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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Michael Schell on December 21, 1998, at 12:00:35
I have recently read one article that claims combining Serzone with Prozac can eliminate the sexual side effects as well as agitation and insomnia. This article stated that you must first start with the Serzone (up to 200 mgs) then add in the Prozac (10mg to 40mg). Does anyone have any experience using these two drugs together (especially for OCD)? If I try this combo, what side effects should I be aware of? It seems like it would be similar to using Prozac, BuSpar and Trazadone together which I did O.K. on exept for the sexual side effects, agitation and headaches. Does anyone think this could be the magical combo I've been looking for or just another experiment that is a waste of time? Please respond with any info. or advice that you think may help me decide. Thanks very much in advance.
Posted by Michael Schell on December 29, 1998, at 9:25:52
In reply to Prozac with Serzone...Any thoughts???, posted by Michael Schell on December 21, 1998, at 12:00:35
> I have recently read one article that claims combining Serzone with Prozac can eliminate the sexual side effects as well as agitation and insomnia. This article stated that you must first start with the Serzone (up to 200 mgs) then add in the Prozac (10mg to 40mg). Does anyone have any experience using these two drugs together (especially for OCD)? If I try this combo, what side effects should I be aware of? It seems like it would be similar to using Prozac, BuSpar and Trazadone together which I did O.K. on exept for the sexual side effects, agitation and headaches. Does anyone think this could be the magical combo I've been looking for or just another experiment that is a waste of time? Please respond with any info. or advice that you think may help me decide. Thanks very much in advance.
>I think this is a pretty good question, and I've started the first part of this combo by getting started on the Serzone. Please respond back to let me know if there is any kind of negative reaction between these two drugs when used together and all other inquiries about this combo.
Posted by Toby on December 30, 1998, at 9:16:41
In reply to Re: Prozac with Serzone...Dr. Bob, Toby, etc. ???, posted by Michael Schell on December 29, 1998, at 9:25:52
Prozac and Serzone are a useful combo and should do as well as anything for OCD. I think I have missed something, as I don't know why one would have to start with Serzone and then add Prozac specifically for sexual side effects. Are we talking about using Serzone for OCD and then if it's not completely effective, adding Prozac and hoping that the Serzone will counteract any sexual side effects Prozac may bring with it? That sounds reasonable. The only thing to keep in mind is that prozac is a very long acting medication and there is a potential to increase blood levels of serotonin too much, causing a nasty thing called Serotonin Syndrome which can cause seizures. Generally this occurs in "slow metabolizers" of particular medications and this is a genetic thing which you don't find out about until the reaction is already occurring. I'm babbling about this because the usual thing is to start with Prozac since it is long acting and then to add the shorter acting medication, Serzone or what have you, to it for augmentation. Dr. Bob or someone may have other thoughts.
Posted by Michael Schell on December 30, 1998, at 10:12:06
In reply to Re: Prozac with Serzone., posted by Toby on December 30, 1998, at 9:16:41
> Prozac and Serzone are a useful combo and should do as well as anything for OCD. I think I have missed something, as I don't know why one would have to start with Serzone and then add Prozac specifically for sexual side effects. Are we talking about using Serzone for OCD and then if it's not completely effective, adding Prozac and hoping that the Serzone will counteract any sexual side effects Prozac may bring with it? That sounds reasonable. The only thing to keep in mind is that prozac is a very long acting medication and there is a potential to increase blood levels of serotonin too much, causing a nasty thing called Serotonin Syndrome which can cause seizures. Generally this occurs in "slow metabolizers" of particular medications and this is a genetic thing which you don't find out about until the reaction is already occurring. I'm babbling about this because the usual thing is to start with Prozac since it is long acting and then to add the shorter acting medication, Serzone or what have you, to it for augmentation. Dr. Bob or someone may have other thoughts.
>Your right on the money in saying that I'm looking to treat OCD with Serzone and then adding in Prozac if it's not effective. Your also right about hoping that the Serzone will fight off the sexual side effects of Prozac. As for why it is said you should start with Serzone first and then add in Prozac is due to the belief that if you start Serzone with an SSRI in your system, you run the risk of having an extreme amount of anxiety for the first week or two. If you start the Serzone first and then add in the SSRI, the belief is that this anxiety problem wont happen. I've heard a lot about the serotonin syndrome, but I haven't heard how to treat it if you do get it. What are some ways to treat it? Also, Are there any long term effects of getting it? I also have read that Serzone has a built in mechanism for not letting the Serotonin Syndrome manifest itself. Is this not true when Prozac is added into the equation?
