Posted by Sunnely on July 30, 2000, at 21:36:16
In reply to extreme sweating when on SSRI's, posted by Steve2 on July 30, 2000, at 16:45:04
>Then recently I heard that people who use Ecastcy (which works on Seretonin [sorry about the spelling]) often die from overheating. So, does Seretonin cause elivated body temp? How?
This is a theoretical possibility. FYI, serotonin is a neuromodulator of dopamine (i.e., increased serotonin effect decreases dopamine action). Body temperature is controlled in the hypothalamus by regulation of various factors. Dopamine exerts some influence on the temperature-regulating function of the hypothalamus. If dopamine action is hampered, this thermoregulatory function of the hypothalamus could be disturbed and usually assumes the ambient temperature. In addition, once body temperature begins to rise, there is an increase in cellular metabolism (13% for every degree centigrade rise in core temperature). These factors can lead to a vicious cycle of ever increasing body temperature, heatstroke, and finally death. However, generally no serious complications occur if the ambient temperature remains within "acceptable" level or the person stays within an acceptable level of ambient temperature (e.g., air-conditioned place).On the other hand, if the ambient temperature is high (e.g., high environmental temperature with high humidity), blocking the action of dopamine can interfere with the ability of the hypothalamus to maintain a stable body temperature which subsequently follows the ambient temperature leading to potentially serious elevation of body temperature (e.g., heatstroke). People on antipsychotics (dopamine receptor blocking effect) and antidepressants (older ones, via anticholinergic effect and, newer ones via serotonergic effect and anticholinergic effect as in Paxil) are at high risk for developing serious elevations of body temperature during high environental temperature and humidity (especially during heat wave). Of course, an effective way to avoid this potentially serious medical problem is to stay in an air-conditioned area during this type of weather.
Another potentially serious complication of serotonin in excess is the condition called "serotonin syndrome." This condition usually occurs in combination of drugs that have serotonin-boosting effects. However, it has also been reported in monotherapy (single drug) with the SSRIs and yes, with "ecstasy." Elevated body temperature and sweating usually occur in this condition but not enough to arrive at a conclusive diagnosis. If fever and sweating are the only symptoms present, you probably do not have "serotonin syndrome." Other symptoms should be present especially muscle twitchings/jerking (myoclonus) and hyperreflexia (overactive reflexes). Chills (teeth-chattering), confusion, agitation, restlessness, tremor, diarrhea may also be present. Deaths from "serotonin syndrome" have been reported. Note that the syndrome caused by "ecstasy" intoxication produces a clinical picture that overlap between serotonin syndrome and neuroleptic malignant syndrome (NMS). The following signs and symptoms have been reported in cases of "ecstasy" intoxication: confusion, agitation, elevated body temperature, muscle rigidity, rapid heart rate, elevated or low blood pressure, sweating, hypperreflexia, myoclonus, sweating, diarrhea, and elevated CPK or CK (muscle enzymes). Deaths may occur from acute kidney failure.
Drug combinations reported to cause or with potential for serotonin syndrome include:
1] monoamine oxidase inhibitors (MAOIs) + SSRIs and other serotnin-boosting drugs such as Serzone, Effexor, Remeron, tryptophan.
2] MAOI + meperidine (Demerol)
3] MAOI + dextromethorphan (e.g., Robitussin DM)
4] tryptophan + SSRIs
5] Trazodone + SSRIs
6] Sumatriptan (Imitrex) + SSRI
7] Tramadol (Ultram) + SSRI
8] St. John's wort + SSRI
poster:Sunnely
thread:41772
URL: http://www.dr-bob.org/babble/20000729/msgs/41810.html