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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4278
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have dysthymia and anxiety disorders. A long time ago I took

Resolved Question:

I have dysthymia and anxiety disorders. A long time ago I took an antidepressant called
Serzone. It worked great for me. Then it was taken off the market. Ssri's don't seem to work. Any suggestions for a med or combination that may work in a similar way. Thank you.
Submitted: 10 months ago.
Category: Mental Health
Expert:  Dr. Z replied 10 months ago.

DoctorZ :

Hello I believe I can help you with your concern

DoctorZ :

I am sorry that you have been experiencing these symptoms associated with anxiety and dysthymia, I can imagine how distressing this is for you

DoctorZ :

Serzone was a very potent antidepressant that was effective, but it also caused severe liver damage in some patients and that is why it was taken off the market.

DoctorZ :

May I ask, how long have you been diagnosed with dysthymia and anxiety disorders for?

DoctorZ :

Serzone is 5-HT2a antagonist, so you may get benefits from another 5-HT2a antagonist, like Valdoxan, which I believed was approved for use in Canada in 2009. Seroquel XR also has 5-HT2a antagonist properties as well

DoctorZ :

How has the Trazadone been working for you so far?

DoctorZ :

In addition, adding Abilify to an antidepressant can be beneficial as well. Abilify has been shown to increase the effectiveness of antidepressants in recent studies and you can take it along with the Trazadone if you feel the Trazadone has been effective for you.

DoctorZ :

Also Serzone has a moderate affinity to the 5-HT1a receptor as well, so it is possible that Buspar or Viibryd could be beneficial for you as well as these medications are partial agonists for this receptor.

DoctorZ :

Serzone actually had a low affinity for Serotonin, norepinephrine, and dopamine receptors, so this could explain why the SSRI and NDRI (e.g. Wellbutrin) medications were not effective for you and why the SNRI and NRI medications may not be as beneficial for you because your symptoms respond better to medications that target the 5-HT2a, 5-HT1a, adrenergic receptors. This is most likely why the Serzone was so effective for you.

DoctorZ :

I see that you are offline right now, but when you get back online I would be very interested in continuing this discussion with you and talking about anything further you would like to share regarding your concern, so if you respond in the chat box I will be able to get back to you as soon as possible.

Customer: I have suffered from dysthymia since very young, but of course, thought it was a normal way to feel, until my early 30's. What does low
DoctorZ :

I am sorry, I can imagine that feeling a chronic depressive disorder like dysthymia at such a young age would make you feel like it was normal because you had nothing to compare it to. But I am glad that you are seeking treatment for it since. I believe your question was cut off you started to say "What does low" and then it was cut off

Customer: I think the trazadone may not be working as well now! How does ability work to improve the antidepressant ? What is valdoxan?
DoctorZ :

The Abilify attaches to key receptors like the antidepressant and enhances the antidepressant's effectiveness in this way. The Valdoxan is a 5-HT2a antagonist like the Serzone, so that is why I thought it would be a good replacement medication for the Serzone you tried years ago.

DoctorZ :

Valdoxan is still relatively new and not prescribed a lot, but I believe you can bring it up with your prescribing physician since it is a major 5-HT2a antagonist like your Serzone

Customer: Can you list other meds that that target the 5ht2a, 5ht1a adrenergic receptors? Also, what does that mean in lay mans terms:) ?
DoctorZ :

Well Seroquel does have those effects as well, but not as strongly as the Serzone did or the Valdoxan. So 5ht2a, 5ht1a adrenergic receptors are neurotransmitter sites in your brain that effect your mood. So those medications react mainly with those neurotransmitters that I mentioned in your brain to help lessen your symptoms

DoctorZ :

In addition, Trimipramine is also a strong antagonist for the 5ht2a receptor like Serzone, so that could be effective for you as well. So in my opinion I would ask about Valdoxan and Trimipramine first, and see if that helps relieve your symptoms. You should start to see benefits in 2-3 weeks and then maximum benefits in 6-8 weeks

DoctorZ :

If those two medications do not work then you can try adding abilify to one of your antidepressants that you believe you had the most success with to enhance its effectiveness for you. But I believe you will find success with Valdoxan and Trimipramine as these medications are so closely similar to the Serzone

Customer: What class of antideppresant are valdoxan and trimipramine ?Are they definitely available in Canada thanks
DoctorZ :

Valdoxan and Trimipramine is available in Canada and they are actually called 5-HT2a antagonist antidepressants, same class as the Serzone was. The Valdoxan is much more recent and supposedly has much less side effects than the Trimipramine

DoctorZ :

Because Valdoxan is new, some doctors are not familiar with it, so you will have to bring it up with the doctor

DoctorZ :