>I hate to go on and on...but I really just want to get all the info. I can in finally finding a comb of drugs that work great in making me feel great without the numerous side effects. I have read some disconcerting info. on Serzone decreasing a persons' creativity and intelligence. Both these things were improved for me on Prozac. I really enjoyed being more creative, having a quicker wit and thinking more clearly on Prozac. I'm afraid I wont get this same result with Serzone, what are your thoughts? I had the problem of being fatigued and tired on Prozac, is this gonna be worse on Serzone? (especially if I end up combing it with Prozac) Will Serzone work like the Trazadone that I took with Prozac or will I still need to take Trazadone in addition to the Serzone and Prozac to fall asleep and sleep through the night? All the info you can give me would be greatly appreciated. I can't praise Dr. Bob enough for having the most helpful, most informative and for my money - "The best site on the Web." Thanks in advance for all responses!
Posted by Dr. Bob on December 30, 1998, at 21:55:34
In reply to Re: Prozac with Serzone. More questions???, posted by Michael Schell on December 30, 1998, at 10:12:06
>I can't praise Dr. Bob enough for having the most helpful, most informative and for my money - "The best site on the Web."
I especially like the "for my money" part. :-)
Happy new year, everyone,
Bob
Posted by steve on December 31, 1998, at 2:02:21
In reply to Re: Prozac with Serzone. More questions???, posted by Dr. Bob on December 30, 1998, at 21:55:34
How does this work? That is, how does Serzone counteract the side-effects of Prozac (especially sexual -- it seems to me that increases in seretonin- the neurotransmitter that is responsible for sedity, will also dimisnish libido).
Posted by Toby on December 31, 1998, at 10:13:33
In reply to Re: Prozac with Serzone. More questions???, posted by steve on December 31, 1998, at 2:02:21
Here's a crash course in Serzone.
SSRI's block serotonin from being reabsorbed into the nerve cells, leaving it out in the synapses to stimulate all serotonin receptors. There are serotonin receptors all over the body; those in the brain, the gut, and the spinal cord are most pertinent to our discussion here. Serotonin stimulation in the dorsal raphe of the brain relieves depression, but serotonin stimulation in the forebrain may cause agitation or anxiety. Stimulation of serotonin receptors in the stomach may give nausea. Stimulation of serotonin receptors in the lower spinal cord lead to sexual dysfunction.
Serzone is a weak serotonin reuptake inhibitor (like the SSRI's) but its most powerful action is to block a specific serotonin receptor called the 5HT2 receptor. The 5HT2 receptor is involved with the following side effects: agitation, anxiety, panic attacks, insomnia and sexual dysfunction. When you block this receptor you don't get those side effects. That's why it can reverse the side effects of the SSRI's that stimulate this receptor. Serzone is less sedating than trazodone (serzone's cousin) because it is a less potent histamine blocker than trazodone. It also causes less dizziness and less of a drop in blood pressure than trazodone can because it very little action on alpha receptors.
People who have been on trazodone in the past for sleep with an SSRI usually don't need it with Serzone, but occasionally somebody needs to add a little dose of trazodone to serzone for deeper sleep. With regard to the sexual dysfunction, I generally add 25 mg of serzone to an SSRI and work up by 25 to 50 mg every 5-7 days until it kicks in and that tends to not cause agitation. If 50 to 100 mg is added to begin with, there is almost always agitation, so i just don't do it that way anymore.
Serotonin syndrome is characterized by fever, abnormal muscle movements like twitches or jerking, increased reflexes, and (rarely) seizures. There may also by a fluctuation in blood pressure, anxiety, shivering, insomnia, confusion or delirium, shock and death. The treatment for this must be given in the hospital. I don't know where the protocol came from that recommended adding prozac to serzone and if it's from a reliable source, then perhaps it is OK. I just worry about adding prozac to other things since it is so long acting, but perhaps I have just developed a myth in my own mind about it. i await words of wisdom from Dr. Bob.
Posted by Michael Schell on January 3, 1999, at 12:55:41
In reply to Re: Prozac with Serzone. , posted by Toby on December 31, 1998, at 10:13:33
> Here's a crash course in Serzone.
> SSRI's block serotonin from being reabsorbed into the nerve cells, leaving it out in the synapses to stimulate all serotonin receptors. There are serotonin receptors all over the body; those in the brain, the gut, and the spinal cord are most pertinent to our discussion here. Serotonin stimulation in the dorsal raphe of the brain relieves depression, but serotonin stimulation in the forebrain may cause agitation or anxiety. Stimulation of serotonin receptors in the stomach may give nausea. Stimulation of serotonin receptors in the lower spinal cord lead to sexual dysfunction.
