWEVER the mechanism of Serzone and Celaxa are quite diferent. Now that you know how Celexa affects you, you can switch to serzone and see if it is effective.
> Has anyone ever been on Celexa at one time and Serzone another? I'm on 60mg of celexa now and I'm gaining weight, and have sexual side effects as well. I heard that with Serzone there is no weight gain and no sexual side effects, but how is it compared to celexa for social phobia? Is it better/worse??
>
> Thanx,
>
> Milena
Posted by jimmygold70 on January 6, 2002, at 5:10:50
In reply to How would you compare CELEXA to SERZONE... ????, posted by Milena on January 5, 2002, at 11:18:09
This is taken from Kaplan and Sadock's Synopsis of psychiatry, 8th Edition
-------------------------------------------
NEFAZODONE
-------------------------------------------
Nefazodone (Serzone) is an antidepressant medication structurally related to trazodone (Desyrel) and unrelated to the classical tricyclic and tetracychc drugs, the monoamine oxidase inhibitors (MAOIs), serotonin-specific reuptake inhibitors (SSRIs), and other available antidepressant drugs. Although trazodone is distinctive in having more marked sedative effects than those found with most other antidepressants, ne-fazodone is relatively free of this adverse effect and generally well tolerated. Nefazodone is less likely than the SSRIs to adversely affect sexual functioning.CHEMISTRY
Nefazodone is a phenylpiperazine analogue of trazodone. Its molecular structure is shown in Figure 35.3.24-1.
PHARMACOLOGICAL ACTIONS
Pharmacokinetics
Nefazodone is rapidly and completely absorbed, but it is then extensively and variably metabolized so that the bioa-vailability of active compounds is about 20 percent of the oral dose. Its half-life is 2 to 4 hours, and dosing must be twice daily. Steady-state concentrations of nefazodone and its principal active metabolite, hydroxynefazodone, are achieved within 4 to 5 days. Metabolism in older people, especially women, is about half that seen in younger patients; thus lower doses are recommended in elderly patients.
Pharmacodynamics
Nefazodone is an inhibitor of serotonin uptake and, more weakly, of norepinephrine reuptake. It also acts as an antagonist of the serotonin type 2 (5-HT2) receptor, antagonism of
which is thought to treat anxiety and depression. The net effect of serotonin reuptake inhibition and 5-HT2 receptor blockade is thought to be selective activation of serotonin type 1 (5-HT1) receptor, which has been suggested to improve both anxiety and depression. Nefazodone causes mild antagonism of the a1-adrenergic receptors and can predispose some patients to orthostatic hypotension. There is no significant activity at a2- and beta-3-adrenergic, serotonin type 1A(5-HT1A), cholinergic, dopaminergic, or benzodiazepine receptors.EFFECTS ON SPECIFIC ORGANS AND SYSTEMS
The main effects of nefazodone are on the central nervous system (CNS). The main extra-CNS effects are related to a1-adrenergic antagonism, which may cause orthostatic hypotension. Unlike its structural relative trazodone, nefazodone has not been reported to cause priapism.
Cardiovascular Effects
In premarketing trials, 5.1 percent of patients taking nefazodone experienced a significant drop in blood pressure, compared with 2.5 percent of placebo patients. Although there was no increase in true syncopal events, symptoms of postural hypotension were experienced by 2.8 percent of patients treated with nefazodone. This rate compares with postural hypotension in 0.8 percent of placebo-treated, 1.1 percent of SSRI-treated, and 10.8 percent of tricyclic antidepressant-treated patients. Sinus bradycardia was seen in 1.5 percent of nefazodone-treated patients compared with 0.4 percent of placebo-treated patients. Nefazodone should therefore be used with caution in patients with underlying cardiac conditions, history of stroke or heart attack, dehydration, and hypovolemia and in patients under treatment with antihypertensive medications.
Activation of Mania
In patients with known bipolar illness, 1.6 percent of those treated with nefazodone experienced mania, compared with 5.1 percent of tricyclic-treated patients and 0 percent of placebo-treated patients. The activation of mania in unipolar patients was no higher with nefazodone than with placebo. Therefore, nefazodone may be a drug to try earlier in the treatment of patients with a history of manic episodes. Electroconvulsive therapy and the antidepressant lithium are least likely to activate mania.
