Deseryl/Trazodone

[lachesis]

Well i'm off the Risperdal with no difficulties. Now I have been prescribed Trazodone and I am worried about serotonin syndrome. I have not read the PI sheet yet, but have read what has been posted here under the sleep section. Crazy Meds says that is often used in adjunction with SSRI's when having difficulty with sleep. But drugs.com medication interaction checker red flags (major) the Trazodone with Effexor because of serotonin syndrome. I am taking 300mg of Effexor. Should I be worried? Does anyone else have experience with taking Trazodone with high doses of an SSRI? Should I wait till I see what a psychiatrist might say, first before taking the first dose?

ty

[resonance]

It's good to know that serotonin syndrome is a possibility, and to keep it in mind for if you start having a bad reaction. But I've heard of it happening only occasionally. In those cases, the people recognized it, went to the ER, and were fine in the long run. I've taken various serotonin-enhancing meds at the same time (including trazodone and effexor) and had no problems; it seems pretty common to do that and be fine, though by no means universal. I can't say what will happen to you, but if your prescribing doctor knew you were also on the effexor, you probably don't need to also call your pdoc. (But if it makes you feel better, go for it.)

[HaloGirl66]

It can never hurt to check with your doc first. But it seems like a pretty common combo - I have heard of several people using it. it all depends on various dosages and such

[LikeMinded]

Chalk another one up here for the SSRI/SSNRI+trazodone crowd.

In a few people, it can be a bad combo due to excess serotonin activity - Trazodone itself posesses its own direct SSRI activity, and more importantly, blocks a couple of the less desirable serotonin receptors, increasing the serotonin sitting around in your synapses. It also sticks weakly directly to some of our serotonin receptors, too.

For many people, though, trazodone helps boost SSRI performance by targeting the serotonin activity better and by generally improving SSRI function.

I'm one of those people, and adding trazodone to my Cymbalta pulled me out of what I thought was a hopeless depression, in March 2005 (Cymbalta alone had no effect).

Now, that combo kept me going a little too far, and rocketed me into a 6 month hypomania, so watch what you're doing...

[lachesis]

Thanks Noemie, halogirl, and herrfous for your input. I hope it helps without too many negative effects. I'll try it on the weekend and report back after a couple of days of use. I'm so cautious with these psych meds but they have always done me good. Fingers crossed this one will too. It is good to be an informed consumer and find out what others have experienced. Thanks again for the help.

[hollywoodfreaks]

I don't take traz on a daily basis with my SSRI, only when I know I'm going to have problems sleeping, but I've taken doses of traz as high as 100mg with no problems. I was worried about serotonin syndrome too, and if I am afraid to take a med I split the tab into four sections, take just a quarter and note its effect, then when I am comfortable I move to 1/2 a tab. Don't know if this is feasible for you but it's an idea. Also, traz is such a powerful sleep inducer that I most frequently take only 25 mg, half of a 50 tab and it works.

[LikeMinded]

lachesis--

Please let us know how things are going with the trazodone... your Effexor/trazodone combo would be very similar to my Cymbalta/trazodone combo from last year (SSNRI + trazodone, that is), so it'd be interesting to hear.

of course, we also want to make sure it didn't give you serotonin syndrome. =)

hollywoodfreaks--

I first started on trazodone for sleep problems in March 2005. I had also been on Cymbalta for 4 weeks by that time, and it wasn't doing anything too significant. I noticed a major mood improvement with adding the trazodone (probably the specific serotonin activity). Hell, it rocketed me into hypomania (though a euphoric, productive one), which is why I'm warning lachesis.

Of course, I needed 150mg to start with for sleep, and by 6 months afterwards, needed 300mg, which is when I switched to Remeron (now I'm on Lunesta, after Remeron failed to maintain sleep for me).

Note that no generalizations apply when it comes to my liver and drug metabolism...

[Jamison]

Forgive me, but isn't Trazadone a Serotonin ANTagonist? Meaning its actions work against those of serotonin?

[Tenebrae]

YMMV and all, but i take 60 mg cymbalta and 50 mg trazodone so far so good! <keeps fingers crossed>

[LikeMinded]

Forgive me, but isn't Trazadone a Serotonin ANTagonist? Meaning its actions work against those of serotonin?

You're both right and wrong.

Serotonin function in how antidepressants treat it is generally dependent on two things:

1) Increasing the amount of serotonin between your nerve cells (this is what SSRIs do)

2) The drug itself hitting the serotonin receptors

There are some 20 identified serotonin receptors! And many MI patients don't want all of them being hit. Not every serotonin receptor helps with depression. The "5HT3" receptor, for example, causes severe nausea and vomiting when overly stimulated.

Trazodone works against serotonin mostly by blocking the "5HT2A" receptor. 5HT2A is associated with certain SSRI side effects, and is often not considered a receptor you want to hit. But when you take an SSRI, serotonin is released everywhere, and hits every serotonin receptor you have, including the ones you don't want hit.