> Serzone is a weak serotonin reuptake inhibitor (like the SSRI's) but its most powerful action is to block a specific serotonin receptor called the 5HT2 receptor. The 5HT2 receptor is involved with the following side effects: agitation, anxiety, panic attacks, insomnia and sexual dysfunction. When you block this receptor you don't get those side effects. That's why it can reverse the side effects of the SSRI's that stimulate this receptor. Serzone is less sedating than trazodone (serzone's cousin) because it is a less potent histamine blocker than trazodone. It also causes less dizziness and less of a drop in blood pressure than trazodone can because it very little action on alpha receptors.
> People who have been on trazodone in the past for sleep with an SSRI usually don't need it with Serzone, but occasionally somebody needs to add a little dose of trazodone to serzone for deeper sleep. With regard to the sexual dysfunction, I generally add 25 mg of serzone to an SSRI and work up by 25 to 50 mg every 5-7 days until it kicks in and that tends to not cause agitation. If 50 to 100 mg is added to begin with, there is almost always agitation, so i just don't do it that way anymore.
> Serotonin syndrome is characterized by fever, abnormal muscle movements like twitches or jerking, increased reflexes, and (rarely) seizures. There may also by a fluctuation in blood pressure, anxiety, shivering, insomnia, confusion or delirium, shock and death. The treatment for this must be given in the hospital. I don't know where the protocol came from that recommended adding prozac to serzone and if it's from a reliable source, then perhaps it is OK. I just worry about adding prozac to other things since it is so long acting, but perhaps I have just developed a myth in my own mind about it. i await words of wisdom from Dr. Bob.
>Well Dr. Bob, I was wondering if you could give us your thoughts on this question that Toby asks. Also I was wondering if you could further answer some of the questions that I asked in a earlier post on this subject. Hope to hear from you real soon.
Posted by steve on January 3, 1999, at 22:51:00
In reply to Re: Prozac with Serzone. Calling Dr. Bob!!! , posted by Michael Schell on January 3, 1999, at 12:55:41
Thanks Tobey for the info. One thing though. Many doctors seem to condemn Prozac's long half-life. I was on Prozac for 4 1/2 years 9and will be going back on it) as well as other meds. To me the long half-life is a benifit because there is a more steady level of medication. For example, I am on Celexa right now, and I can feel the up's and downs of the medication, espcially if I miss a dose or two. On the other hand, when I was on Prozac I never felt this rapid cycling. I compare it in theory to Klonopin. I have been taking small amounts of Klonopin for years. Before that I took Xanax or Ativan. The problem being with those meds is that with their short half lifes you can feel (dramaticly) when they begin to leave the system. Klonopin, on the other hand, provides a less severe, gradual decrease of its metabolities and thus and more comfortable "let down". In short, I think the long half-lifes are beificial, not a handicapp. What do you think?
Posted by Toby on January 4, 1999, at 14:47:03
In reply to Re: Prozac with Serzone. , posted by steve on January 3, 1999, at 22:51:00
I agree that Prozac's long half is generally a positive aspect of the medication. There's no withdrawal syndrome and the blood level stays quite high even if you forget to take it for several days. It's only a problem if it gives bad side effects or doesn't work well enough and you have to switch to a different medication; then you have to have a "wash out" period to make sure the new medication doesn't interact with the Prozac and give the problems we discussed before.
Posted by curt on May 6, 1999, at 13:38:47
In reply to Re: Prozac with Serzone (Steve), posted by Toby on January 4, 1999, at 14:47:03
> I agree that Prozac's long half is generally a positive aspect of the medication. There's no withdrawal syndrome and the blood level stays quite high even if you forget to take it for several days. It's only a problem if it gives bad side effects or doesn't work well enough and you have to switch to a different medication; then you have to have a "wash out" period to make sure the new medication doesn't interact with the Prozac and give the problems we discussed before.
I missed both medications for 2 1/2 days. I doubled up the dosage on the serzone. What a mistake. I was flopping around uncontrolably in my bed for 6 hours.
Posted by Nick on May 9, 1999, at 12:55:20
In reply to Re: Prozac with Serzone (Steve), posted by curt on May 6, 1999, at 13:38:47
> Dear Michael & Steve
Are either of you on the combination presently - sorry if I'm being obtuse. The reason I ask is that sometimes the combination leads to the acumulation of a nefazadone metabolite mCPP, which can be extremely provoking of anxiety symptoms. I *think* this happens because of metabolic pathway inhibition by the prozac.Nick
Posted by Mark on May 10, 1999, at 5:06:50
In reply to Prozac with Serzone...Any thoughts???, posted by Michael Schell on December 21, 1998, at 12:00:35
It probably doesn't matter which you add first.