And definitely mention how Serzone worked for you in the past and how Valdoxan is a similar class medication

Customer: As mentioned the trazadone doesn't seem to be working now. I thought it was similar to serzone ?
DoctorZ :

No actually Trazadone is in the Serotonin antagonist and reuptake inhibitors class (SARI) and has a strong connection with serotonin like most antidepressants. Serzone worked differently and did not have a strong connection with Serotonin. Serzone was 5-HT2a antagonist receptor class antidepressant

DoctorZ :

I am sorry I mistyped, Trazadone did work by blocking Serotonin lreuptake like Serzone, but it did not effect the 5-HT2a antagonist like the Serzone and that is what makes them inherently different

DoctorZ :

For some reason I thought you mentioned Thorazine and that is why I was mistyped.

DoctorZ :

I still think the Valdoxan would be a good choice over the Trazadone because of it 5-HT2a antagonist profile like Serzone.

DoctorZ :

Unfortunately psychotropic medications are not an exact science because every body reacts differently to the medications, so trying to find the right combination of medications may take some trial and error approach

Customer: Are you familiar with dysthymia?
DoctorZ :

Yes dysthymia is often called a less severe form of depression because it usually does not have as severe symptoms as a major depressive disorder, but I feel is a very severe depressive disorder due to its chronic nature and feelings of hopelessness commonly attached to it.

DoctorZ :

It is also a difficult disorder to treat as well due to the chronic nature of it

Customer: I was considering Pristiq, does it work on the 5ht2a 5ht1a receptors? The serzone worked so well on my anxiety also. I felt I didn't need the ativan for my anxiety. You don't mention the ativan. Do many people still find the need for a benzo, since not all antidepprasants work on both illnesses. So often we hear that certain antideppressant work on both. I think that is rare, do you agree?
DoctorZ :

Pristiq works mostly on serotonin and norepinephrine, so it will not have strong binds to those receptors that the Serzone has binds to. Many antidepressants work well for anxiety, but not all of them. Also anxiety and depression often co-occur (around 60-65 percent of the time do they occur together) so it is possibly that when your dysthymia symptoms lessen, so will your anxiety symptoms and that is probably why the Serzone worked so well. Yes many individuals do find the need to take a benzodiazepine in conjunction with an antidepressant if their anxiety is moderate to severe, so you can continue to take the Ativan if you wish and if it is still beneficial to you

DoctorZ :

In addition, if the medication is not working you may also want to try Transcranial Magnetic Stimulation (TMS). Which has shown in some studies to be effective in treating resistant depressive disorders

DoctorZ :

Here are couple links describing it

DoctorZ :

http://www.mayoclinic.com/health/transcranial-magnetic-stimulation/MY00185

Customer: Ok I will do some research and ask my doc about valdoxan. Does valdoxan work on melatonin ?
DoctorZ :

It does effect melatonin, so there are no insomnia or day time sleep effects associated with this medication. So this medication will actually improve your sleep quality

Customer: Have you heard of any positive feedback with using valdoxan? Why haven't I heard do this med before today?
Customer: I am always researching for a similar drug to serzone, this one has never come up.
DoctorZ :

Well like I said this medication is new, it will get approval in the United States later this year or possibly early next year, and it has been allowed in Canada since 2009, and yes there have been some positive results from studies that show its effectiveness.

DoctorZ :

Here is a study about Valdoxan for you

Customer: Thank you so much. Your patience is much appreciated. Keep your fingers and toes crossed for me:) I will first call my pharmacy to
DoctorZ :

Also that author wrote another study on it as well, not sure if it is very different, but I want to give you everything I have.

DoctorZ :

It is my pleasure, I am happy to help you today and I truly hope this medication is the key in helping you

Customer: If you think of anything else that might be of help, you have my email:) once again thanks!
DoctorZ :

I actually do not have your email, only the administrators do, but I can follow up using the Q&A format after you rate me and post anything that I think would be helpful for you

DoctorZ :

Is there anything else I can assist you with today?

DoctorZ :

Here is one last study for you too

DoctorZ :

Sorry I am big nerd on studies

Customer: Believe it or not I think that is it!! Bye and god bless!
DoctorZ :

I am happy that I was able to help you, I hope everything works out for you. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer: Oh really, I can pick your brain again at another time, how would I do that?
DoctorZ :

Well all you have to do is put "For Doctor Z only" to ask another question, but if you have follow up questions on this matter, you can ask me them for free at anytime. You should have a link in your email to this chat, so you can click on that and ask me follow up questions for free at anytime in the future.

Customer: Ok thanks, XXXXX XXXXX now.
DoctorZ :

Good bye and good luck :)

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4278
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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