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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by DebbieLynn on May 3, 2002, at 9:02:26
I have been on Serzone for about 4 weeks. I am slowly coming off of Effexor. I have been on Effexor XR 225mg for a year and it has "pooped out". My doctor suggested Serzone. I take 1 tab in the am and 1 tab in the pm. (200mg) So far...(KNOCK ON WOOD) I have not suffered any withdrawal symptoms from Effexor. I am down to 112.5mg. However...I have heard very disturbing information about the link to liver failure to Serzone. My doctor did mention that liver enzymes could become elevated, but not what I have been reading. I realize that all meds have there quirks...BUT this really bothers me. It seems to be working to my advantage, but I am willing to sacrifice my health. The makers of Serzone put a Black Box Warning in January of this year stating this information about liver failure. I think 1 in 250,000-300,000 will experience some type of problem. I am physically healthy overall, but this REALLY BOTHERS ME!
Does anyone have any info, or is anyone taking Serzone?
Any information is appreciated!
Debbie
Posted by Phil on May 3, 2002, at 10:02:17
In reply to Started on Serzone, LIVER FAILURE?, posted by DebbieLynn on May 3, 2002, at 9:02:26
When Dr. Kramer was on babble, he mentioned that he liked Serzone.
You might consider blood work w/ a liver panel a few times a year.
I've taken a lot od AD's for a long time, my liver is fine but I'm still nuts.
Posted by DebbieLynn on May 3, 2002, at 11:29:58
In reply to Re: Started on Serzone, LIVER FAILURE?, posted by Phil on May 3, 2002, at 10:02:17
So far I feel great. I dont know if the combo of drugs is the reason, but, it really concerns me. I called and talked to someone in my pdoc's office and she did tell me that my pdoc will probably order liver function tests the next time I go to her, which is next week (may 6) My son was on Depakote and I know it too can cause liver problems also. I think to myself...wow, I finally find something that works and here all of these frightening things about it. It was the same with Effexor...the withdrawal syndrome really scared me...but I am having good luck so far!!
Thanks!
Debbie
Posted by katekite on May 3, 2002, at 20:16:23
In reply to Started on Serzone, LIVER FAILURE?, posted by DebbieLynn on May 3, 2002, at 9:02:26
Well I'm not sure this will help, but the liver is one of the very very few organs that can recover from injury almost completely. For example alcoholics do amazing damage to their livers, they can look horrible, be bright yellow, and feel awful with liver damage, but if they quit drinking toxic amounts of the stuff and get help, they will stop the damage and it will recover to the point that they can lead a normal life. To think that they cause horrible damage over and over for years and years and often survive to a ripe old age still an alcoholic. Yes the liver looks like a cauliflower in an old alcoholic, but often it still works fine. A risk of liver damage is a much better risk than say, possible kidney failure, heart disease, etc.
Secondly, liver enzymes in bloodwork are usually raised before any actual liver function is lost. Liver enzymes are released into the blood (where they are measured in the blood panel) if liver cells break open. Since there are lots of extra liver cells to begin with (because they have to deal with us trying to drink alcohol and other toxic things), losing a few is not dangerous short term. They can regenerate and divide to produce new liver cells at any time (unlike heart muscle cells or kidney cells for which death is permanent). The liver is more like the skin in this regard, so that a wound will eventually heal and leave a smaller scar than one thinks would happen from looking at the wound the first day.
So the risk of liver failure may be the best risk to have if you have to have a risk of some organ having a problem. Risk of something is pretty common with all of these drugs. Take that awful possibly fatal rash with lamictal! A rash that can be fatal! Now that serzone is known to have liver risk doctors will be aware, catch it much sooner, will be monitoring so that if enzymes are raised one could stop it before any actual function problems are encountered.
Having said that, I hated serzone, LOL.... I could barely think and I still wasn't happy.
Oh, and also not saying that alcoholism's effect on the liver is to be taken lightly. And not saying concern over liver effects is silly -- its totally reasonable.
What scares me about these things is more what I don't know are problems with all these drugs. Like if they are just finding out they need to watch liver with serzone, how about even newer drugs or ones that are not used as much?
Anyhow, I am coming at the issue from the other end, the 'what if the worst did happen?' end. Sometimes that helps me, to assume the worst will happen and see if I can be ok with it.
That's awesome you are doing ok getting off of effexor. Its nice to hear a success story with it after everything I see here -- I haven't tried it because I'm too scared of the withdrawal.
Sorry to be longwinded.
Kate
Posted by DebbieLynn on May 3, 2002, at 23:53:04
In reply to well, livers do grow back pretty well., posted by katekite on May 3, 2002, at 20:16:23
You are on Effexor as well? Effexor was wonderful for me when it worked. The only downfall was decreased libido. I tried to augment with Wellbutrin...that didn't work. The wellbutrin made me a B**CH! (extremely irritable) I was terrified to go off of Effexor. I had too, it wasn't working. I am still a little uneasy. I am to 112.5mg. I am dropping in 37.5 increments every 7 days. This Monday I go down to 75mg. (yikes!) At that point, my doctor is going to increase my dose of Serzone to a total of 250mg (am on 200 now) I do have increased energy, my moods are better, I am sleeping better, (I was taking Trazadone to help with sleep, but unfortunately it is very similar to Serzone, so I cannot take it) But anyway...I am doing much better.
That was a great description of the liver. I am in my last year of nursing, and do know quite a bit about the liver, but as far as the different enzymes are concerned, I do not have much knowledge. I know how to read labs, what it does (the many, many, many, things that it does. It is an amazing organ!) and do know that it can regenerate, but I did not realize how tough of an organ it is. As you said, it tolerates alcohol and other toxins well.
