![[dr. bob]](/dr-bob-sm.gif)
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 ben on August 4, 2002, at 2:31:51
Hi
I take 225 mg/d Effexor in the morning and have sleep problems (awakening several times during the night).
My pdoc added Desyrel (Trazodone) for some weeks now. The problem still exists and increasing the dose of
Desyrel gives me headache in the morning. Does anyone have experiences with adding Serzone to Effexor ? Serzone does not interfer with the REM sleep and has a longer half life than Desyrel. I cant take Remeron (knocked me out at a tiny dose) as well as the TCAs like Amitryptiline.
Posted by Fuscia on August 4, 2002, at 14:05:41
In reply to SERZONE - EFFEXOR COMBO - please help, posted by ben on August 4, 2002, at 2:31:51
How long have you been taking Effexor and when did the sleep problems begin? Did you recently increase Effexor dose? If so, reducing dosage should reduce the problem. Also, if you recently increased dosage, the insomnia side effect will wane most of the time. At higher doses, Effexor is more stimulating due to its higher affinity for norepinephrine. At lower doses, this effect isn't as strong since it mainly acts as a serotonin reuptake inhibitor.
If you still want to try the trazodone augmentation, try lowering the dose, instead of increasing it. I have taken trazodone to help with insomnia, while taking 50mg of Zoloft. At 50mg, trazodone made my nose so stuffy and mouth dry, that I couldn't sleep for two hours after taking it at bedtime, but after these effects passed I slept like a baby. I decided to lower dose to 25mg the next night, and it worked even better for I had less of a stuffy nose and still had the sedating effects. Eventually I tried 12.5 mg of trazodone and this worked best of all - no side effects and slept great.
I have read that adding VERY low dose of nefazodone (Serzone) to Effexor can be helpful to get a good night's sleep. Otherwise, be careful, as at higher doses Serzone can cause anxiety and insomnia.
You might consider a sublingual form of vitamin B12 - a lozenge that you allow to disolve under the tongue, taken at bedtime. It can greatly improve sleep. Calcium citrate, with added vitamin D is also very helpful for a good night's sleep. It can be taken on an empty stomach - take at bedtime. Remove caffeine from the diet, especially no caffeine after lunchtime.
Here is one poster's experience with combining Effexor and Serzone:
How psychiatry wrecked my life posted by rjk
http://www.dr-bob.org/babble/20020718/msgs/113521.html
Posted by ben on August 5, 2002, at 0:56:13
In reply to Re: SERZONE - EFFEXOR COMBO - please help, posted by Fuscia on August 4, 2002, at 14:05:41
> How long have you been taking Effexor and when did the sleep problems begin? Did you recently increase Effexor dose? If so, reducing dosage should reduce the problem. Also, if you recently increased dosage, the insomnia side effect will wane most of the time. At higher doses, Effexor is more stimulating due to its higher affinity for norepinephrine. At lower doses, this effect isn't as strong since it mainly acts as a serotonin reuptake inhibitor.
I d didnt change the dose since mor than a month.
>
> If you still want to try the trazodone augmentation, try lowering the dose, instead of increasing it. I have taken trazodone to help with insomnia, while taking 50mg of Zoloft. At 50mg, trazodone made my nose so stuffy and mouth dry, that I couldn't sleep for two hours after taking it at bedtime, but after these effects passed I slept like a baby. I decided to lower dose to 25mg the next night, and it worked even better for I had less of a stuffy nose and still had the sedating effects. Eventually I tried 12.5 mg of trazodone and this worked best of all - no side effects and slept great.I dont sleep with lower doses than 50 mg at night. Tried it several times.
>
> I have read that adding VERY low dose of nefazodone (Serzone) to Effexor can be helpful to get a good night's sleep. Otherwise, be careful, as at higher doses Serzone can cause anxiety and insomnia.Insomnia from Serzone ? I wonder why, but all is possible with ADs as I experienced.
>
> You might consider a sublingual form of vitamin B12 - a lozenge that you allow to disolve under the tongue, taken at bedtime. It can greatly improve sleep. Calcium citrate, with added vitamin D is also very helpful for a good night's sleep. It can be taken on an empty stomach - take at bedtime. Remove caffeine from the diet, especially no caffeine after lunchtime.What about Melatonine ?
