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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by beardedlady on April 1, 2002, at 6:15:43
Hi, Dr. Kramer:
My psychiatrist prescribed Serzone (after Ambien, Xanax, Zoloft/Xanax, Xanax/Trazodone failed), and I have been on it for three years. I now take a reduced dose of 250 mg. and will be reducing further on April 15th. (In emergencies, I take Sonata, too.) I am not depressed, but I developed a panic problem related solely to insomnia.
Right now, I sleep wonderfully (though I wake up groggy when I sleep more than eight hours). I started a Super B complex over one month ago, and I am feeling great. I have not needed a sleeping pill since I started the B vitamins! But I am worried about taking Serzone for much longer--the liver thing, you know. Some folks suggested I try SAM-e. My pdoc knows nothing about it but says it's okay to take with the Serzone.
Questions:
1.) Is it? (Okay with Serzone?)
2.) Should I wait until the day I reduce my Serzone dose to 200 mg.? (So I notice the Serzone less?)
3.) Will SAM-e, which is supposed to promote liver health, counteract the possible liver problem?
4.) Could you explain Serzone's black box, in layman's terms, so that I understand my risk (patient years is a tough one)?
5.) Will SAM-e cause problems if you discontinue use suddenly, like other anti-depressants?
6.) Know any good sleep disorder meds for someone who doesn't really have any big problems? (Sleep is really it for me, but if I don't get it, I panic the next night, and then I don't get it again. And then I get depressed.) I don't want sexual side effects or weight gain, of course.Phew. That's a lot. Thanks in advance.
bearded lady : )>
Posted by Dr. Kramer on April 1, 2002, at 9:20:40
In reply to Kramer: SAM-e and Serzone, posted by beardedlady on April 1, 2002, at 6:15:43
I'm a big SAMe fan, but I'd be nervous about it for you. SAMe can make folks pretty zippy, and since your big problem is insomnia, I'd advice against it. For completeness sake, Yes, as far as I know it's safe with Serzone, and it won't have any effect on Serzone's liver toxicity, plus or minus.
Serzone's liver problems, while more common than some other meds, are quite rare. Usually, people who are going to have problems get them when they are first exposed to the drug, not years after starting it. It's sort of like an allergic reaction. If you are doing well on it, I'd stay on it, and get your blood drawn every 6 months or so to see if your liver enzymes are normal. If they are, I wouldn't fix anything that works. Serzone is a good drug.
Posted by beardedlady on April 1, 2002, at 9:56:34
In reply to Re: Kramer: SAM-e and Serzone, posted by Dr. Kramer on April 1, 2002, at 9:20:40
Dr. Kramer:
Thanks! I like Serzone and am glad to be on it, though I would like to be cured by now. I guess I should say that the energy I get from the B vitamins makes me sleep like a rock at night. I have heard some others say that SAM-e has helped them use their energy better during the day so that they sleep soundly at night. I have also had low-grade blahs all my life--happy things not making me happy but for a moment, etc.
Do those zippy effects of SAM-e wear off in the evening? (I go to bed at 9:00 or 9:30 because I have a small child who wakes at 6:00.)
Will I be able to try it for a few days and then go off it if it's not right? I would so much rather be on a supplement than a med.
My thinking about all this is that I had been through a birth, then suffered three deaths, my husband's job loss, and a cold turkey nursing cessation all in 7 months, which led to the insomnia three and a half years ago. Maybe if I felt good, good, good during the day, I'd worry less about whether I was going to sleep--or anything else. And then I would sleep.
Thank you again; it's a pleasure to have you here.
beardy : )>
Posted by beardedlady on April 1, 2002, at 10:31:44
In reply to Re: Kramer: SAM-e and Serzone » Dr. Kramer, posted by beardedlady on April 1, 2002, at 9:56:34
I was only planning to take 200 mg. when I first wake up. (I am med sensitive, so that's all I would need, probably.)
beardy : )>
Posted by Dr. Kramer on April 1, 2002, at 20:37:46
In reply to Kramer--p.s., posted by beardedlady on April 1, 2002, at 10:31:44
I don't like to fix things that work. I stand by what I said.
Posted by dennison on April 2, 2002, at 11:14:18
In reply to Kramer: SAM-e and Serzone, posted by beardedlady on April 1, 2002, at 6:15:43
> Hi, Dr. Kramer:
>
> My psychiatrist prescribed Serzone (after Ambien, Xanax, Zoloft/Xanax, Xanax/Trazodone failed), and I have been on it for three years. I now take a reduced dose of 250 mg. and will be reducing further on April 15th. (In emergencies, I take Sonata, too.) I am not depressed, but I developed a panic problem related solely to insomnia.
