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bruce, sins and serotonin

Posted by Harry Anslinger on January 2, 2000, at 19:24:51

In reply to Re: drug sins and serotonin syndrome, posted by Bruce on December 31, 1999, at 19:47:52


> > All I saw that Greg was *seeking* was information. Most of what he was offered was information he didn't ask for.
> >
> > As for consequences, you are right that serotonin syndrome is a relative risk. But think about this before you respond next time...
> >
> > 1. Since he would discontinue the SSRI at least SEVERAL DAYS previous to doing MDMA, this should be no special risk -- unless you have new info on the half lives of SSRIs. It is like MDMA alone.
>
> Prozac's main metabolite (norfluoxetine, which is a potent SSRI) has a half-life of 9-14 days according to Lilly literature. Using the rule-of-thumb that one should wait 5 half-lives to ensure total elimination, Greg should wait , of, 5-6 weeks. With Zoloft it is 2 weeks. Etc.

Actually the washout recommendations refer to ongoing administration of another serotonergic drug. I assume Greg is *asking* about a single dose of MDMA.

However, if we talk about washout recommendations, you are correct about fluoxetine. But using the '5 half lives rule', the other SSRIs have a washout of 5-7 days. see: http://www.cma.ca/jpn/vol-23/issue-4/0264.htm


> > 2. Any SSRI that might remain (very minimal) also inhibits entry of MDMA into the neuron, and interferes with its release of serotonin.
>
> The combo of MDMA & SSRI seems to be SSRI dependent. A quick literature search shows Proxac can (sometimes) potentiate MDMA effects, Zoloft negates it. But you are right, generally speaking, SSRi's do offer protection against Ecstasy. Or reduce its effects if protection is the wrong word.

But interestingly, the SSRI can be taken 4-6 hours after the MDMA, thus permitting most of the MDMA experience but blocking much of the toxicity.

> > I find it curious you don't offer these warnings when people ask for information about SSRIs and MAOIs for example.
>
> I haven't been asked. But if I were, I sure would offer the warning.
>
> In general, this bulletin board is about depression, and the effectiveness of various palliative measures.

This bulletin board -- this site -- is oriented primarily to psychopharmacology. This includes but is not limited to depression and its treatment. Anxiety and attentional disorders are about as frequent topics as depression.


> As such, most people would, I think, naturally want to warn off someone like Greg from experimenting with MDMA.

Read Greg's message again. Where does he say he plans to take MDMA?


> This warning results not from the prudish point of view, but from the standpoint of not further exacebating his depression (which is presumably why he is reading this BB in the first place).

The purpose of this board is dialogue about issues in Psychiatry and Psychopharmacology.

I'd hoped we could just respond to his question directly with too presuming too much.

OK, ecstasy could reportedly exacerbate the condition he's taking the SSRI for. (Not necessarily depression.)

Ecstacy also reportedly has psycotherapeutic action and can foster beneficial personality changes.


> He wanted info on any dangers, he got info.

Many doctors have been well warned about the dangers of narcotics. Meanwhile patients in severe, chronic pain go undermedicated. Fears of addiction supercede appropriate analgesia in patients with terminal illnesses.

BTW, Dr. Peter Breggin wants people to have information too. Go take a look at www.breggin.com . This is what morality breeds...


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Psycho-Babble Medication | Framed

poster:Harry Anslinger thread:17636
URL: http://www.dr-bob.org/babble/20000101/msgs/17860.html