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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Lynn on April 25, 2000, at 16:56:53
Hi, I'm new to this board. You all sound VERY knowledgable about antidepressant meds and switching and or using some in combination. I've been treated for depression with anxiety for the past four years with Zoloft(100mg) and a small amount of Doxepin(10)mg with moderate success. Recently it appeared to be less effective, and I found myself crying again. My Dr. wanted me to try Effexor, but I had heard its pretty activating (nervousnes/insomnia) and read horror stories about withdrawl should I ever need to get off it. I was put on Remeron instead, at a higher dose to combat sedation. I tried it for two weeks, but couldn't believe how stoned it makes you feel at first. It also caused a wierd "rush" feeling which caused an anxiety attack. So, I ended up going on St. John's Wort for a few weeks, but wasn't able to sleep and my Dr. said I couldn't mix anything with it as far as antidepressants to address the sleep problem.
So, after a month of this, I went back to the Zoloft/Doxepin. I don't have much faith in this combination since it stopped working and I'm not even sure if starting it again after a month will work now or not. I am thinking of giving Serzone a try. I get really bad PMS though and don't need the "anger" symptoms that I've read about. Any advice would be very appreciated. Thanks and peace to all. Lynn
Posted by Lucy on April 25, 2000, at 17:44:08
In reply to Input requested on Serzone, posted by Lynn on April 25, 2000, at 16:56:53
Hello-
I have been on Serzone for almost three years and have not experienced any "anger" problems. It's been very effective for me treating both my anxiety and depression. I had headaches and nausea for the first three weeks, but then it was smooth sailing. I do have problems with fatigue, however, and will probably reduce my dosage (400 mg/day). I have been really happy with the results treating my anxiety.Good luck!
> Hi, I'm new to this board. You all sound VERY knowledgable about antidepressant meds and switching and or using some in combination. I've been treated for depression with anxiety for the past four years with Zoloft(100mg) and a small amount of Doxepin(10)mg with moderate success. Recently it appeared to be less effective, and I found myself crying again. My Dr. wanted me to try Effexor, but I had heard its pretty activating (nervousnes/insomnia) and read horror stories about withdrawl should I ever need to get off it. I was put on Remeron instead, at a higher dose to combat sedation. I tried it for two weeks, but couldn't believe how stoned it makes you feel at first. It also caused a wierd "rush" feeling which caused an anxiety attack. So, I ended up going on St. John's Wort for a few weeks, but wasn't able to sleep and my Dr. said I couldn't mix anything with it as far as antidepressants to address the sleep problem.
> So, after a month of this, I went back to the Zoloft/Doxepin. I don't have much faith in this combination since it stopped working and I'm not even sure if starting it again after a month will work now or not. I am thinking of giving Serzone a try. I get really bad PMS though and don't need the "anger" symptoms that I've read about. Any advice would be very appreciated. Thanks and peace to all. Lynn
Posted by Racer on April 25, 2000, at 20:42:06
In reply to Input requested on Serzone, posted by Lynn on April 25, 2000, at 16:56:53
I tried Serzone for about four months. It was awful for me, lowered my blood pressure terribly, nauseated me so much I couldn't keep food down, rekindled anorexia, hightened my anxiety, and made me so wobbly that I could hardly walk. It also made it more difficult for me to sleep or wake up.
That's just me, and I do have very low blood pressure to begin with and a typically indiosyncratic metabolism.
I take a combination of Effexor XR and Prozac now, which works pretty well for me. Let's see: first week I almost didn't sleep at all, but was calm and relaxed and more rested after a totally sleepless night on Effexor than I had been after a full night's sleep on Serzone. Everyone reacts differently, so don't let someone else's reaction stop you from trying unless there's something empirically significant to stand in the way. An example of what I mean is don't take a drug that lowers blood pressure if your normal BP is 90/60. Don't take a drug that causes lack of appetite or weight loss if you've a history of anorexia. Otherwise, talk to your doctor and keep an open mind.
The Effexor hasn't been particularly activating for me, though I tend towards insomnia anyway. I do have to take it first thing in the morning, and I try very hard to keep fairly regular hours, so that I can habituate myself to sleeping well. I feel healthy and 'normal'. None of the artificial feeling I had on Paxil, none of the semi-OK of tricyclics, none of the emotional constipation of SSRIs. Just normal. I got upset and sulky when my car was broken into last week, but put it in perspective. (Yeah, they broke in, they damaged my car, they took stuff, but they didn't take my saddle, my chaps, etc. The car's insured, the insurance company will make it as easy as possible for me - that's what they're paid for. You know -- a normal reaction!) I love this feeling, that I can react to a really rotten day by being normally cranky, rather than thinking the world will end or being numb.
Good luck on finding what works this well for you!
Posted by Cindy W on April 25, 2000, at 21:47:31
In reply to Re: Input requested on Serzone, posted by Racer on April 25, 2000, at 20:42:06
> I tried Serzone for about four months. It was awful for me, lowered my blood pressure terribly, nauseated me so much I couldn't keep food down, rekindled anorexia, hightened my anxiety, and made me so wobbly that I could hardly walk. It also made it more difficult for me to sleep or wake up.
>
> That's just me, and I do have very low blood pressure to begin with and a typically indiosyncratic metabolism.
>
> I take a combination of Effexor XR and Prozac now, which works pretty well for me. Let's see: first week I almost didn't sleep at all, but was calm and relaxed and more rested after a totally sleepless night on Effexor than I had been after a full night's sleep on Serzone. Everyone reacts differently, so don't let someone else's reaction stop you from trying unless there's something empirically significant to stand in the way. An example of what I mean is don't take a drug that lowers blood pressure if your normal BP is 90/60. Don't take a drug that causes lack of appetite or weight loss if you've a history of anorexia. Otherwise, talk to your doctor and keep an open mind.
