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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Crystal on November 20, 2000, at 12:02:41
Hello, this is my first post!
Last week I asked my dr to change my medication for depression and slight anxiety, I was on paxil 40 mg a day. I wanted to change because of the weight gain and sexual side effects. So I did some research and decided to try Serzone.
He started me at 150mg twice a day and stop the paxil cold turkey.
Well it is the fourth day and I am dizzy , loss of balance, sleepy, and my stomach gets upset which is unusual for me.
Is there anything I should do to ease this transition? I cannot miss work for this and I want to go home right now. How long will it be like this?
Thank you for your help
crystal
Posted by fitgrl on November 20, 2000, at 16:57:13
In reply to From Paxil to Serzone, posted by Crystal on November 20, 2000, at 12:02:41
Crystal,
I can't really give you any advice, but I have switched from paxil 20mg to wellbutrin 100mg twice daily.
I stopped the paxil 3 days ago. I tapered off of it by taking on half the dose for a week. My doctor said it would be ok to go ahead and stop the paxil all together and start the wellbutrin.
I am responding to you because I am feeling the same as you are. I am dizzy and don't have my balance like I normally should. I'm not sleepy and my stomach isn't upset, but at times through the day I feel ok and then its like all of a sudden, I feel horrible.
I feel for you. I'm not sure you should've stopped the paxil so quickly. You should've tapered off of it. I'm not sure which is causing me to feel this way, but I really have been thinking its the wellbutrin doing this, but not sure now. Good luck, Michelle
Posted by MarkinBoston on November 20, 2000, at 17:39:28
In reply to From Paxil to Serzone, posted by Crystal on November 20, 2000, at 12:02:41
> He started me at 150mg twice a day and stop the paxil cold turkey.
> Well it is the fourth day and I am dizzy , loss of balance, sleepy, and my stomach gets upset which is unusual for me.I had a hard time ramping up on Serzone. I take 100mg at 6-7pm and 50mg when waking up. It made me sleepy, so I am probably ready to step up the dose a little more. Ritalin did nothing to counteract the sleepines, only dose reduction and gradually increasing it. Technically, I am at a sub therapeutic dose, but I notice if I miss a day, so its doing something right.
BTW, I felt awful the two times I tried Welbutrin - like I had the flu, even on small dosages of the original or extended release.
Posted by Sunnely on November 20, 2000, at 19:05:45
In reply to From Paxil to Serzone, posted by Crystal on November 20, 2000, at 12:02:41
Hi Crystal,
What you are experiencing may be a combination of a rapid discontinuation of Paxil i.e., withdrawal symptoms, and a high starting dose of Serzone.
FYI, Paxil is the most potent among the SSRIs (Celexa, the most selective). By discontinuing Paxil abruptly, Serzone may not be adequately "covering" the acute serotonin deficiency ("hyposerotonergic state") that ensued. Aside from this, Serzone has a shorter half-life than Paxil which may not be enough to compensate for the dramatic drop in Paxil blood level.
Serzone can also cause orthostatic hypotension which can manifest itself as dizziness, loss of balance, and even falls. To avoid this potential side effect, it is clinically advisable to start Serzone at a lower dose and increased gradually, as tolerated. For example, start as 50 mg twice a day for 4 days, then 100 mg twice a day for 4 days, then increase to 150 mg twice a day. (This is just an example. Individuals vary as to their tolerance of the adverse effects of a drug.) Maximum recommended antidepressant dose of Serzone is 600 mg/day (usually in 2 divided doses, bulk of dose given at night). Both Paxil and Serzone can cause upset stomach because of their stimulating effect on the serotonin receptors (5HT3 receptors) in the gut. Another common side effect of Serzone is sedation. As with orthostatic hypotension, this is another reason why it should be started at a smaller dose and increased as tolerated.
You may need to resume Paxil, gradually reduce the dose, and discontinued according to your tolerance of the withdrawal symptoms. Your Serzone dose may need to be reduced and gradually increased, again according to your tolerance. Not an easy task to do. You should be aware that there is a potential risk for "serotonin syndrome" when 2 or more serotonin-boosting antidepressants are combined. Your doctor should inform you of this risk. If he doesn't tell you, ask him.
Posted by Sunnely on November 20, 2000, at 19:24:01
In reply to Re: From Paxil to Serzone, posted by fitgrl on November 20, 2000, at 16:57:13
> Crystal,
> I can't really give you any advice, but I have switched from paxil 20mg to wellbutrin 100mg twice daily.
> I stopped the paxil 3 days ago. I tapered off of it by taking on half the dose for a week. My doctor said it would be ok to go ahead and stop the paxil all together and start the wellbutrin.
> I am responding to you because I am feeling the same as you are. I am dizzy and don't have my balance like I normally should. I'm not sleepy and my stomach isn't upset, but at times through the day I feel ok and then its like all of a sudden, I feel horrible.
> I feel for you. I'm not sure you should've stopped the paxil so quickly. You should've tapered off of it. I'm not sure which is causing me to feel this way, but I really have been thinking its the wellbutrin doing this, but not sure now. Good luck, Michelle++++++++++++++++++++=
Hi Michelle,
If you have been taking Paxil for quite some, it is most likely withdrawal symptoms from abrupt discontinuation of Paxil. Unless there is a serious medical concern, it is NOT OK to abruptly stop Paxil at 20 mg/day (and switch to Wellbutrin immediately). It requires a gradually transition from Paxil to Wellbutrin. FYI, Wellbutrin does not have serotonin-enhancing property. So in effect, when you abruptly stopped Paxil, your system went into an acute serotonin deficiency ("hyposerotonergic state") causing the withdrawal symptoms (dizziness, loss of balance, etc.). Wellbutrin, being devoid of serotonin-enhancing effect, was unable to prevent the withdrawal symptoms of Paxil from happening.
