Sedation from Mirtazapine (Remeron) vs. Nefazodone (Serzone)?

[Sleepy_Slumber]

I am currently taking Remeron for anxiety/mild depression and find that it does a pretty good job of helping me sleep at night. Apparently it sedates by blocking histamine H1 receptors.

I am, however, considering switching over to Serzone as there is more compelling evidence that it a) improves sleep efficiency and b) reduces frequency of night time awakenings.

Through what mechanism does Serzone cause sedation? Is it likely to be a more effective hypnotic than Remeron (even though it is not intended for this purpose I know)? Am I likely to be able to convince my doctor to prescribe this medecine for this very reason?

 

[jasoncrest]

Switching to Serzone is not a good idea: in many countries it's no longer sold, because it causes hepatic problems...
From RxList:
"Cases of life-threatening hepatic failure have been reported in patients treated with SERZONE...etc..."

I think it causes sedation because it antagonizes alpha1-adrenergic receptors.

 

[BilZ0r]

Nefazodone supposidly doesn't touch H1 receptors, though it messes around with adrenergic receptors, which is going to piss around with your sleep.

In my opinion, antihistamines are the best drugs for sleep, for people with mild insomnia. There effects on REM are vastly smaller than typical sleeping pills. I don't know what the compelling evidence of which you speak is, but were it's authors all employed by the drug company that makes Nefazodone?

Finally, I think nefazodone is a pretty shit drug. Some of it's break down products have pretty nasty psychopharmacological profiles (mCPP)...

 

[illuminati boy]

Regarding their practical/empirical use, one knows a psychiatrist who is pretty comfortable in Rx mirtazapine for sleep aid, but really never Rx Serzone / nefazodone for much of anything. There can be some really serious side-effects for some taking nefazodone. One is not that familiar with it compared to the other psychotherapeutics/ psychotropics. One did find information indicating that risk of liver failure resulting in death or transplant is about = 1 per 250,000 patient years. One also would note that BM-S pulled Serzone from the Canadian market.

I B

 

[illuminati boy]

AUC Multiples and T½ for Three Metabolites of Nefazodone (100 mg BID)

Metabolite
AUC Multiple
T½

HO-NEF
0.4
1.5–4 h

mCPP
0.07
4–8 h

Triazole-dione
4.0
18 h

 

[Sleepy_Slumber]

What about Trazodone? Is it that good a drug for insomnia?

 

[BilZ0r]

Keep away from Trazodone, it's a nasty drug. If you want sleep, either get a benzo, preferably one of the new ones, zaphalon, zolpidem and zaleplon, or go down the shop, and get some benadryl, diphenhydramine is good stuff.