Serzone and trazodone (Desyrel) are very similar
and should THEORETICALLY help block the sexual
side effects and sleep side effects of
SSRI's. That said, there many ways that MIGHT
help minimize the side effects of SSRI's--they
each have varying effectiveness and some
drawbacks--very few have been systematically
studied. Some of the possibilities include:
lowering the dose of the SSRI, weekend holidays
off the SSRI, adding Buspar or Trazodone or
Serzone or Wellbutrin or Dexedrine or Remeron...
> I have recently read one article that claims combining Serzone with Prozac can eliminate the sexual side effects as well as agitation and insomnia. This article stated that you must first start with the Serzone (up to 200 mgs) then add in the Prozac (10mg to 40mg). Does anyone have any experience using these two drugs together (especially for OCD)? If I try this combo, what side effects should I be aware of? It seems like it would be similar to using Prozac, BuSpar and Trazadone together which I did O.K. on exept for the sexual side effects, agitation and headaches. Does anyone think this could be the magical combo I've been looking for or just another experiment that is a waste of time? Please respond with any info. or advice that you think may help me decide. Thanks very much in advance.
>
Posted by Mark on May 10, 1999, at 5:10:48
In reply to Re: Prozac with Serzone...Dr. Bob, Toby, etc. ???, posted by Michael Schell on December 29, 1998, at 9:25:52
Serzone has a metabolite called mCPP that, if
combined with a medication that inhibits it's
metabolism (i.e., Luvox (and maybe Prozac))
can increase anxiety. If you're starting with
Serzone first, then just add in Prozac slowly
and carefully and track your anxiety and
depressive symptoms---they should get better; if
they get worse, talk with your psychiatrist.> > I have recently read one article that claims combining Serzone with Prozac can eliminate the sexual side effects as well as agitation and insomnia. This article stated that you must first start with the Serzone (up to 200 mgs) then add in the Prozac (10mg to 40mg). Does anyone have any experience using these two drugs together (especially for OCD)? If I try this combo, what side effects should I be aware of? It seems like it would be similar to using Prozac, BuSpar and Trazadone together which I did O.K. on exept for the sexual side effects, agitation and headaches. Does anyone think this could be the magical combo I've been looking for or just another experiment that is a waste of time? Please respond with any info. or advice that you think may help me decide. Thanks very much in advance.
> >I think this is a pretty good question, and I've started the first part of this combo by getting started on the Serzone. Please respond back to let me know if there is any kind of negative reaction between these two drugs when used together and all other inquiries about this combo.
Posted by Mark on May 10, 1999, at 5:15:20
In reply to Re: Prozac with Serzone. More questions???, posted by Michael Schell on December 30, 1998, at 10:12:06
You shouldn't need Serzone AND trazodone (they are
more or less the same except for side effects).The issue with increased anxiety shouldn't be
any different adding one before the other---
just watch it carefully.Serotonin syndrome involves muscle cramps,
fever, sweating, low blood pressure---it is
dangerous though not common if a psychiatrist
is closely following you. You treat it
symptomatically in an emergency room.> > Prozac and Serzone are a useful combo and should do as well as anything for OCD. I think I have missed something, as I don't know why one would have to start with Serzone and then add Prozac specifically for sexual side effects. Are we talking about using Serzone for OCD and then if it's not completely effective, adding Prozac and hoping that the Serzone will counteract any sexual side effects Prozac may bring with it? That sounds reasonable. The only thing to keep in mind is that prozac is a very long acting medication and there is a potential to increase blood levels of serotonin too much, causing a nasty thing called Serotonin Syndrome which can cause seizures. Generally this occurs in "slow metabolizers" of particular medications and this is a genetic thing which you don't find out about until the reaction is already occurring. I'm babbling about this because the usual thing is to start with Prozac since it is long acting and then to add the shorter acting medication, Serzone or what have you, to it for augmentation. Dr. Bob or someone may have other thoughts.