THERAPEUTIC INDICATIONS
Nefazodone has been approved for the treatment of depression on the basis of data from at least two large clinical trials. Nefazodone has been shown to be equally as efficacious as imipramine, fluoxetine, and paroxetine for treatment of moderate, severe, melancholic, nonmelancholic, chronic, and recurrent depression. Preliminary clinical reports indicate that nefazodone may also be an effective treatment for depression accompanied by anxiety, such as for panic disorder and panic with comorbid depression or depressive symptoms, for obses-
sive-compulsive disorder, for premenstrual dysphoric disorder, and for the management of chronic pain of neuropathic or non-neuropathic origin. Although small studies report that nefazodone was associated with a trend toward a reduction in obsessive thoughts, a case report documents the initial appearance of obsessive thoughts during nefazodone treatment, which ceased when the drug was discontinued. More data are needed to establish whether nefazodone is as effective for obsessive-compulsive disorder as are the SSRIs and clomipramine.PRECAUTIONS AND ADVERSE REACTIONS
In preclinical trials, 16 percent of patients discontinued nefazodone because of an adverse event. The most common reasons for discontinuance were nausea (3.5 percent), dizziness (1.9 percent), insomnia (1.5 percent), and agitation (1.2 percent). The adverse reactions reported with nefazodone are listed in Table 35.3.24-1. The adverse events were dose dependent and tended to appear at significant levels only in the dosing range of 300 to 600 mg a day. Nefazodone causes little sexual dysfunction, weight gain, or cardiotoxicity. Nefazodone and trazodone are unusual among antidepressants, in that they do not decrease but, rather, increase REM sleep and improve sleep continuity. However, nefazodone is much less likely than trazodone to produce daytime sedation.
Nefazodone was not shown to cause cancer in laboratory animals or to cause mutagenesis in several common assays. It caused mild loss of fertility at doses comparable to 3 times the highest recommended human dose. Although no teratogenic effects were noted, early neonatal mortality of laboratory animal offspring occurred with doses in the mothers comparable to 5 times the highest recommended human dose. There are no data on the effects of nefazodone on human mothers. Nefazodone should therefore be used during pregnancy only if the potential benefit to the mother outweighs the potential risk to the fetus. It is not known whether nefazodone is excreted in human breast milk. Therefore, it should not be used by women who are breast-feeding.
Table 35.3.24-1
Adverse Reactions Reported with Nefazodone
(300-600 mg a day)
________________%
Headache 36
Dry mouth 25
Somnolence 25
Nausea 22
Dizziness 17
Constipation 14
Insomnia 11
Weakness 11
Lightheadedness 10
Blurred vision 9
Dyspepsia 9
Infection 8
Confusion 7
Scotomata 7
DRUG INTERACTIONSAs is true for all antidepressant medications, nefazodone should not be given concomitantly with MAOIs. In addition, nefazodone has particular drug-drug interactions with the tria-zolobenzodiazepines, triazolam (Halcion) and alprazolam (Xanax), with so-called third-generation antihistamines, terfen-adine (Seldane) and astemizole (Hismanal), and with cisapride (Propulsid) because of the inhibition of cytochrome P450 (CYP) isoenzyme CYP 3A4 by nefazodone. Potentially toxic levels of each of these drugs can develop after administration of nefazodone, whereas the levels of nefazodone are generally not affected. The manufacturer recommends that the dose of triazolam be lowered by 75 percent, the dose of alprazolam be lowered by 50 percent when given concomitantly with nefazodone, and terfenadine and astemizole not be used at all with nefazodone.
Nefazodone may modestly increase levels of concomitantly administered haloperidol (Haldol). Nefazodone may slow the metabolism of digoxin; therefore, digoxin levels should be followed carefully in patients taking both medications. Conversely, nefazodone appears to reduce the bioavailability of propranolol (Inderal), and concomitant use of these two drugs should prompt a reevaluation of the dose of propranolol on clinical grounds. Nefazodone should not be given within 14 days of beginning or stopping an MAOI.LABORATORY INTERFERENCES
No laboratory interferences have been reported for nefazodone.
DOSAGE AND ADMINISTRATION
Like other antidepressant drugs, nefazodone begins to improve mood between 2 and 4 weeks of initiation of therapy. The recommended starting dose of nefazodone is 100 mg 2 times a day. To limit the development of adverse effects, the dosage should be slowly tapered up to increments of 100 to 200 mg a day at intervals of no less than 1 week per increase. Older patients should receive doses about two thirds of the usual nongeriatric doses, with a maximum of 400 mg a day. Dosages should be lowered in patients with hepatic impairment. In common with other antidepressants, clinical benefit of nefazodone usually appears after 2 to 4 weeks of treatment. Nefazodone is available in 100, 150, 200, and 250 mg tablets.
REFERENCES
Baldwin DS, Hawley CJ, Abed RT, Maragakis BP, et al: A multicenter double-blind comparison of nefazodone and paroxetine in the treatment of outpatients with moderate-to-severe depression. J Clin Psychiatry 57 (2, Suppl): 46, 1996.
