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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Roslynn on April 10, 2023, at 14:10:13
Dear Scott,
I hope your remission is going well :)
I just had a question regarding Serzone. I am hearing more about it lately. Did you ever try it?
Also, do you happen to know if you can take Serzone together with Effexor? Or can you taper Effexor while starting up Serzone?
Thank you for any help!
Roslynn
Posted by SLS on April 10, 2023, at 21:09:03
In reply to To SLS, posted by Roslynn on April 10, 2023, at 14:10:13
> Dear Scott,
>
> I hope your remission is going well :)Thanks, Roslynn. It is going very well. I wish I could share it.
> I just had a question regarding Serzone. I am hearing more about it lately.
What sorts of things have you heard?
>Did you ever try it?For some reason, it never made my list of things to try. I don't think it ever occurred to me - which would be weird. I'm sure that I never rejected it as a potential cure.
> Also, do you happen to know if you can take Serzone together with Effexor?Theoretically, taking two drugs that increase serotonin neurotransmission - even if they have different mechanisms - have the potential to cause Serotonin Syndrome. However, this reaction is now considered relatively rare. If you do try to combine these drugs, you should make yourself familiar with the reaction.
This is a good resource:
https://www.drugs.com/interaction/list/?drug_list=1477-0,1549-0
> Or can you taper Effexor while starting up Serzone?
I doubt doing that would reduce any risks.
> Thank you for any help!
Roslynn, I am very happy to see you moving forward again. I sent you two Babble-Mail letters. When I didn't hear from you, I was concerned. You sound really good today! (Everything is relative, of course).Along my journey, I often said, "At any moment in time, I am using all of what little God gave me to work with." It seems to me that you do, too. Hopelessness is a normal human reaction to what you have been asked to suffer through. Fortunately, it comes and goes.
- Scott
Posted by undopaminergic on April 11, 2023, at 10:34:33
In reply to Re: To SLS » Roslynn, posted by SLS on April 10, 2023, at 21:09:03
>
> Theoretically, taking two drugs that increase serotonin neurotransmission - even if they have different mechanisms - have the potential to cause Serotonin Syndrome.
>Not "even", but "especially", because of the potential for synergistic effects, as in the case of MAOI+SSRI. SSRI+SSRI would be merely additive, and moreover, there is a peak of 100% reuptake inhibition which is insufficient to cause life-threatening serotonin toxicity. Venlafaxine (Effexor), however, seems to be more potent in elevating serotonin according to Gillman; he speculates that it may have serotonin-releasing properties.
> > Or can you taper Effexor while starting up Serzone?
>
> I doubt doing that would reduce any risks.Tapering would allow you time to notice early signs of serotonin toxicity, so that you can stop tapering, and if necessary, reduce the dose.
-undopaminergic
Posted by Roslynn on April 11, 2023, at 14:43:31
In reply to Re: To SLS » Roslynn, posted by SLS on April 10, 2023, at 21:09:03
> > I just had a question regarding Serzone. I am hearing more about it lately.
>
>
What sorts of things have you heard?It seems like more people are taking it now? I'm not sure how it got on my radar.
>
>
> Theoretically, taking two drugs that increase serotonin neurotransmission - even if they have different mechanisms - have the potential to cause Serotonin Syndrome. However, this reaction is now considered relatively rare. If you do try to combine these drugs, you should make yourself familiar with the reaction.
>
> This is a good resource:
>
> https://www.drugs.com/interaction/list/?drug_list=1477-0,1549-0.
Thank you very much.
> > Or can you taper Effexor while starting up Serzone?
>I doubt doing that would reduce any risks.
>But effexor plus serzone is one of Stahl's heroic combos, right?
> Roslynn, I am very happy to see you moving forward again. I sent you two Babble-Mail letters. When I didn't hear from you, I was concerned. You sound really good today! (Everything is relative, of course).I never got them! I wonder what happened to them?
> Along my journey, I often said, "At any moment in time, I am using all of what little God gave me to work with." It seems to me that you do, too. Hopelessness is a normal human reaction to what you have been asked to suffer through. Fortunately, it comes and goes.
