Posted by Elizabeth on April 8, 2002, at 0:56:20
In reply to Combine Effexor + SSRI.?? Anyone???, posted by jay on April 5, 2002, at 21:16:23
I actually heard some very good things about this from a pdoc I knew in Boston who was really up on all the latest tricks and techniques. It seems like a weird thing to do (I mentioned it to another MD and he responded, "That's a lot of serotonin!"), but apparently it really works great for some people.
The serotonin syndrome shouldn't be a problem as long as you start out adding a very low dose of the SSRI (like 5 mg Prozac or Paxil, 12.5-25 of Zoloft, etc.) and increasing very gradually, watching for any side effects.
I've had the CSS several times (don't ask how this happened), including twice when it was pretty severe, and I'm alive and well today. So it's not like it's always fatal, or anything. Really there's a continuum from general serotonin-mediated side effects to the CSS. So those types of side effects are the ones you want to watch for: jitters, nausea, diarrhea, dilated pupils, abnormal sweating, etc. The milder CSS symptoms, in other words. Increase the dose only as tolerated; if you start getting some side effects, stay at that dose for a while and see if they recede.
If you're interested, I posted some stuff about the serotonin syndrome recently:
http://www.dr-bob.org/babble/20020402/msgs/101847.html
-elizabeth
poster:Elizabeth
thread:102096
URL: http://www.dr-bob.org/babble/20020402/msgs/102350.html