Posted by SLS on March 11, 2001, at 11:05:38
In reply to Re: Trazadone stimulating?!, posted by One in Ten Thousand on March 10, 2001, at 16:53:27
Dear One in Ten Thousand,
> I was prescribed Trazodone in conjunction with Immovane to aid in sleep. It helped me get some sleep but increased my libido to the point that my every waking moment was obsessed with sex.> I had to discontinue after one month. I had no idea it was related to the drug and was fortunate that my doctor identified it as an extremely rare side effect (one in ten thousand women). I'm looking for feed-back from any other women who have had this problem. This is not a joke and I implore you to respond with respect and compassion.
Two other antidepressants, Serzone (nefazodone) and Remeron (mirtazapine), are also used as sleep aids at dosages lower than those usually used to treat depression. It seems that Remeron is chosen more often, and is prescribed in a range of 7.5mg to 15mg. to be taken before bed. It is difficult to predict with certainty how any one person will respond to any given drug. Both drugs are worth a try.
Although I was able to find examples of your trazodone (Desyrel) experience elswhere, I haven't seen any explanations as to what drug mechanisms might be responsible for it. The way some of the abstracts are worded, one would think that the same trazodone mechanism is responsible for sex-specific phenomena: priapism in men and increased libido in women. I would guess that there is more of an overlap, however.
These unusual side effects may involve a chemical metabolite that is produced when the body breaks down trazodone. This is only a silly guess. The metabolite is known as mCPP (m-chlorophenylpiperazine). This is also a chemical product of the breakdown of Serzone (nefazodone), although I am not sure as to how the amounts produced compare. I think it is important to note that nefazodone is a structural analogue of trazodone. They do have some things in common, but they are still very different in the way they act clinically. Serzone does not appear on Medline as producing priapism.
It is also worth noting that Remeron, along with Serzone and trazodone, shares another serotonergic property, 5-HT2 receptor antagonism. This is thought to be the reason why Serzone and Remeron produce so few sexual side effects (lowered libido and anorgasmia), and why they are sometimes used successfully to reverse those produced by the other antidepressants. Perhaps all three drugs will produce the same side effect in you. That would probably make you one in a million. Lucky you. :-( I doubt it though. :-)
If you do react in a similar way to both Remeron and Serzone, and you want to continue searching for sedating antidepressants to treat insomnia, I would recommend looking at two tricyclic medications, Elavil and Sinequan. Both of these drugs have been used routinely in the past, and are dramatically different drugs than those mentioned above. As with trazodone, they differ from sleeping pills like Imovane (zopiclone) in that little or no tolerance develops to require escalating dosages, and that there is very little potential for abuse or severe withdrawal reactions.
I hope this has you helped you rather than confused you. I think you should act under the assumption that trazodone is uniquely the only drug capable of causing you the troubling side effects you have experienced. I recommend that you go on to try drugs in the order that your doctor suggests, even if Serzone is his first choice. You cannot be sure that any one drug will cause you problems just because it is superficially similar to one that did. All of the guessing and hypothesizing above might explain some things, but can only be evaluated through hindsight. Any association might be useful to you in the future.
Good luck.
- Scott
poster:SLS
thread:28737
URL: http://www.dr-bob.org/babble/20010310/msgs/56201.html