Posted by silvercoin on June 14, 2006, at 15:44:20
In reply to Re: Serotonin Syndrome Reaction, posted by Karen44 on June 11, 2006, at 13:40:31
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> Thanks for your response, Scott. My psychiatrist thinks this is what occured with me when the Risperidone was added to the Parnate. I had confusion, slurred speech (not realizing this), would forget what I was saying in the middle of a sentence (not realizing this), mild incoordination, and I suffered from nausea, fluctuating blood pressure, chills and mild fever, involutary movements, stiff muscles and soreness in muscles. I was away from home where no phone service was available including cell phones. I did not know what to do when the confusion got really bad. But since the Risperidone was added to help with sleep at night, I had been taking it only two weeks with increasing symptoms after increasing the dose from .25 to .5 mg in the p.m. I decided to stop the Risperidone, and this brought on almost immediate improvement with the exception of some residual restlessness and involuntary movements that I am told should resolve in another week.
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> My psychiatrist said he researched this (is at a top University and said he has never heard of this before-- with an MAOI and an antipsychotic but said it is possible since both deal with serotonin levels. Thanks for your input.
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>It sounds very likely you were indeed suffering symptoms of serotonin syndrome, given the combination of medications and your symptoms. What many clinicians appear to be unaware of is that serotonin syndrome can propagate through not just the serotonin 2A receptor but through the 1A receptor, as well. This makes it exceedingly problematic given that Risperdal is a strong 2A antagonist and would tend to generally be regarded as an antidote for serotonin syndrome because of the widespread belief that the 2A receptor is the culprit.
However, if a particular individual happens to be vulnerable to serotonin syndrome propagating through the 1A receptor, adding an agent such as Risperdal can actually worsen the situation because blockading the 5-HT2A receptor reinforces the gene expression on 1A. It sounds like this is what happened in your particular case, and serotonin syndrome has also been reported in at least 2 cases where Risperdal was added to the SSRI paroxetine. My feeling is that we may see more case reports of serotonin syndrome in the near future with increased use of the EMSAM patch and concomitant prescription of atypical antipsychotics by unwary clinicians.
Todd
poster:silvercoin
thread:655417
URL: http://www.dr-bob.org/babble/20060610/msgs/656947.html