Ellingrod VL, Perry PJ: Nefazodone: A new antidepressant. Am J Health System Pharm 52: 2799, 1995.
DeMartmis NA, Schweizer E, Rickels K: An open-label trial of nefazodone in high comorbidity panic disorder. J Clin Psychiatry 57: 245, 1996
Feiger A, Kiev A, Shnvastava RK, Wisselink PG, Wilcox CS: Nefazodone versus sertraline in outpatients with major depression. Focus on efficacy, toler-ability, and effects on sexual function and satisfaction. J Clin Psychiatry 57 (2, Suppl): 53, 1996.
Lader MH: Tolerability and safety: Essentials in antidepressant pharmacotherapy. J Clin Psychiatry 57 (2, Suppl): 39, 1996.
Marcus RN, Mendels J- Nefazodone in the treatment of severe, melancholic, and recurrent depression. J Clin Psychiatry 57 (2, Suppl): 19, 1996.
Nemeroff CB, DeVane CL, Pollock BG: Newer antidepressants and the cytochrome P450 system. Am J Psychiatry 153: 311, 1996.
Robinson DS, Marcus RN, Archibald DG, Hardy SA: Therapeutic dose range of nefazodone in the treatment of major depression J Clin Psychiatry 57 (2, Suppl): 6, 1996.
Posted by Milena on January 6, 2002, at 7:50:05
In reply to SERZONE - THE FACTS from Synopsis of Psychiatry, posted by jimmygold70 on January 6, 2002, at 5:10:50
Thanx to both Rick, Oldschool, and jimmygold. I have taken trazadone for my insomnia before. I hope serzone is not like that at all. I'll have to ask my doctor about it. Thanx guys!
Milena
Posted by ST on January 7, 2002, at 3:35:07
In reply to How would you compare CELEXA to SERZONE... ????, posted by Milena on January 5, 2002, at 11:18:09
Milena,
I just had to pipe up as well: I used to be on Wellbutrin and once my doc added Serzone to the mix my sex life went out the window. I switched to Celexa three years later (Serzone wasn't consistent at helping me fight depression) and my sexual appetite went up a bit. However, so did my appetite for food. I was always hungry. I gained thirty pounds in three months. Be aware of how much you eat and good luck!
Sarah
> Has anyone ever been on Celexa at one time and Serzone another? I'm on 60mg of celexa now and I'm gaining weight, and have sexual side effects as well. I heard that with Serzone there is no weight gain and no sexual side effects, but how is it compared to celexa for social phobia? Is it better/worse??
>
> Thanx,
>
> Milena
Posted by Milena on February 8, 2002, at 16:01:13
In reply to Re: How would you compare CELEXA to SERZONE... ????, posted by ST on January 7, 2002, at 3:35:07
Hi guys, It's Milena again. Well I finally did it, I'm on Serzone now. It's been exactly a week and a day since I started taking it...along with my celexa of couse. I can't just totally drop the celexa, I need to do it gradually. I just need to know if Serzone will make me gain waight? Celexa definitely did it, that is one of the reasons I want to stop taking it. Has anyone lost waight on Serzone? Will it help me lose waight?? Does it help with depression? What's the number one side effect while on Serzone?
Ehh...
Milena
Posted by IsoM on February 8, 2002, at 16:56:55
In reply to SERZONE and weight gain??, posted by Milena on February 8, 2002, at 16:01:13
I think a lot must have to do with our own individual metabolism on whether we gain weight while taking meds. I wish there was some way of taking a survey on weight gain while on ADs & other psychotropic drugs.
Does how we eat when depressed have anything to do with chances of gaining weight? If anyone reads this, would you be willing to say whether you've gained or lost on ADs, or just remained the same? And also whether you tend to eat more (carbs or anything) when depressed, or whether you lose your appetite instead & eat little?
Many of the ADs that people say has caused them to gain has had no effect on me. And one, Effexor caused such anorexia in me, I had to stop it. But I know the weight gain is very real. I can tell when one friend switches meds, her weight will go up again. She's normally a slim, healthy person but on some meds she's gains terribly & hates the way she feels.
There must be something behind the reason for weight gain in one person & not in another. And that happens whether the diet changes or not. You'd think I'd be heavier when depressed as I become very inactive, but my appetite, too, drops off sharply. Please post any experiences you may have & I'm sorry, Milena, but I didn't gain on Celexa, while my friend did gain on Serzone.
Posted by Milena on February 8, 2002, at 17:18:09
In reply to Weight Gain/Loss with ADs » Milena, posted by IsoM on February 8, 2002, at 16:56:55
Thanx you! But I'm still confused. I barely ever eat, no matter what I do I still gain waight. Before meds I was skinny and could eat what I wanted. No more. I feel like shitt. Nothing helps..