>
> The Effexor hasn't been particularly activating for me, though I tend towards insomnia anyway. I do have to take it first thing in the morning, and I try very hard to keep fairly regular hours, so that I can habituate myself to sleeping well. I feel healthy and 'normal'. None of the artificial feeling I had on Paxil, none of the semi-OK of tricyclics, none of the emotional constipation of SSRIs. Just normal. I got upset and sulky when my car was broken into last week, but put it in perspective. (Yeah, they broke in, they damaged my car, they took stuff, but they didn't take my saddle, my chaps, etc. The car's insured, the insurance company will make it as easy as possible for me - that's what they're paid for. You know -- a normal reaction!) I love this feeling, that I can react to a really rotten day by being normally cranky, rather than thinking the world will end or being numb.
>
> Good luck on finding what works this well for you!Lynn, I took Serzone for a few months and really liked its effects. I felt much less depressed and much less socially anxious. I had some problems the first couple of weeks, but they went away (mood instability and anger, dizziness, etc.). My problem now (am on Effexor 375 mg/day) is that since I raised the dosage (I have OCD and it takes a larger dose to help with that), I have real trouble sleeping. I have trouble falling asleep and staying asleep. Does anybody have any suggestions for something to combine with Effexor-XR to improve sleep (not benzos, but another AD?). In the past, I tried a small dose of Serzone, and that seemed to help. Will talk about any suggestions people have, with my pdoc on Moday. Thanks!!!
Posted by medlib on April 26, 2000, at 11:39:11
In reply to Re: Serzone Effexor-XR and sleep problems, posted by Cindy W on April 25, 2000, at 21:47:31
... My problem now (am on Effexor 375 mg/day) is that since I raised the dosage (I have OCD and it takes a larger dose to help with that), I have real trouble sleeping. I have trouble falling asleep and staying asleep. Does anybody have any suggestions for something to combine with Effexor-XR to improve sleep (not benzos, but another AD?). In the past, I tried a small dose of Serzone, and that seemed to help. Will talk about any suggestions people have, with my pdoc on Moday. Thanks!!!
**************************
Cindy--Have you tried low-dose Remeron (mirtazipine) with your Effexor? It's taken at night for its sedating effects, but it also has AD properties. Many pdocs (including mine) speak very highly about the effectiveness of this combination. If you're unfamiliar with the drug, check out Dr. Bob's Tips section.
I'm on 300mg. Effexor XR and take Ambien 10mg. (an hypnotic--true sleeping pill, not benzo) for sleep problems. It wears off in 4 hours, tho, and isn't, like most hypnotics, really intended for long-term use. I'm considering Remeron instead, but am a little leary of its reputation for weight gain; hopefully, that's less of a problem at low doses. I'll probably ask for it at my pdoc appt. next week. If you decide to try it, will you please let us know your experience with it?
Best wishes--medlib
Posted by Racer on April 26, 2000, at 15:01:47
In reply to Re: Serzone Effexor-XR and sleep problems, posted by Cindy W on April 25, 2000, at 21:47:31
I take Periactin (cyproheptidine) to counteract anorgasmia and sleep trouble. It's an antihistimine, and it works.
As with any other antihistimine, you can wake up kinda groggy, so take it earlier rather than later.
Posted by JohnL on April 27, 2000, at 4:56:06
In reply to Input requested on Serzone, posted by Lynn on April 25, 2000, at 16:56:53
> Hi, I'm new to this board. You all sound VERY knowledgable about antidepressant meds and switching and or using some in combination. I've been treated for depression with anxiety for the past four years with Zoloft(100mg) and a small amount of Doxepin(10)mg with moderate success. Recently it appeared to be less effective, and I found myself crying again. My Dr. wanted me to try Effexor, but I had heard its pretty activating (nervousnes/insomnia) and read horror stories about withdrawl should I ever need to get off it. I was put on Remeron instead, at a higher dose to combat sedation. I tried it for two weeks, but couldn't believe how stoned it makes you feel at first. It also caused a wierd "rush" feeling which caused an anxiety attack. So, I ended up going on St. John's Wort for a few weeks, but wasn't able to sleep and my Dr. said I couldn't mix anything with it as far as antidepressants to address the sleep problem.
> So, after a month of this, I went back to the Zoloft/Doxepin. I don't have much faith in this combination since it stopped working and I'm not even sure if starting it again after a month will work now or not. I am thinking of giving Serzone a try. I get really bad PMS though and don't need the "anger" symptoms that I've read about. Any advice would be very appreciated. Thanks and peace to all. LynnLynn,
I know one doctor who is actually having good success with Serzone in his patients. But he claims the success is due to his dosing strategy. He starts patients at 50mg a day, and then increases dose by 25mg to 50mg no faster than every four days. But he tries to keep dose increases in small steps spaced a week apart. This is considerably more conservative than the instructions in literature. But for some reason, the doc claims this low and slow approach works. I takes a few weeks longer to get to the higher doses, but the end result may be worth the patience.
To diminish side effects, he doses Serzone only once a day (usually late afternoon, early evening) up to 300mg. Controlled studies have shown once daily dosing is not significantly different from multiple dosing in desired results. He claims the low and slow approach goes a long way to diminishing side effects as well. Any amount over 300mg is taken in a second dose, at whatever time of the day works best for the patient.
I've also read sporadic accounts of a narrow therapeutic window with Serzone. The low and slow method allows us to find that window without blowing right past it.
This is the end of the thread.
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