>
>
> - ScottThank you for your kind words of support.
Roslynn
Posted by Roslynn on April 11, 2023, at 14:50:02
In reply to Re: To SLS » SLS, posted by undopaminergic on April 11, 2023, at 10:34:33
> >
> > Theoretically, taking two drugs that increase serotonin neurotransmission - even if they have different mechanisms - have the potential to cause Serotonin Syndrome.
> >
>
> Not "even", but "especially", because of the potential for synergistic effects, as in the case of MAOI+SSRI. SSRI+SSRI would be merely additive, and moreover, there is a peak of 100% reuptake inhibition which is insufficient to cause life-threatening serotonin toxicity. Venlafaxine (Effexor), however, seems to be more potent in elevating serotonin according to Gillman; he speculates that it may have serotonin-releasing properties.
>
> > > Or can you taper Effexor while starting up Serzone?
> >
> > I doubt doing that would reduce any risks.
>
> Tapering would allow you time to notice early signs of serotonin toxicity, so that you can stop tapering, and if necessary, reduce the dose.
>
> -undopaminergic
>Thank you for the information.I though Effexor+Serzone was one of Stahl's heroic combos?
Posted by SLS on April 11, 2023, at 21:17:41
In reply to Re: To SLS, posted by Roslynn on April 11, 2023, at 14:43:31
Hi Roseylyn
Undopaminergic is really sharp - sharper than me.
> But effexor plus serzone is one of Stahl's heroic combos, right?
It's been a long time, but I think Stahl recommended combining Effexor with Remeron (mirtazapine). I first saw it in the medical literature in 2000, but the literature was a few years older. There was a lot enthusiasm at first. However, it never really took root. I'm not exactly sure why, but perhaps this article will explain things:https://www.thecarlatreport.com/articles/2996-mirtazapine-augmentation-running-low-on-rocket-fuel
I might look for some literature about combining a tricyclic with mirtazapine. Together, they should increase norepinephrine neurotransmission through two different mechanisms. I don't recall seeing anyone take it.
I'd be interested to know what Undopaminergic thinks of this.
- Scott
Posted by SLS on April 11, 2023, at 21:38:00
In reply to Re: To SLS » SLS, posted by undopaminergic on April 11, 2023, at 10:34:33
UD,
Sometime in the mid 1990s, I was taking Parnate, and probably desipramine as well. I had already tried venlafaxine without success, so I had some pills floating around. Desperation got the better of me, and I couldn't help but to want to try a serotonergic antidepressant in combination with a MAOI. I spoke to my doctor about doing that, but he didn't want to take a chance. I decided to try it anyway. So, I nibbled off a tiny piece of venlafaxine and swallowed it. 10 mg maybe? Within an 30 minutes, I was lying in bed, unable to move and incoherent. When my parents came in to check on me, I was jabbering away. I was delirious and barely knew where I was. I just remember seeing the ceiling. However, I knew what was happening. I asked my mother to get a thermometer and take my temperature. It was normal. I told them not to worry. I just needed to reboot myself.
I chose Effexor because it had a relatively short half-life - just in case.
- Scott
Posted by undopaminergic on April 12, 2023, at 7:49:13
In reply to Re: To SLS, posted by SLS on April 11, 2023, at 21:17:41
Hi SLS and Roslynn.
>
> Undopaminergic is really sharp - sharper than me.Thank you for the praise!
>
> > But effexor plus serzone is one of Stahl's heroic combos, right?
>
>
> It's been a long time, but I think Stahl recommended combining Effexor with Remeron (mirtazapine). I first saw it in the medical literature in 2000, but the literature was a few years older. There was a lot enthusiasm at first. However, it never really took root. I'm not exactly sure why, but perhaps this article will explain things:
>
> https://www.thecarlatreport.com/articles/2996-mirtazapine-augmentation-running-low-on-rocket-fuel
>I'm not familiar with Stahl's heroic combos, but I do know that the name heroin was a reference to heroism.
> I might look for some literature about combining a tricyclic with mirtazapine. Together, they should increase norepinephrine neurotransmission through two different mechanisms. I don't recall seeing anyone take it.
