Serzone (nefazodone)

US Brand Name: Serzone
Other Brand Names: Dutonin (UK), Menfazona, Nefadar, Nefirel, Reseril, Rulivan (other Forn Parts)
Generic Name: nefazodone hydrochloride
Other Forms:FDA Approved Uses: Depression
Off-Label Uses: Panic/Anxiety, Bipolar Depression, Chronic Fatigue, Fibromyalgia, Arthritis, Lupus, Irritable Bowel Syndrome, Eating Disorders
Pros: The mildest of the serotonin & norepinephrine reuptake inhibitors, so discontinuation syndrome isn’t as harsh. Works on serotonin & norepinephrine equally and at a consistent rate, not in a funky way like Effexor.
Cons: So mild that it was proven ineffectual on people hospitalized with severe depression. Oh, it could destroy your liver. They won’t even prescribe it in Canada anymore because of that.

Typical Side Effects: The usual for SSRIs and SNRIs – headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido and a host of other sexual dysfunctions, urinary retention and/or hesitancy. Most everything but the weight gain, sexual dysfunctions and not being able to go usually goes away within a couple of weeks. The urinary retention or hesitancy with SNRIs is something that either sticks around or strikes at random. The sexual dysfunction with Serzone is a lot less common and less intense than most other meds that mess with your serotonin.

Not So Common Side Effects: A variety of vision weirdness – go ahead and get your eyes checked, but if an eye doctor doesn’t find anything on a cursory examination, it’s not your eyes, it’s the Serzone. Plus edema and lowered blood pressure and excessive sleepiness. Serzone is chemically related to Desyrel (trazodone), and it targets specific serotonin receptors, so that probably accounts for the sleepiness.

Freaky Rare Side Effects: Night blindness, loss of taste (those shoes just don’t work with that shirt), drooling, inability to produce clear speech, priapism. Wait a minute, is this Serzone or Ecstasy?

Interesting Stuff Your Doctor Probably Won’t Tell You: Your doctor had better tell you about the liver thing, because I have never seen more black box warnings on a PI sheet than on the latest edition of Serzone’s. Literally in a black box right on top, just like in the good old days. Once you’ve tried Serzone you can never go back again. It’s a jealous and unforgiving drug. If you put it aside to try others, too bad. You must pledge your devotion to it from the start, otherwise it will get you where it can hurt you the most – right in the liver.

Be careful when mixing benzos and Serzone. Some of them, like Xanax, may suddenly get a lot stronger. Surprise! It’s spelled out in the PI sheet, but always check for drug-drug interactions yourself, online and with your pharmacist.

Don’t take it with food, as you’ll be getting less out of it. The bioavailability of Serzone is bad enough to start, which is why it destroys your liver from the inside out, taking it with food just makes it worse.

Dosage: The initial dose is 200mg a day, divided into two 100mg doses. If there’s no improvement after a month that may be increased by 100-200mg a day per week to a maximum of 600mg a day.

Days to Reach a Steady State: Four to five days.
When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long it Takes to Work: As with any reuptake inhibitor, it can take up to a month.

Half-Life & Average Time to Clear Out of Your System: Like Effexor, Serzone has to do a double metabolism. Like Wellbutrin it has to break down into three different metabolites. So Serzone itself has a half-life of 2-4 hours, and its component metabolites have half-lives that range from 1.5-18 hours. Fortunately the good people at Bristol-Myers Squibb R&D did some heavy research and found the mean total half-life of all components to be 11-24 hours. Allow five days to step down by 100-200mg a day to discontinue. I just stopped cold turkey because it put me in such a foul mood, and I couldn’t tell the difference for a few days. But I don’t get along with serotenergic drugs at all, so don’t go by me!
If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.

Comments: Supposedly the weakest of all official antidepressants on the market, the combination of serotonin and norepinephrine reuptake was just the thing to send me into a rage that destroyed an innocent computer monitor. Bear in mind that I am especially sensitive to any adjustment to my serotonin levels. Serzone has been pulled from the market in Europe by Bristol-Myers-Squibb (allegedly for poor sales) and Canada’s national health system has warned Canadian doctors about the potential liver problems. There is, of course, a lawsuit here in the US over just that. Is Serzone any worse for your liver than other hepatically metabolized drugs? I honestly have no idea, but I have never seen so many warnings on a PI sheet for the same damn thing. However I’d really question taking Serzone in combination with any other medication or taking it if you have any concerns about the status of your liver until the whole liver question is settled, preferably by scientists and not lawyers. Lawyers are needed only if there really has been corporate malfeasance. A regular liver panel probably isn’t a bad idea.

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