You may need to resume Paxil, then gradually reduce the dose to the level of your tolerance of the withdrawal symptoms. You can continue Wellbutrin at the same dose or increased as needed.
Posted by fitgrl on November 21, 2000, at 10:58:57
In reply to Re: From Paxil to Serzone, posted by MarkinBoston on November 20, 2000, at 17:39:28
I posted this question before. Didn't get a response so I thought I'd try once more. Does anyone know if wellbutrin is used for OCD (obsessive compulsive disorder) if so, how effective was it?
Posted by Shell on November 21, 2000, at 17:52:28
In reply to WELLBUTRIN AND OCD ?????????????????, posted by fitgrl on November 21, 2000, at 10:58:57
> I posted this question before. Didn't get a response so I thought I'd try once more. Does anyone know if wellbutrin is used for OCD (obsessive compulsive disorder) if so, how effective was it?
As far as I know (and I am no expert), Wellbutrin is not used for OCD, nor is it approved by the FDA for this purpose. Wellbutrin works by increasing the levels of the neurotransmitters dopamine and norepinephrine in the brain. OCD responds to drugs that increase brain levels of serotonin. Usually, SSRI's, Anafranil or Effexor are prescribed for OCD.
There are people with both OCD and depression who do take Wellbutrin in combination with one of the above drugs, but the Wellbutrin is prescribed for their depression, not for the OCD.
Shell
Posted by fitgrl on November 22, 2000, at 6:06:30
In reply to Re: WELLBUTRIN AND OCD ?????????????????, posted by Shell on November 21, 2000, at 17:52:28
Thank you Shell for your response to my question.I figured that was the case but wanted to be sure.
I have been on the wellbutrin now for a week and decided this morning I was done with it. Yesterday I went in a rage because someone was in my way at the grocery store. I have felt angry for the past couple of days. I haven't been able to sleep and am having bad dreams ever since I started the wellbutrin.
I really want to see if I can stop all medicines even though they say I have OCD. The paxil was a lifesaver for me. It really helped me, but the hunger and loss of sex drive was horrible too. I thought I'd get off the paxil and I have been off of it almost a week and my hunger has already got better and my sex drive is almost back to normal. It's hard to choose those things in life or the medicines. Thanks again
Posted by Noa on November 22, 2000, at 14:15:33
In reply to From Paxil to Serzone, posted by Crystal on November 20, 2000, at 12:02:41
I am surprised he started you at 150. There is a "starter pack" that many docs have that starts you as low as 50, I think (my doc even had me start with half of that).
Anyway, I experience some of these adverse effects in the first few weeks--balance problems, grogginess (I wasn't dizzy, perhaps becasuse I started at a lower dose and worked up slowly), as well as emotional lability--crying, inense emotions, etc.
But it all went away after about 3-4 weeks. I take serzone in conjunction with effexor and it is a good comgo for me.
I take the serzone in the evening and it helps me sleep at night, as well as counters the overactivating effects of the effexor, and adds AD effect for me, too.
It is a bit sedating for me, but not too bad. I usually feel some sedation about 30 minutes after dosing and that lasts for about 30-45 minutes, but then it lifts. Later, I am tired enough for bed, but not groggy like I was with trazodone.
If you can stick through the first few weeks, and titrate up more slowly, perhaps, it might be worth it.
Posted by Crystal on November 28, 2000, at 9:58:34
In reply to Re: From Paxil to Serzone » Crystal, posted by Noa on November 22, 2000, at 14:15:33
I backed down to 75 mg twice a day for one week and now I have went up to the 150 twice a day.
The dizziness is almost completely gone. My stomach tends to get upset which has never been a problem before taking this serzone.
I have noticed ( and others have as well) that I have a very short temper and seems like the smallest things set me off.
I have been taking this for a little over a week. Will the irritability go away soon? How long should I give it?> I am surprised he started you at 150. There is a "starter pack" that many docs have that starts you as low as 50, I think (my doc even had me start with half of that).
>
> Anyway, I experience some of these adverse effects in the first few weeks--balance problems, grogginess (I wasn't dizzy, perhaps becasuse I started at a lower dose and worked up slowly), as well as emotional lability--crying, inense emotions, etc.
>
> But it all went away after about 3-4 weeks. I take serzone in conjunction with effexor and it is a good comgo for me.
>
> I take the serzone in the evening and it helps me sleep at night, as well as counters the overactivating effects of the effexor, and adds AD effect for me, too.
>
> It is a bit sedating for me, but not too bad. I usually feel some sedation about 30 minutes after dosing and that lasts for about 30-45 minutes, but then it lifts. Later, I am tired enough for bed, but not groggy like I was with trazodone.
>
> If you can stick through the first few weeks, and titrate up more slowly, perhaps, it might be worth it.
Posted by Noa on November 28, 2000, at 11:34:18
In reply to Re: From Paxil to Serzone, posted by Crystal on November 28, 2000, at 9:58:34
I can't say what will happen for you, but for ME, it took about 3-4 weeks for this to wear off. Hasn't been a problem in the year + since.
This is the end of the thread.
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