> >Your right on the money in saying that I'm looking to treat OCD with Serzone and then adding in Prozac if it's not effective. Your also right about hoping that the Serzone will fight off the sexual side effects of Prozac. As for why it is said you should start with Serzone first and then add in Prozac is due to the belief that if you start Serzone with an SSRI in your system, you run the risk of having an extreme amount of anxiety for the first week or two. If you start the Serzone first and then add in the SSRI, the belief is that this anxiety problem wont happen. I've heard a lot about the serotonin syndrome, but I haven't heard how to treat it if you do get it. What are some ways to treat it? Also, Are there any long term effects of getting it? I also have read that Serzone has a built in mechanism for not letting the Serotonin Syndrome manifest itself. Is this not true when Prozac is added into the equation?
> >I hate to go on and on...but I really just want to get all the info. I can in finally finding a comb of drugs that work great in making me feel great without the numerous side effects. I have read some disconcerting info. on Serzone decreasing a persons' creativity and intelligence. Both these things were improved for me on Prozac. I really enjoyed being more creative, having a quicker wit and thinking more clearly on Prozac. I'm afraid I wont get this same result with Serzone, what are your thoughts? I had the problem of being fatigued and tired on Prozac, is this gonna be worse on Serzone? (especially if I end up combing it with Prozac) Will Serzone work like the Trazadone that I took with Prozac or will I still need to take Trazadone in addition to the Serzone and Prozac to fall asleep and sleep through the night? All the info you can give me would be greatly appreciated. I can't praise Dr. Bob enough for having the most helpful, most informative and for my money - "The best site on the Web." Thanks in advance for all responses!
Posted by Mark on May 10, 1999, at 5:19:05
In reply to Re: Prozac with Serzone. More questions???, posted by steve on December 31, 1998, at 2:02:21
The side effects of SSRI's are thought to be based
on serotonin, and perhaps specifically on
activation of the serotonin receptor subtype 2
and 3. Serzone and trazodone specifically
block the serotonin 2 receptor. Serzone
increases serotonin (like SSRI's) while
blocking the troublesome serotonin 2 receptor.
Somehow, blocking this receptor also seems
to have antidepressant efficacy.> How does this work? That is, how does Serzone counteract the side-effects of Prozac (especially sexual -- it seems to me that increases in seretonin- the neurotransmitter that is responsible for sedity, will also dimisnish libido).
Posted by Mark on May 10, 1999, at 5:22:45
In reply to Re: Prozac with Serzone. , posted by steve on January 3, 1999, at 22:51:00
Steve, you are describing the biggest benefit
of Prozac (this also cuts down on the
serotonin discontinuation syndrome).
The downside is that when you
want it out of your system--it can take many
weeks.> Thanks Tobey for the info. One thing though. Many doctors seem to condemn Prozac's long half-life. I was on Prozac for 4 1/2 years 9and will be going back on it) as well as other meds. To me the long half-life is a benifit because there is a more steady level of medication. For example, I am on Celexa right now, and I can feel the up's and downs of the medication, espcially if I miss a dose or two. On the other hand, when I was on Prozac I never felt this rapid cycling. I compare it in theory to Klonopin. I have been taking small amounts of Klonopin for years. Before that I took Xanax or Ativan. The problem being with those meds is that with their short half lifes you can feel (dramaticly) when they begin to leave the system. Klonopin, on the other hand, provides a less severe, gradual decrease of its metabolities and thus and more comfortable "let down". In short, I think the long half-lifes are beificial, not a handicapp. What do you think?
Posted by Mark on May 10, 1999, at 5:23:53
In reply to Re: Prozac with Serzone (Steve & Michael), posted by Nick on May 9, 1999, at 12:55:20
Nick, you are right and very wise (not obtuse!)
> > Dear Michael & Steve
> Are either of you on the combination presently - sorry if I'm being obtuse. The reason I ask is that sometimes the combination leads to the acumulation of a nefazadone metabolite mCPP, which can be extremely provoking of anxiety symptoms. I *think* this happens because of metabolic pathway inhibition by the prozac.
>
> Nick
Posted by Elizabeth on May 10, 1999, at 8:40:08
In reply to Re: Prozac with Serzone (Steve & Michael), posted by Nick on May 9, 1999, at 12:55:20
>The reason I ask is that sometimes the
>combination leads to the acumulation of a
>nefazadone metabolite mCPP, which can be
>extremely provoking of anxiety symptoms. I
>*think* this happens because of metabolic
>pathway inhibition by the prozac.Yeah, I do think that CYP2D6 is responsible for metabolism of mCPP.
Would sertraline, citalopram, or venlafaxine be safer choices to use with Serzone? And come to think of it, does this problem ever pop up with trazodone (commonly used with Prozac, Paxil, etc. for insomnia)?
This is the end of the thread.
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