Milena
Posted by IsoM on February 8, 2002, at 17:36:55
In reply to Re: Weight Gain/Loss with ADs, posted by Milena on February 8, 2002, at 17:18:09
Milena, has depression made you inactive? I guess that's a stupid question as I don't know anyone who's depressed that feels like being active, but are you lots more inactive when depressed? When you're on meds & they're working for you, do you feel like becoming more active? Or are you still sluggish?
You do realise, don't you, that your body will (at least normally) slow its metabolic rate way down when you eat little? It senses starvation ahead & tries to conserve what energy it can. If your rate slows down, it needs to be reset. Sommetimes, returing to normal eating & vigourous exercise will do it.
It wouldn't hurt to get your thyroid checked too. Even slightly low thyroid function will add to depression. Some doctors will treat depression by adding a low dose of thyroxine. Hypothyroidism is fairly common among women aged 30-55 yrs old.
Feeling tired or sleepy, cold, lethargic, slower heartrate, mentally foggy & forgetful are often signs of hypothyroidism. Surprisingly, I wasn't cold at all or had a slow heart-rate when I found I had it.
There's no way I have an answer for weight gain on meds. I feel bad for friends who've have that problem though & wish I could help. I know I gained some weight while I was hypothyroidic & hated the way I looked. But I lost it again when I was properly treated.
Posted by Reneeb on February 9, 2002, at 13:51:31
In reply to SERZONE and weight gain??, posted by Milena on February 8, 2002, at 16:01:13
Hi Milena, I have a girlfriend who has been on serzone for about a year and hasn't gained any weight. I read a posting someone wrote who believes if you gain weight on one you will gain weight on all. The same goes with losing weight. I was on zoloft years ago and gained alot of weight. I have been of effexor for a year and didn't realize that the weight I put on was from effexor til I found this site. I am in the process of weaning myself off as we speak. I am also on wellbutrin. I haven't heard anyone having problems with it, but I am sure it will come. I know its soo frustrating you try to fix one problem and cause another.
Renee
Posted by IsoM on February 9, 2002, at 14:42:42
In reply to Re: SERZONE and weight gain?? » Milena, posted by Reneeb on February 9, 2002, at 13:51:31
Renee, about the idea of gaining weight on one AD means gaining weight on any makes it more likely, well...
It 'may' be true, or not. I never gained weight on any AD, but the friend I mentioned who gained on Serzone doesn't gain on all ADs, just some. I wish there were some real studies done on weight gain with ADs but I'm not aware of any. Don't give up hope of finding one you don't gain on.
Posted by Eloy on February 9, 2002, at 15:49:04
In reply to SERZONE and weight gain??, posted by Milena on February 8, 2002, at 16:01:13
i'm in my early 40's and suffer with social anxiety and intermittent periods of depression, and i also have a chronic liver disease. i've been on Serazone for a few years with very good results and minimal weight gain. If i did not have a chronic liver disease, i would probably unreservedly remain on Serzone inspite of the recent report that it can cause liver damage. It works so very well for me in stabilizing my anxiety and depression, and the only adverse side effect that i have is a gradual weight gain of eight pounds. Because i now have to take special care of my liver, which is vitally responsible for filtering the toxins in my body, and now learning of the liver damage that Serzone can cause, the Dr. is weaning me off of it and prescribed Remeron, but after reading up on Remeron lastnight- No Way! Because of my age (and my liver impairment), i already have a natural slow metabolism (ie: heart rate, cellular growth, and rate to burn off food), therefore i should not take a medicine that would cause constipation and weight gain of 15 to 20 pounds. i think not, because then i'd be overweight which would ironically increase my depression rather then help my condition, and not to mention causing a host of additional problems which stem from becoming overweight, like blood pressure issues and diabetes and the increase chance of heart attacks, etc. (i also believe, though long term follow-up research is lacking, that the sexual dysfunction side effect commonly attributed to many anti-depressants will increase the risk of testicular cancer for long-term using males, which are maintained on these particular anti-depressants associated with this side effect). No i'm not going to take this new Remeron, it's my body and my health and i don't want to carelessly damage it. i'm going to see if the Dr. will prescribe Wellbutrin (known not to cause an increase in weight) together with a Anti-anxiety medicine (one that doesn't cause harmful side effects) and cause any irreversible health damage in the long run. i use to take Ativan years ago, i wonder if this medicine would be safe for me.
Does anyone know of any Anti-anxiety medicine that does not cause weight gain or sexual dysfunction or is too hard for the liver to metabolize?
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