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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 overlydetailedanswer on July 21, 2015, at 14:33:37
The reason why I ask is that as most anxious patients I've fervently researched my medication options. Over the years, I've run full trials (at least 12 weeks, minimum therapeutic dose but up to max dose as tolerated) with most of the SSRI class (all but Luvox), the TCA's clomipramine and desipramine, and SNRI's Effexor and Cymbalta. All of the antidepressants, but particularly the SRI's, cause me to experience a significant increase in my anxiety, insomnia and restlessness which made it intolerable as a treatment option. On every option, I'd try to tough out the side effect for 8-12 weeks but they would never diminish. The only medication that did not do this to me was Remeron, however, I had to discontinue that as it made me snippy/angry. My current provider denies that I might be bipolar though we've gone off label a lot with trials of Latuda (EPS symptoms), AC's such as Trileptal and Lyrica (dysphoric reactions), and Lamictal (caused significant anxiety during ramp up).
Currently I'm "maintaining" on a low dose of IR Seroquel at night for sleep but find that it makes me so tired that I have to strike a balance with my caffeine intake to function at work. Too little and I'm grogged out, too much and I'm jittery.
Now, to the point, from what I understand nefazodone is a pretty effective SARI that not only compares well with the SSRI's in effectiveness but also without the activating SE's, associated weight gain and sexual SE's that is often found with SSRI's. I spoke with my current prescriber about this who declined a trial citing it's potential for fulminant hepatic failure. My research shows that it's 1 in 250,000 patient years, but my google-fu is failing me. How does this fare with other known liver killers like valproic acid? Is the liver damage reversible? I've only located handful of patient cases that required transplantation and 1 death. How does 1 in 250,000 patient years compare to the risk of QT prolongation on Seroquel? To me it seems to be a reasonable risk considering my less than adequate responses to over a dozen med trials over the past 6 years but I wanted to get another opinion.
TL; DR: is nefazodone as dangerous as it's said to be?
Posted by overlydetailedanswer on July 21, 2015, at 14:36:54
In reply to Are the risks of nefazodone as what they appear to, posted by overlydetailedanswer on July 21, 2015, at 14:33:37
Sorry I forgot to add. I have panic disorder (panic has actually stopped but I still fear them) and dysthymia.
Posted by Lamdage22 on July 22, 2015, at 12:05:13
In reply to Are the risks of nefazodone as what they appear to, posted by overlydetailedanswer on July 21, 2015, at 14:33:37
Aside from the risk it sounds like a kickass medication.
I have been wondering about this, too.
Posted by Chris O on July 24, 2015, at 3:01:57
In reply to Are the risks of nefazodone as what they appear to, posted by overlydetailedanswer on July 21, 2015, at 14:33:37
I took a fairly huge dose of Serzone (1600mg/day) for about, I don't know, 8-10 months a few years back. I did not have any elevated liver enzymes while taking the medication. (I know I had them measured near the middle of my trial.) At the same time, Serzone did not do much of anything for my GAD and panic (my primary symptoms). It was just another failure for me. But I think it's definitely worth a try. I know I did not gain weight on Serzone, nor do I remember having many sexual side effects.
This is the end of the thread.
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