>
> Right now, I sleep wonderfully (though I wake up groggy when I sleep more than eight hours). I started a Super B complex over one month ago, and I am feeling great. I have not needed a sleeping pill since I started the B vitamins! But I am worried about taking Serzone for much longer--the liver thing, you know. Some folks suggested I try SAM-e. My pdoc knows nothing about it but says it's okay to take with the Serzone.
>
> Questions:
>
> 1.) Is it? (Okay with Serzone?)
> 2.) Should I wait until the day I reduce my Serzone dose to 200 mg.? (So I notice the Serzone less?)
> 3.) Will SAM-e, which is supposed to promote liver health, counteract the possible liver problem?
> 4.) Could you explain Serzone's black box, in layman's terms, so that I understand my risk (patient years is a tough one)?
> 5.) Will SAM-e cause problems if you discontinue use suddenly, like other anti-depressants?
> 6.) Know any good sleep disorder meds for someone who doesn't really have any big problems? (Sleep is really it for me, but if I don't get it, I panic the next night, and then I don't get it again. And then I get depressed.) I don't want sexual side effects or weight gain, of course.
>
> Phew. That's a lot. Thanks in advance.
>
> bearded lady : )>Hi BeardedLady --Actually Sam-e-- " s-adenosyl-L-methionine " - Which produces it's effect through methylation. Sam-e is a "methyl" (((ch3))) group donor. Sam-e is an endogenous "intrinsic" compound in your body, your body produces it naturally so essentially you are augmenting the natural reserve pool that is formed in the body, but having additional, sam-e " which is biologically active" , whereas the body must produce it through combining the amino acid "methionine" & " that always important energy molecule "adenosine triphosphate-atp" , thus the name - s-adenosyl-L-methionine-- ""SAM-e".......................................................................Ok here's the correlation with your serzone liver toxicity issue-- . Sam-e has been shown to improve "glutathione" levels in liver . Glutathione is one of two primary antioxidant and """"""""""""""""Detoxifying""""""""""""""""""""""" enzymes produced by the liver. Many many liver toxicities occur as glutathione reserves are exceeded in the liver, or somehow diminished, after it is no longer avaliable- drugs, toxic chemicals "poisions essentially" are no longer detoxified but allowed to build to excessive levels. Although sam-e effects on liver obviously aren't what are looked for to help depression, sam-e is a so called ""ubiquitous"" substance-meaning it's functions are extremely diverse and has significant effects on many body functions--""one being--helping to prevent liver toxicity"" ............................................................................................................Btw in depression sam-e "putative " --meaning supposed modality is #1 aiding transmethylation rxn's essential for proper membrane formulation -"hence proper permeabilty" of the proper lipid soluble substrates as well as basic membrane function--which forms core of all nervous system activity--""ions"" electrochemical gradients - and ability to polarize and of course "depolarize" -which causes the action potential--(((((nerve fires))))) transmitts impulse. .............................................................................................................#2 - neurotrasmitters and sam-e - synthesis of which requires methyl group in active avaliable form -- #3 That crazy enzyme "comt" catechol -O-methyltransferase-which requires S-adenosyl-methionine to donate a methyl group to function. ""COMT"" is essential for maintaining proper synaptic levels of dopamine-norepinephine -epinephrine ""the 3 catecholamines"" #4 Sam-e is essential for conversion of phosphatidyl ethanolamine into phosphatidyl choline --an extremely important important compound for proper nervous system function "acetylcholine" etc and essential membrane lipids as stated before!!
Posted by Ron Hill on April 2, 2002, at 13:39:05
In reply to Re: Kramer: SAM-e and Serzone, posted by Dr. Kramer on April 1, 2002, at 9:20:40
> I'm a big SAMe fan, but I'd be nervous about it for you. SAMe can make folks pretty zippy, and since your big problem is insomnia, I'd advice against it. For completeness sake, Yes, as far as I know it's safe with Serzone, and it won't have any effect on Serzone's liver toxicity, plus or minus.
-------------------------Dr. Kramer;
First and foremost, a special thanks to you for donating your time to us at pbabble for a week. I hope we don't wear you out. Thank you!
I'm happy to hear that you are a SAM-e fan. Me too! But, I respectfully disagree with your advice to Beardy. First, however, here is the Reader's Digest version of my experience with SAM-e.