>
> I'd be interested to know what Undopaminergic thinks of this.If you benefit from more noradrenaline (-epinephrine), or want to test whether you do, it is indeed an interesting combination. It's probably not good for your cardiovascular system though. Also, the antihistamine effects of mirtazapine may dampen the "stimulant-like" noradrenergic effects. Yohimbine would be a more selective alternative to mirtazapine. On the other hand, the serotonin 5-HT2A antagonism of mirtazapine may be a positive aspect.
-undopaminergic
Posted by Roslynn on April 12, 2023, at 12:26:38
In reply to Re: To SLS, posted by SLS on April 11, 2023, at 21:17:41
Posted by SLS on April 12, 2023, at 14:54:52
In reply to Re: To SLS, posted by undopaminergic on April 12, 2023, at 7:49:13
Hi.
I was thinking seriously about adding yohimbine to a tricyclic as early as 1983. That's when I first started pouring over the literature in the Rutgers medical school library. Doctors were not comfortable with the idea. In 1992, I had a consultation with Andrew Nierenberg at Harvard / Mass General. He included a TCA / yohimbine combination among his recommendations. I was very impressed. He is genuinely concerned for the welfare of suffering individuals. I found him to be very friendly.
- Scott
Posted by Jay2112 on April 14, 2023, at 16:03:50
In reply to Re: To SLS » undopaminergic, posted by Roslynn on April 11, 2023, at 14:50:02
Hi Roslynn,
Serzone + Effexor WAS the perfect combination for me, until Serzone got pulled from the market here in Canada. (Generic nefazodone did as well..a stupid move, since a simple blood test could determine any liver problems.)
If you have access to Serzone/nefazodone, I would HIGHLY recommend giving it a shot!
Best,
Jay
Posted by SLS on April 14, 2023, at 17:22:07
In reply to Re: To SLS » Roslynn, posted by Jay2112 on April 14, 2023, at 16:03:50
> Hi Roslynn,
>
> Serzone + Effexor WAS the perfect combination for me, until Serzone got pulled from the market here in Canada. (Generic nefazodone did as well..a stupid move, since a simple blood test could determine any liver problems.)
>
> If you have access to Serzone/nefazodone, I would HIGHLY recommend giving it a shot!
>
> Best,
> Jay
Hi, Jay.It was to prevent law suits, I guess. It would make sense from a business perspective to discontinue such a problematic drug for which there is little demand.
I recall a few babblers for whom nefazodone was the only drug that improved their depression. One person who did so also had problems with thyroid function. I don't know if there is any association.
- Scott
Posted by Jay2112 on April 15, 2023, at 18:22:33
In reply to Re: To SLS » Jay2112, posted by SLS on April 14, 2023, at 17:22:07
Hi Scott,
Nefadozone is HUGE in the autism community. It's 5ht2a blockage brings about very little side-effect wise, and it works wonders in combination with other drugs. I've been trying to find a way to get my pdoc to import it into Canada. And it is a major anxiolytic, and doesn't have the risk antipsychotics present.
Best,
Jay> > Hi Roslynn,
> >
> > Serzone + Effexor WAS the perfect combination for me, until Serzone got pulled from the market here in Canada. (Generic nefazodone did as well..a stupid move, since a simple blood test could determine any liver problems.)
> >
> > If you have access to Serzone/nefazodone, I would HIGHLY recommend giving it a shot!
> >
> > Best,
> > Jay
>
>
> Hi, Jay.
>
> It was to prevent law suits, I guess. It would make sense from a business perspective to discontinue such a problematic drug for which there is little demand.
>
> I recall a few babblers for whom nefazodone was the only drug that improved their depression. One person who did so also had problems with thyroid function. I don't know if there is any association.
>
>
> - Scott
>
>
Posted by SLS on April 19, 2023, at 11:03:08
In reply to Re: To SLS, posted by undopaminergic on April 12, 2023, at 7:49:13
Hi, UD.