Also, trazodone is in and of itself a mild SSRI and a mild agonist at the 5HT1 receptor family (pro-serotonin actions)

Remeron, a somewhat similar drug, blocks the 5HT2 family and the 5HT3 receptor. This is one reason it increases appetite and can alleviate nausea.

Interestingly, all this "anti-serotonin" activity leaves more serotonin to hit the 5HT1 family of receptors, the ones implicated in depression. Trazodone also has a mild SSRI activity in and of itself. So, in that respect, trazodone (and Remeron) works with the (desirable) actions of serotonin.

So that's why the "anti-serotonin" drugs trazodone (and Remeron) often increase the effect of SSRIs. Even though they block serotonin receptors, they can still help with depression.

Hope this helps a bit, and I apologize for the fact I don't sound too clear today... my mind is a little off and I'd much rather be lying face flat on my bed than sitting here at work crunching data.

Oh yeah, Panicky--

cool that the combo works for you! just watch out for hypomania (the same combo, but with 150mg trazodone, converted me from MDD to BP-II, though I'm not sure that's all a bad thing).

[lachesis]

Why do I worry about getting too much serotonin when I can't seem to ever get enough. This Trazodone stuff is doing nothing to help me sleep. Nothing. I got 1 1/2 hours sleep last night. And yeah the dreams are wild, but I'm use to that as a side effect from Effexor. I started at 25mg and am now taking 50mg. Tomorrow I will try 100 mg to see if that helps. I think these are sugar pills. Blah.

[LikeMinded]

Why do I worry about getting too much serotonin when I can't seem to ever get enough. This Trazodone stuff is doing nothing to help me sleep. Nothing. I got 1 1/2 hours sleep last night. And yeah the dreams are wild, but I'm use to that as a side effect from Effexor. I started at 25mg and am now taking 50mg. Tomorrow I will try 100 mg to see if that helps. I think these are sugar pills. Blah.

The stuff absolutely won't work at all for some people, but like me, you might just be insensitive to the effects and will need a high dose for it to work. It did nothing for my sleep until 150mg.

Trazodone tends to increase the intensity and duration of most stages of sleep, including dream sleep (which is mainly REM) as well as deep sleep. Which is why your dreams might be a little wilder than they are normally on just Effexor.

I'm surprised the Effexor makes your dreams more intense. Cymbalta tends to tone down the intensity and duration of my dreams, and it works almost the same way as Effexor. It's pretty well known that norepinephrine (which both Cymbalta and Effexor work on) is pretty important for maintaining deep sleep.

I know this for a fact, since trying to come off Cymbalta (and I mean only halving the dose!) caused me to have intense dreams and night sweats. As in my entire sleep cycle was REM sleep. (REM is physically demanding, but considered necessary for proper memory functioning.) I'd wake up more exhausted than I would have been if I'd just stayed awake the entire night.

[celestia]

Trazodone tends to increase the intensity and duration of most stages of sleep, including dream sleep (which is mainly REM) as well as deep sleep. Which is why your dreams might be a little wilder than they are normally on just Effexor.

Ok, so I read the whole thread...so if I missed this being addressed, forgive me.

Do the negligible s/e's, wild nightmares, sleep paralysis, and horrible hangover wear off in time when taking Traz for sleep? I also take 150 mgs. of Effexor in the AM. I've also notice traz to be a "hit or miss" drug for insomnia, it has worked occassionally for me, but more often than not it sucks ass due to the above-referenced s/e's.

Herr FOUS? Anyone?

S9 (who would really like to sleep well...)

[LikeMinded]

Ok, so I read the whole thread...so if I missed this being addressed, forgive me.

Do the negligible s/e's, wild nightmares, sleep paralysis, and horrible hangover wear off in time when taking Traz for sleep? I also take 150 mgs. of Effexor in the AM. I've also notice traz to be a "hit or miss" drug for insomnia, it has worked occassionally for me, but more often than not it sucks ass due to the above-referenced s/e's.

My intense dream stuff went back to baseline after a few weeks at 150mg. I never had the problem with hangovers, then again, drugs for me only last about half as long as they should each day since my liver's freaky that way.

Also, I tend to get intense dreams every night nonetheless (have as far back as I can remember, when I was younger, they were all nightmares, often 2-3 every night). I'm just weird that way, though.

If it's hit-or-miss situation for you, AND it's giving you hangovers, my wild-ass guess is that you try reducing the dose. Now if less of a dose can't get you to sleep, you really need to go ask your Pdoc for something else.

Remeron (not to be confused with Rozerem, the new sleep med!!) is a similar drug and is often given to people who don't get along with trazodone (or if traz stops working for them). I had to go up to 300mg trazodone for sleep and then we decided that I'd have to switch sleep meds, since 300mg trazodone and 120mg Cymbalta is REALLY asking for serotonin syndrome.

So, you might want to discuss Remeron (generically known as mirtazapine) with the pdoc. The biggest side effect (besides drowsiness, of course) is increased appetite, resulting in weight gain. But that's more of a concern at doses where it's used as an antidepressant, and not a sleep aid.

P.S.

for us males, the worst side effect of trazodone is that it can make things a little too hard for us in the morning. and by "hard" I don't mean difficult.