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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by garyengelm on December 18, 2007, at 15:12:06
Why can't I get off this medication. I can't combine it with an SSRI as I go into pre-serotonin syndrome or so it seems. I've tried multiple SSRI's and other antidpressants.
Just started Lyrica today as the Lamictal I took for 9 days, exacerbated my anxiety 4 fold. I've been off it for 3 days now. It did seem to lift my mood, but so did the SSRI's for the few days I was able to take them.
So, when I wean down just 25mg of Serzone from 400mg, my anxiety skyrockets. Is this because of the 5HT2a blockade being reduced. If so, would Abilify, Seroquel, or Zyprexa fix this and allow me to wean down without the increased anxiety. I really want to get on a true SSRI. I've tried every way to work around the Serzone and everything has failed me. My pdocs don't know if I'm BP II, just have GAD with co-morbid Depression, or if I have PTSD due to my brothers death a year ago.
Appreciate any feedback......
Gary
Posted by Phillipa on December 18, 2007, at 16:24:32
In reply to Serzone (nefazadone) and 5HT2a question.. !!!!!!!, posted by garyengelm on December 18, 2007, at 15:12:06
Is it possible you need a mood stabalizer? I found trileptal to not have side effects at low doses and dosed at night and could sleep with the benzos. Did you know trileptal is tegretol with one less oxygen ion. Try l50 of it maybe it will help. Why do you want an SSRI? There's also cymbalalta and effexor. Hope this helps Phillipa
Posted by amigan on December 19, 2007, at 20:31:07
In reply to Serzone (nefazadone) and 5HT2a question.. !!!!!!!, posted by garyengelm on December 18, 2007, at 15:12:06
Well, it isn't heroin. How difficult can it be to get off this medicine? If you feel that you are going into a serotonin syndrome when you combine it with a SSRI, then it's simple: Don't combine it. Nefazodone has such short half-life that you only have to stop taking for one day and then you can start the SSRI. If you still feel that you are going into pre-SS it's probably your imagination.
Another good approach is to switch to trazodone. It's almost identical to Nefazodone but has a longer half-life and it would be much easier to quit from it.
Posted by Dove on December 20, 2007, at 11:36:11
In reply to Re: Serzone (nefazadone) and 5HT2a question.. !!! » garyengelm, posted by amigan on December 19, 2007, at 20:31:07
The withdrawal syndrome from Serzone is no cake-walk. It may not be heroin (i.e. no euphoric effects) but it can be really difficult to quit taking. I would also caution against switching to or adding Effexor (Venlafaxine) if you are having problems withdrawing Serzone. For me personally, getting off of Effexor is much more trying than ramping down Serzone, but as always, your mileage may vary.
Trazodone is not a terrible idea, will be much more sedating and is a close match to Serzone to help with some of those withdrawal effects.
I would also consider adding a mood stabilzer to see if that helps, perhaps your whole system is getting too agitated from the anti-depressants.
What does your doctor think? Are they willing to test out a sedating anti-depressant and/or mood stabilzer? Do they think you are getting pre-seretonin syndrome or just getting agitated? There are many sedating ADs out there, even old-school Tricyclics (such as Amitriptyline) that can lessen the withdrawal effects along with dampening your anxiety, along with utilizing benzo's.
You have to decide which issue needs to be addressed first. Your depression, your severe anxiety or your withdrawal from Serzone. If you can't get off the Serzone or add any other med to help with the first two issues then you need to concentrate on removing the Serzone and deal with the anxiety with-drawal effects the best you can until that step is done.
You can essentially ramp up quick on a sedating ad (or low-dose Remeron) while withdrawing from the Serzone (I have done this--while also utilizing klonopin as needed). Spent two weeks in a drowsy fog but did get off both Serzone and Effexor using this method.
However, if you think all of this is connected to some sort of bipolar cycling, then you may need to visit the mood stabilizer and/or atypical anti-psychotic route to enable you to remove the Serzone.
This is the end of the thread.
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