Posted by Fuscia on August 5, 2002, at 12:38:09
In reply to Re: SERZONE - EFFEXOR COMBO - please help, posted by ben on August 5, 2002, at 0:56:13
Hi Ben,
"Insomnia from Serzone ? I wonder why, but all is possible with ADs as I experienced." The reason Serzone can cause insomnia, mainly at higher doses, is partly because of one of its metabolites, m-chlorophenylpiperazine (mCPP), which can have anxiety-producing effects. Trazodone also has this same metabolite. Serzone also has some affinity for alpha 1 adrenergic receptors which can cause anxiety and insomnia. Of the two closely related antidepressants; trazodone and nefazodone (Serzone), trazodone is more sedating and so the better choice for antidepressant-induced insomnia.
Melatonin can be a good choice, but for some it can actually cause anxiety and restlessness, so no sleep. Its a hormone substance, so be certain to start out at the lowest dose that helps, 1.5mg taken two hours or less before bedtime. If this is not effective, gradually increase the dosage until and effective level is reached (up to 5mg daily). This natural hormone should only be used occasionally, since there is still much unknown about long term use. It shouldn't be used by people with autoimmune diseases, and cancer. There is a sublingual (under the tongue)form available if you have malabsorption problems, as well as a timed-release form if you frequently awaken after several hours' sleep. If you experience grogginess and feel tired in the morning - reduce the dosage.
A very good choice to help with a good night's sleep is calcium citrate 500mg, with added vitamin D to aid in abosorption of calcium - taken at bedtime. On occasion I use an herbal mix product called Hops-Valerian (by Nature's Herbs, 4 capsules contain herbal blend of hops flowers and valerian root as well as skullcap, 400mg each. Recommended dosage is 4 capsules at bedtime, but I take 2.) It works great for me.
Posted by Noa on August 5, 2002, at 14:58:59
In reply to SERZONE - EFFEXOR COMBO - please help, posted by ben on August 4, 2002, at 2:31:51
I take both Serzone and Effexor--Effexor in the am and Serzone at night.
The combo works for me. The serzone was originally added when I needed more AD effect and the small dose of trazodone I took for sleep stopped working after a while.
At first, the ratio of Effexor to Serzone was large, but over time, we adjusted them so that I took less effexor (to avoid some of the unwanted effects I experience at higher doses) and more Serzone (to increase the AD effect and also to counteract more of the overactivating effects of the effexor). I have been on 262.5 Effexor and 500 Serzone for a long while now, and it is the best combo I've found--not perfect, of course--but the best of all the meds and med combos I've tried.
We are all different, though, so think carefully about and talk to your pdoc about your history with different meds and what serzone might or might not offer for you.
Good luck.
Posted by ben on August 12, 2002, at 12:11:19
In reply to Re: SERZONE - EFFEXOR COMBO - please help, posted by Noa on August 5, 2002, at 14:58:59
Thats interesting ! I think the Efexor helped me but seem to poop out. I wonder if I should go higher with Efexor but there is the sleep problem ?! I also take Neurontin 900 mg divided in 3 doses and Lithium. Another problem is fibromyalgia like pain. Effexor should be good for that but I feel no effect - even worser !?
> I take both Serzone and Effexor--Effexor in the am and Serzone at night.
>
> The combo works for me. The serzone was originally added when I needed more AD effect and the small dose of trazodone I took for sleep stopped working after a while.
>
> At first, the ratio of Effexor to Serzone was large, but over time, we adjusted them so that I took less effexor (to avoid some of the unwanted effects I experience at higher doses) and more Serzone (to increase the AD effect and also to counteract more of the overactivating effects of the effexor). I have been on 262.5 Effexor and 500 Serzone for a long while now, and it is the best combo I've found--not perfect, of course--but the best of all the meds and med combos I've tried.
>
> We are all different, though, so think carefully about and talk to your pdoc about your history with different meds and what serzone might or might not offer for you.
>
> Good luck.
Posted by ben on August 17, 2002, at 0:28:03
In reply to Re: SERZONE - EFFEXOR COMBO - please help » Noa, posted by ben on August 12, 2002, at 12:11:19
Whats the difference between these two beside the half life ? I have sleep probs (several awaking) and cant go over 100 mg Desyrel because I get headache in the morning ! Which one works better for fibro ?
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.