Posted by Sunnely on May 6, 2001, at 1:31:19
In reply to Serzone Sedation, posted by afatchic on May 5, 2001, at 18:31:15
Indeed, nefazodone (Serzone) is a sedating antidepressant. The recommended antidepressant dose of Serzone is between 300-600 mg/day. Unfortunately, the sedation from Serzone is dose-related, that is, increase in dose leads to increase sedation. A couple ways to deal with Serzone-, and other antidepressant-induced sedation, are:
1. Start the antidepressant drug at a lower dose and increase it slowly.
2. Take the bulk of the antidepressant dose at bedtime and less during daytime. (Note: Norman Sussman, MD from NY University, Department of Psychiatry, suggests that Serzone can be given as a once-a-day dosing at bedtime. One caution with this dosing is that, giving all the daily dose of Serzone as a single dose also increases the risk of a marked drop in blood pressure with accompanying dizziness (orthostatic hypotension) and could possibly lead to fall and head injury. If you and your doctor decide to dose it this way, it will be clinically prudent to slowly transition your morning dose with the evening dose, taking into account your ability to tolerate the transition.)
3. Add a stimulant to alleviate the antidepressant-induced daytime sedation. Modafinil (Provigil), a drug approved for narcolepsy, seems to be gaining popularity in this regard. The usual dose is between 100 to 200 mg/day in the morning (max of 400 mg). Caution, however, as there may be some drug-drug interactions between Serzone and Provigil. It appears that based on in vitro study, Provigil may induce the liver enzyme (CYP3A4), which Serzone depends on for metabolism. Theoretically, this may lower the blood level of nefazodone but probably clinically insignificant since Serzone is converted into 3 active metabolites, anyway. One caveat, however. One of Serzone's active metabolites called mCPP (meta-chlorophenylpiperazine) have anxiety-provoking effects hence, rapid conversion and excess amount of this compound may provoke anxiety episodes. Provigil has less abuse potential than the other psychostimulants.
4. Do nothing and let the side effect wears off (tolerance develops).
++++++++++++++++++++++++++++++++++
> Hello All, This is my first post in many months. I suffer from dysthimia (a chronic form of depression) and have been on ADs since 1989. Most of the time, I took Prozac and Trazodone, which are a wonderful combination for me except for the sexual side effects. I tried augmenting with Buspar for a few weeks and had zero results. Now I'm on Serzone. I've been taking it for about a month. I started at 75mg twice a day and am now up to 150mg twice daily. I barely have the energy to work and have started sleeping through my alarm and being late to work. I'm normally very punctual. Anyone have any advice? I've asked my doctor to reduce my dose and let me gradually increase the dose. So far she hasn't responded to my message (and no, I'm not one of those annoying patients who monopolizes a doc's time). Should I be considering augmenting with something more activating? Thanks for your responses
poster:Sunnely
thread:61723
URL: http://www.dr-bob.org/babble/20010424/msgs/61745.html