The following URL post was not addressed to you, but I hope it offers you reinforcement of my message. You and Rosalynn are probably the last people standing. I don't care. If people think I have no appreciation for what they have been through, the last four decades of MY life indicate otherwise. I was hoping to take some people along with me by having them reevaluate the behaviors that will ABSOLUTELY cause them to remain depressed, and might very well go to their graves without having lived without depression for decades. If people thought I returned just to criticize them, they would be right if I were judged by my more recent words. Nice didn't work.
The best hope for those who are now gone lies in the novel treatments that will become available in the future. Some of them - maybe all of them - will be worth considering. I'm disappointed that zuranolone has taken so long to be approved by the FDA. However, it is scheduled to be so by late 2023. It is a member of a sequence of synthesized substances that acts as a positive positive allosteric modulator of GABA-A receptors. Believe it or not, the DEA has to sign off on zuranolone. I guess they want to make sure it doesn't have abuse potential like a benzodiazepine do have. Both drugs are positive modulators GABA-A receptors, albeit via different mechanism.
Without prejudice, consider the source - again. I was not manic when I composed this second draft. It is a rather long narrative chronicling my adventures and what I learned from them.
-------------------
http://www.dr-bob.org/babble/20220917/msgs/1121312.html
-------------------
Take care of yourself. I think you have the best judgment among those who had been posting here regularly. Please use it.
- Scott
Posted by undopaminergic on April 22, 2023, at 11:14:13
In reply to Re: To SLS » undopaminergic, posted by SLS on April 19, 2023, at 11:03:08
> Hi, UD.
Hi SLS.
>
> The following URL post was not addressed to you, but I hope it offers you reinforcement of my message. You and Rosalynn are probably the last people standing. I don't care. If people think I have no appreciation for what they have been through, the last four decades of MY life indicate otherwise. I was hoping to take some people along with me by having them reevaluate the behaviors that will ABSOLUTELY cause them to remain depressed, and might very well go to their graves without having lived without depression for decades. If people thought I returned just to criticize them, they would be right if I were judged by my more recent words. Nice didn't work.
>
> The best hope for those who are now gone lies in the novel treatments that will become available in the future. Some of them - maybe all of them - will be worth considering. I'm disappointed that zuranolone has taken so long to be approved by the FDA. However, it is scheduled to be so by late 2023. It is a member of a sequence of synthesized substances that acts as a positive positive allosteric modulator of GABA-A receptors. Believe it or not, the DEA has to sign off on zuranolone. I guess they want to make sure it doesn't have abuse potential like a benzodiazepine do have. Both drugs are positive modulators GABA-A receptors, albeit via different mechanism.
>
> Without prejudice, consider the source - again. I was not manic when I composed this second draft. It is a rather long narrative chronicling my adventures and what I learned from them.
>
> -------------------
>
> http://www.dr-bob.org/babble/20220917/msgs/1121312.html
>
> -------------------
>
> Take care of yourself. I think you have the best judgment among those who had been posting here regularly. Please use it.
>
>
> - ScottI'm in an awkward situation. I'm at a "tertiary" care psychiatric hospital, which one might assume would offer cutting-edge treatment. The problem is that they specialise in serious psychoses, meaning essentially schizophrenia and schizoaffective disorder. So they aren't focussing on my main complaints, of which is first and foremost depression, and secondarily, I'd probably rank ADHD.
Progress from treatment to treatment is excruciatingly slow. I was stuck at 5 mg vortioxetine for months, and I've now taken 10 mg for a little over a week. The (only?) good thing about all this is, from the perspective espoused by your referenced post, is that I get to (or am forced to) evaluate each treatment for enough time.
I did read it when you first posted it, but I don't feel it justified to re-read it now.
-undopaminergic
Posted by zonked on June 2, 2023, at 16:54:36
In reply to Re: To SLS » Roslynn, posted by SLS on April 10, 2023, at 21:09:03
Scott you're in remission? How? If you have documented it elsewhere here, link to the post. I am so curious.
I have wondered about you over the years even during the years where I didn't participate in babble.
I am so happy for you. You deserve it, you've worked very hard and endured too much pain.
-z
This is the end of the thread.
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