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.
poster:Sunnely
thread:49107
URL: http://www.dr-bob.org/babble/20001115/msgs/49144.html