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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by AndrewB on May 16, 2000, at 10:30:24
I took Serzone for 7 months and never felt anything but fatigued, foggy headed, and emotionally numbed. My mood never improved, from low to high doses. Does that indicate other serotenergic ADs also would not change my mood. Why do some serotenergic ADs, but not all, give some but not all people these side effects?
Thank you,
Andrew B
Posted by tina on May 16, 2000, at 10:43:33
In reply to Serotonin Response??, posted by AndrewB on May 16, 2000, at 10:30:24
> I took Serzone for 7 months and never felt anything but fatigued, foggy headed, and emotionally numbed. My mood never improved, from low to high doses. Does that indicate other serotenergic ADs also would not change my mood. Why do some serotenergic ADs, but not all, give some but not all people these side effects?
>
> Thank you,
>
> Andrew B******************************
I don't know much about serzone but I did have a similar reaction to an MAOI. It didn't do anything but make me sleepy. My doctor said there wasn't much point in trying other MAOI's and switched me immediately to an SSRI. I don't know if it helps but I thought I'd put in my 2 cents.
Posted by bob on May 16, 2000, at 17:56:16
In reply to Re: Serotonin Response??, posted by tina on May 16, 2000, at 10:43:33
I think I remember reading that while SSRIs are all the same "class" of medication, they differ enough to have quite different effects for the same person.
My own experience? Zoloft the first time around worked out really well, then eventually too well (manic response, the only one I've had in my life and DAMN do I miss it). Second and third try, it did little for me. Prozac was somewhat activating (though there were some other med complications at the time) and I actually lost weight on it. Paxil was just a nightmare. Prozac and zoloft wound up being similar (other than a difference of 50 lbs in weight -- 10 lost, 40 gained from "normal" respectively), but paxil was just a plain nightmare.
Then again, I'm responding well to TCAs. Maybe someone who has had more success with SSRIs can give a better account for your question.
cheers,
bob
Posted by PeterJ on May 16, 2000, at 19:18:24
In reply to Serotonin Response??, posted by AndrewB on May 16, 2000, at 10:30:24
> I took Serzone for 7 months and never felt anything but fatigued, foggy headed, and emotionally numbed. My mood never improved, from low to high doses. Does that indicate other serotenergic ADs also would not change my mood. Why do some serotenergic ADs, but not all, give some but not all people these side effects?
Serzone has a very complex constellation of biochemical effects. It is a mild uptake
inibitor for serotonin but it also blocks post-synaptic 5-HT2 serotonergic receptors.
It has a metabolite, mCPP which is very active as a serotonin agonist and has
pronounced noradrenergic effects. Serzone itself also has some noradrenergic effects.Trazadone is related to Serzone and also has many complex effects. It is usually more
sedative than Serzone.This complex mix of activities is not shared with most other serotonergic drugs. Most
SSRIs in particular, by definition, primarily inhibit serotonin uptake only. Thus one
definitely cannot predict response to an SSRI from one's response to Serzone. They are
too different.I say this not only based on biochemistry but on observation. I have known individuals
who responded very poorly to Serzone or Trazodone, but nonetheless responded well to an SSRI.
The reverse also happens: good response to Serzone or Trazodone and bad response to an SSRI.SSRIs would include Prozac (Fluoxetine), Luvox (Fluvoxamine), Paxil (Paroxetine), Celexa
(Citlopram), and Zoloft (Sertraline). Effexor is an SNRI (Serotonin-Norepinephrine uptake
inhibitor.) Remeron (Miratzepine) has both serotonergic and adrenergic effects, but it is
not primarily an uptake inhibitor.Peter
Posted by JohnL on May 17, 2000, at 4:18:50
In reply to Serotonin Response??, posted by AndrewB on May 16, 2000, at 10:30:24
> I took Serzone for 7 months and never felt anything but fatigued, foggy headed, and emotionally numbed. My mood never improved, from low to high doses. Does that indicate other serotenergic ADs also would not change my mood. Why do some serotenergic ADs, but not all, give some but not all people these side effects?
>
> Thank you,
>
> Andrew BFailure on one serotonin medication does not predict failure with others. Though the details are beyond my knowledge, the serotonin meds all work in very different ways in accomplishing the same end result. I think it's HOW they inhibit serotonin that makes the difference. They all do so in very different ways. Some attach to the serotonin molecule preventing its reuptake. Others block the reuptake pump. And there are other mechanisms as well. But like I said, my knowledge of these mechanisms is not good. I do know however that they all work differently to accomplish the same end result. Those different mechanisms determine how well a drug works or not for a particular person--varying depending on that particular person's unique chemistry.
Serzone has additional mechanisms to complicate the picture. It blocks some serotonin receptors. And it also has some norepinephrine reuptake inhibition. And it antagonizes somewhat alpha-1 receptors. All of these things contribute to how well it works, doesn't work, or causes worsening, depending on the unique chemistry of each person. It's just my own opinion and theory, but I believe many of the complaints concerning Serzone are a result of its alpha-1 antagonism. I say this because I am one of those people--like you--who responded very poorly to Serzone. But I responded very positively to Adrafinil--which is an alpha-1 agonist, not antagonist like Serzone.
These varying mechanisms of action also account for the varying side effects. I think it's very simple to say they all inhibit serotonin reuptake. But in reality, there is a whole lot more than that going on at a molecular level.
JohnL
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