Just a word... Don't be scared of Effexor withdrawal. I was and still am a little uneasy, but I know numerous people do successfully wean off of Effexor with little or no side effects. We hear a lot of horror stories of people having problems and seeking out for help, trying to overcome the awful withdrawals it can cause. There are other medications to aid in the weaning process. My pdoc fortunately has a good knowledge base about Effexor. Other meds by the way can also have horrible withdrawal effects. I am extremely medicine sensitive. To tell you the truth, I am amazed that I have not had side effects. I am sure the Serzone is helping.
Oh...is Serzone an older drug?
Thank you so much for replying. You were extremely helpful. Hope to hear from you again!
Thanks
Debbie
Posted by Phil on May 4, 2002, at 6:20:41
In reply to Re: well, livers do grow back pretty well.Kate, posted by DebbieLynn on May 3, 2002, at 23:53:04
I would guess that Serzone has been around since 96 maybe..don't feel like looking it up.
Serzone, and I didn't notice it, made me mean!
I've always heard that dosing is tricky with it, also.
I had to get off of it before I got myself beat up but it was working otherwise.
Posted by katekite on May 5, 2002, at 9:28:41
In reply to Re: well, livers do grow back pretty well.Kate, posted by DebbieLynn on May 3, 2002, at 23:53:04
I haven't tried effexor but I think probably have learned from this board enough about how to avoid withdrawal that I would give it a try if I needed to. Right now I'm actually not depressed, haven't been since last September.... pretty surprising, tempting to assume I'll just never ever be depressed again, LOL. I am in withdrawal right now from klonopin though.
Interesting about the libido as my pdoc thinks effexor has less sexual side effects than, say, ssris. Wellbutrin made me agitated and nasty too.
I haven't looked it up but that date of 96 or so sounds about right for serzone. Which actually does make it pretty darn new... since I have tried some stuff that's not even approved in the US (moclobemide for instance) something that's 6 years old starts to sound tried and true to me. Although it shouldn't.
See ya 'round.
kate
Posted by allisonm on May 7, 2002, at 10:57:52
In reply to Started on Serzone, LIVER FAILURE?, posted by DebbieLynn on May 3, 2002, at 9:02:26
I think many drugs are processed through the liver, so there often is risk involved. However, Serzone has an extra warning now on its literature. I have been on Serzone for about a year. I asked my pdoc about the warning. He said that he might not be as apt to prescribe Serzone to someone new, but since I've been taking it and show no trouble he has no problem with my continuing. I think as others have said that keeping an eye on liver enzymes would be a good precautionary measure. All of this said, my pdoc now wants to wean me off Serzone because it doesn't appear to be able to control my increased anxiety levels.
Take care,
Allison
Posted by IsoM on May 7, 2002, at 23:23:09
In reply to well, livers do grow back pretty well., posted by katekite on May 3, 2002, at 20:16:23
Much depends on what sort of liver damage is done by what chemicals on whether a liver will recover, or not. Some damage is irreversible & irreparably harm can be done that CANNOT be healed. Just an extra comment as a warning.
Posted by yachats on November 24, 2002, at 19:54:05
In reply to Livers healing..., posted by IsoM on May 7, 2002, at 23:23:09
The incidence of liver disease damage from Serzone may be much higher than the Black Box figures due to under-reporting. For example, a recent study concluded that the incidence of liver toxicity from Serzone was 28.96 cases per 100,000 patient years. That translates into 1 in 3,453 patient years.
J Clin Psychiatry 2002 Feb;63(2):135-7
Hepatotoxicity associated with the new antidepressants.
Carvajal GP, Garcia D, Sanchez SA, Velasco MA, Rueda D, Lucena MI.Also, as the following quote from the August 2000 Harvard Mental Health Letter indicates, liver function tests may provide a false sense of security.
"Many physicians now order liver function tests before prescribing nefazodone and periodically during treatment. They are checking for damaged liver cells, which usually mend when the patient stops taking the drug. Unfortunately, the tests do not always accurately identify the damage, so patients must also watch for characteristic symptoms — stomach pain, appetite loss, nausea, dark urine, yellowing skin — and report them immediately." http://www.health.harvard.edu/medline/Mental/M0802e.htmlFurthermore, medication-induced liver dysfunction differs from alcohol-related liver disease in that the condition does not always develop gradually over time but can come on quite suddenly. Thus monitoring liver function every few months may be insufficient to detect reversible damage in time.
You might also want to see the following study which found "32 reported cases of hepatotoxicity associated with nefazodone in Canada, 81.3% of which were severe," and which also note that "In common with similar databases, the CADRMP [Canadian Adverse Drug Reaction Monitoring Programme] database includes only a small proportion of suspected drug reactions.
Can J Psychiatry 2002 May;47(4):375-7 Related Articles, Links
Hepatic adverse reactions associated with nefazodone. Stewart DE
As others have pointed out, Serzone also has an increased risk of drug interaction problems due to enzyme inhibition. Of particular interest to patients on psych med is that Serzone inhibits the metabolism of bezodiazepines. Thus going on Serzone will increase one's benzo level and going off Serzone may result in benzo withdrawal symptoms.
I think the bottom line is that there are real risks associated with Serzone that are greater than the 1/250,000 number that people have used to rationalize its use. If its the only thing that works for you, then by all means stick with it. However, if you are someone who hasn't tried everything else first, I would suggest you do that before trying Serzone.
This is the end of the thread.
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