What is Serzone?

Manufactured by Bristol-Myers Squibb and approved by the U.S. Food and Drug Administration in December 1994, Serzone (nefazodone hydrochloride) is a new antidepressant medication found to be safe and effective during prolonged treatment of depression. Structurally different from other antidepressants (selective serotonin reuptake inhibitors [SSRIs], tricyclics, and monoamine oxidase inhibitors [MAOIs]), but similar to trazodone (Desyrel), Serzone inhibits serotonin reuptake and blocks one type of serotonin receptor. Its low incidence of side effects and customer-sensitive pricing make Serzone a favorable addition to the antidepressant medications currently available.

What does Serzone treat?

Serzone is used to treat moderate to severe symptoms of major depression. Clinical depression is a serious medical illness that affects as many as 11.6 million adult Americans each year. Many depressed individuals experience unwanted medication side effects that may cause them to stop taking a drug before benefiting from it. Serzone works to treat major depression within several weeks without a high incidence of troublesome side effects.

What are the advantages of Serzone over other antidepressants?

Although different medications work differently for different people, Serzone has been shown to improve depression-related anxiety and relieves depression-related insomnia. Studies have found that Serzone decreases the amount of wake time and fragmented sleep in depressed patients, suggesting that it may actually improve overall sleep quality. Unlike some antidepressants, Serzone does not cause weight gain or loss or elevated blood pressure. An additional benefit lies in cost of Serzone. It is priced 10 percent to 20 percent below average wholesale prices for selective serotonin reuptake inhibitors (SSRIs).

Who can benefit from taking Serzone?

Serzone can provide effective relief of depression and its symptoms of anxiety and sleep disturbance. It is useful for treating elderly depressed patients as well as younger persons. The recommended initial dose (see below) for elderly or debilitated patients is half the usual dose, however. Pregnant women and nursing mothers should discuss with their doctor the effects of Serzone before taking it or any other medication.

What is the standard dose of Serzone?

The recommended starting dose of Serzone for most patients is 100 mg taken twice daily. (Remember, elderly patients receive half this.) Dosage increases should occur in increments of 100 mg/day at intervals of no less than one week. Daily dosage should never exceed 600 mg. The effective dose range is 300-600 mg/day in two doses. Serzone may be taken with or without food.

Can I take Serzone with other medications?

It is contraindicated, according to the manufacturer's instructions, to use Serzone in combination with any MAOI (monoamine oxidase inhibitor) medication such as Marplan, Nardil, or Parnate. Therefore, there should be a fourteen-day interval between stopping the MAOI and starting Serzone, and at least seven days should be allowed between ending Serzone treatment and beginning an MAOI medication. Serzone should not be taken with Seldane or Hismanal, and it is not advisable to use Serzone in combination with alcohol. It should be used cautiously with certain benzodiazepines, including Halcion and alprazolam (Xanax).

What are the side effects of Serzone?

The side effects of Serzone are relatively mild in comparison with some other anti-depressant medications. The most commonly observed adverse effects associated with Serzone are asthenia (lack of physical strength), dry mouth, nausea, constipation, drowsiness, dizziness, light-headedness, confusion, and blurred or abnormal vision. Only a small percentage of people have discontinued using Serzone due to side effects.

There is some risk of postural hypotension associated with the use of Serzone, so this drug should be administered cautiously to patients with known cardiovascular or cerebrovascular disease.

How soon will I feel better?

Clinical studies show that many depressed patients treated with Serzone experience significant improvement within several weeks of the initiation of treatment. However, individual reactions may vary. It is best to try this medication for four to six weeks to determine the effect it will have on individual patients.

How long should I take Serzone?

Limited studies are available on long-term administration of Serzone. It is generally agreed that drug treatment of depression should continue for up to six months or longer. A study of 250 patients receiving treatment for twelve or more months showed that Serzone is well tolerated and has an excellent safety profile. As with any pharmacological drug, however, patients should be closely monitored while being treated with Serzone, and physicians should periodically re-evaluate the long-term usefulness of the drug for each individual patient.

Reviewed by Elliot Gershon, M.D., chief, Clinical Neurogenetics Branch, NIMH 7/95