Posted by yxibow on September 14, 2009, at 23:49:26
In reply to 1st bad case of serotonin syndrome, YUCK!!, posted by cactus on September 14, 2009, at 15:06:15
> long story short, taken off 10mg Edronax (high dose) by pdoc, 24hr washout then onto Cymbalta. 2 doses later, very sick boy. Very smart GP picked it up instantly, next day pdoc took my lamictal from 125mg a day to 50mg the next then nothing.
What does the Lamictal have to do with serotonin ? Its a sodium-gate anti-epileptic drug. It has no action directly related to serotonin.
Its also a very good antidepressant in its own right and also in combination with other antidepressants among other things to improve mood and lessen suicidal thoughts.
> The worst of it is over now but I had NO idea Lamictal causes withdrawal, which for me is very similar to SSRI/SNRI but not quite as intense and slower to come on. So for now I'm riding that one out. What a horrible, horrible 9 days, it has been.
I'm sorry to hear you had withdrawal from it. As far as I can see its not supposed to be dropped like a lead brick unless you experience severe rash that could be SJS.In fact if you've been off of Lamictal for parts of a week or so because you've forgotten doses, you have to start the taper all over again for safety's sake.
>
> The thing that bugs me most, is that I told my relatively new pdoc that anything with serotonin doesn't really agree with me but he really forced me to try cymbalta.
I'm not sure about "serotonin not agreeing with you". Most all non-MAOI/etc antidepressants incorporate 5HT manipulation for a reason. But I know that not everyone responds to everything. I tend these days to be a bit off put by noradrenergic agents, opposite to what you seem to be responsive to. And our transmitters aren't set in stone, they change over time with neuroplasticity. So its possible some day that you may respond better to 5HT.
So you're lucky to be in a place that still has reboxetine and as you probably know is an NRI.
But in the US at least, we now have Strattera (atomoxetine).You can read up on NRIs if you want at
http://www.crazymeds.us/nri.html
I feel like a total idiot, I never should have taken it. Luckily I didn't have to go to hospital. The couch is my friend for now. I'll never touch Lamictal again either. I got some Atenolol (beta blocker) for my blood pressure which went up to 170/90. It's usually 110/70.
How much Cymbalta were you given ? Dumping an SNRI will cause a ton of problems. Not 2 days worth though, probably.
It sounds like a lot of medication was dumped and added way too quickly. The actions of all of that plus the anxiety surrounding it is not surprising that you had hypertension.
However the diastolic is more important. 90 is not a high diastolic. The systolic of that rate means you had a temporary disturbance. Excercise alone can raise things temporarily to 200.... but that's actually the point, because it changes resting blood pressure over time.
> Does Atenolol have withdrawal? Now all I have to do is very, very slowly ditch my clonazepam. Then I'll be drug free again. Why don't pdocs listen? Then again why did I listen to him?
Atenolol doesn't have "withdrawal" per se -- if you have been using it for more than a week or so, you should cut down on it slower. Its a heart medication and cardioselective, so don't drop it cold if you're taking it long term. You could have high blood pressure spikes or pulse problems if you do.
Doctors do listen -- unfortunately some aren't the best, and some are rather cursory. I'm sorry you had a bad relationship. You go to a doctor for advice, and if the relationship doesn't agree, you try something else.
At any rate, what you had was not serotonin syndrome. Not that I can tell. Its more likely that you had a bad reaction to Cymbalta, especially if you were given a high dose to start with (e.g. 60mg).
Serotonin syndrome manifests itself in a completely different manner -- in fact, you might not even be aware of it which admittedly is an alarming thought, it causes much more things than a temporary blood pressure (or pulse) spike -- including hallucinations, psychosis, and most notably very high temperature.
Since there is no serotonergic profile in Reboxetine, as noted before, something else happened.
Nonetheless I do share your sympathy. I wouldn't give up on medications -- it sounds like you had a fair scare.I've had nasty situations, Trazodone once caused a pulse rate over 150, which is a possible and known idiosyncratic effect.
There are always side effects. It depends whether the benefits outweigh the risks and whether you can be functional in life without medication, which would be a wonderful place to be, I completely agree.- tidings
Jay
poster:yxibow
thread:917060
URL: http://www.dr-bob.org/babble/20090912/msgs/917136.html