I'm Bipolar II. Lithobid adequately controls my hypomania but does nothing for my depression. Any of the SSRI's will take away my "I want to die" mood but leave me with anergic and anhedoniaic side effects (loss of ambition, loss of energy, lack of motivation, blunted emotions, loss of pleasure in life, etc). I attribute these symptoms to low dopamine transport. For six years I went from one failed AD med trial to the next without finding a solution for the depressive phase of my BPII disorder. In the process, the AD meds (and an inept pdoc) destroyed my life (lost my engineering career, went through bankruptcy, etc).
Roughly five months ago, my current pdoc suggested that I try SAM-e (added to my existing 600 mg/day Lithobid). For me personally, SAM-e is a lifesaver! The bottom line is that 200 mg/day of SAM-e has helped me more than any of the many ADs I've tried over the years. So far I have five months of excellent results and absolutely no hint of poop out. SAM-e is, of course, not the answer to every psychiatric disorder under the sun, but it sure gave me back my life!
My observation (not a scientific study) is that SAM-e seems to be of particular value to depressive (especially bipolar depressive) patients that are initially hypersensitive to AD's (favorable response in a matter of days to very low dosage), but soon thereafter, suffer anergy (low drive, low energy, etc.) and anhedonia (inability to fully experience pleasure, blunted emotions, etc.). It is my layman's opinion that, over time, AD's (SSRI's in particular) lower dopamine levels and/or impede DA transmission in some (most?) patients and this, in turn, causes the aforementioned symptoms. I think SAM-e is particularly useful in treating anergy and anhedonia, and that it does so by increasing the amount of DA produced by the body. Further, I (layman) hypothesize that one reason SAM-e works so well is that it increases both serotonin and dopamine in a very balanced synergistic kind of way. IMHO, it is very important for patients to take plenty of B-6, B-12 (sublingual bioactive form), and folate with the SAM-e to prevent the build up of homocystiene.
Okay, now on to Beardy's situation. Dr. Kramer, will you please click on the link below and read the response I wrote to Beardy this morning regarding this topic. Then please post your comments, as you see fit, to this post as well as the linked post.
Once again, thank you VERY much for investing some of your valuable time in the lives of us in pbabbleland!
http://www.dr-bob.org/babble/20020402/msgs/101456.html-- Ron
Posted by beardedlady on April 2, 2002, at 13:41:47
In reply to Re: Kramer: SAM-e and Serzone » beardedlady, posted by dennison on April 2, 2002, at 11:14:18
Dennison:
Thanks for your reply, but I have no idea what you were trying to say! What's important to me is that I get in my car, turn the ignition on, and go. I don't have to know HOW the car works. A lot of posters are into knowing about enzymes and neurotransmitters and all that stuff. It would take me a lifetime to learn all that.
It would be great if you could address my questions. But could you keep it simple for me?
Thanks.
b-more beardy : )>>
YEA TERPS!
Posted by beardedlady on April 2, 2002, at 14:02:23
In reply to Re: Kramer: SAM-e and Serzone » Dr. Kramer, posted by Ron Hill on April 2, 2002, at 13:39:05
I'm not sure he'll know to read your post, but maybe. Thanks, Ron. You're sweet.
b-more beardy : )>>
WAY TO GO, TERPS!
Posted by Dr. Kramer on April 2, 2002, at 19:38:40
In reply to Re: Kramer: SAM-e and Serzone » Dr. Kramer, posted by Ron Hill on April 2, 2002, at 13:39:05
Facinating. I stand by what I said earlier, but I'm grateful for your imput and thoughts. This is a remarkable place, this board. Exhausting, but remarkable! You have taught me a great deal.
Posted by Elroy on February 6, 2005, at 10:22:54
In reply to Re: Kramer: SAM-e and Serzone, posted by Dr. Kramer on April 2, 2002, at 19:38:40
http://www.remedyfind.com/rem.asp?id=120
Serzone etc. (Nefazodone)
May 19, 2004. Bristol-Myers Squibb said it would no longer make or sell its antidepressant Serzone, which has been linked to life-threatening liver problems. A company spokesman said the brand name drug, earlier withdrawn in major markets such as Europe and Canada, was being discontinued worldwide as of June 14, 2004.
> Facinating. I stand by what I said earlier, but I'm grateful for your imput and thoughts. This is a remarkable place, this board. Exhausting, but remarkable! You have taught me a great deal.
Posted by ravenstorm on February 6, 2005, at 23:03:49
In reply to Re: Serzone, posted by Elroy on February 6, 2005, at 10:22:54
This is the end of the thread.
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