Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
BRAND NAME: Serzone (This brand no longer is available in the U.S.)
DRUG CLASS AND MECHANISM: Nefazodone is an oral antidepressant drug that
affects chemicals in the brain that nerves use to send messages to one another,
called neurotransmitters. The neurotransmitters that are released by nerves are
taken up again by the nerves that release them for reuse. Many experts believe
that depression is caused by an imbalance among the amounts of neurotransmitters
that are released. Nefazodone works by inhibiting the uptake by nerves of
serotonin and norepinephrine, two neurotransmitters, resulting in more serotonin
and norepinephrine to transmit messages to other nerves. Nefazodone is
chemically unrelated to the serotonin reuptake inhibitors (SSRIs), the
tricyclic antidepressants (TCAs), or the monoamine oxidase (MAO) inhibitors. It is
chemically related to another antidepressant, trazodone (Desyrel) and shares its
actions. Compared with trazodone, nefazodone has a lesser risk of priapism
(prolonged penile erection). The FDA approved nefazodone in December 1994.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 50, 100, 150, 200, and 250 mg.
STORAGE: Tablets of nefazodone should be kept at room temperature, below 40 C
(104 F).
PRESCRIBED FOR: Nefazodone is used for the treatment of depression.
DOSING: The recommended dose range is 150-300 mg twice daily. The maximum
dose is 600 mg daily. As with all antidepressants, the full effect may take a
few weeks to become manifest. Doses are often adjusted slowly upward to find the
optimal dose. Elderly patients and debilitated persons may need lower doses.
DRUG INTERACTIONS: All antidepressants whose actions include increasing brain
concentrations of serotonin, including nefazodone, should not be taken with any
of the MAO (monoamine oxidase) inhibitor class of antidepressants, for example,
isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate),
procarbazine (Matulane), and selegiline (Eldepryl). Such combinations may lead
to confusion, high blood pressure, tremor, and increased activity. If a patient
is switched from nefazodone to an MAO inhibitor, at least one week should be
allowed after stopping nefazodone before starting the MAO inhibitor. Two weeks
should be allowed between stopping an MAO inhibitor and initiating treatment
with nefazodone.
Nefazodone may increase the blood concentration of several drugs by reducing
their removal by the liver. Through this mechanism nefazodone may markedly
increase the blood concentrations of triazolam (Halcion) and alprazolam (Xanax),
resulting in excessive sedation and impaired ability to perform tasks. It is
recommended that people taking triazolam who need to be started on nefazodone
should have their triazolam dose reduced by 75%. Similarly, those people taking
alprazolam who need to take nefazodone should have their alprazolam dose reduced
by 50%. Nefazodone also may increase the blood concentration and possibly the
side effects of eletriptan (Relpax), eplerenone (Inspra), pimozide (Orap),
ranolazine (Ranexa), and silodosin (Rapaflo).
Carbamazepine (Tegretol,
Tegretol XR, Equetro, Carbatrol) may decrease nefazodone blood levels and possibly its
effectiveness by increasing nefadone's removal by the liver. Conversely,
nefazodone may increase the levels of carbamazepine, possibly leading to
toxicity, by decreasing the removal of carbamazepine by the liver.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Nightmares are dreams that cause high anxiety or terror. Nightmares may be a part of posttraumatic stress disorder (PTSD), and they usually occur during rapid eye movement (REM) sleep. There are several different treatment options for nightmares, including cognitive-behavioral therapy and medications.
Depression in teenagers may be caused by many factors. Symptoms of teen depression include apathy, irresponsible behavior, sadness, sudden drop in grades, withdrawal from friends, and alcohol and drug use. Treatment of depression in adolescents may involve psychotherapy and medications.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
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