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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by UgottaHaveHope on December 18, 2006, at 12:47:08
Anyone have any to share? Are there meds to take in case you accidentially mix a MAOI with something you shouldnt? What does it feel like? How do you know if something is wrong?
Posted by laima on December 18, 2006, at 14:00:46
In reply to Serontonin Syndrome experiences???????, posted by UgottaHaveHope on December 18, 2006, at 12:47:08
Thank goodness I never experienced this, my doctor warned me about it- he essentially said that there is not much medicine can do to solve this, other than attempt to stabilize the patient somewhat in the hospital. He really emphasized to me that if one eats the wrong food with an MAOI and gets a hypertensive crisis, that is straightforward enough and can be "solved" with drugs. But he said if one takes the wrong drug with an MAOI and developes a serotonin syndrome, that's much, much more serious and dicey than a hypertyensive crisis. He said vital signs such as heart, temperature, breathing, etc become unstable and go all over the place with the syndrome- I imagine one would feel pretty weird if they had it. It can be fatal.Good to keep in mind that all strengths of Emsam require users to follow drug warnings- most of the warnings are due to possibility of seratonin crisis-the patch is no protection against the possibility.
> Anyone have any to share? Are there meds to take in case you accidentially mix a MAOI with something you shouldnt? What does it feel like? How do you know if something is wrong?
Posted by tessellated on December 18, 2006, at 14:48:50
In reply to Re: Serontonin Syndrome experiences??????? » UgottaHaveHope, posted by laima on December 18, 2006, at 14:00:46
Yeah, I'm pretty sure I had it off high dose parnate a couple times, in the ranges over 120mg/day. I never had a hypertensive reaction. And the symptoms of Serotonin Syndrom are pretty wide and various. My experience was severe muscle rigidity, and chills, which were slept off using xanax typically.
I would like to hear of others experiences as the symptoms are so diverse.
l8
Posted by blueberry1 on December 18, 2006, at 16:27:36
In reply to Serontonin Syndrome experiences???????, posted by UgottaHaveHope on December 18, 2006, at 12:47:08
I think I had serotonin syndrome once. Maybe I've been on the edge of it several times.
The time I am pretty sure of was a month into adding 600mg-900mg st johns wort to ongoing 20mg prozac+5mg zyprexa. St johns wort worked real well for a short time, pooped out, and then I upped the dose to 1200mg. That was trouble. I got chilled, very foggy, dizzy, shakey, and was hit with a deeper depression than I had had in years. I waited it out which took about a day, and then promptly weaned off st johns wort.
Symptoms of serotonin syndrome vary so much. I think it is tricky to diagnose. But one thing for sure is that whatever symptoms they are, they feel very serious and scary.
Posted by laima on December 18, 2006, at 17:42:21
In reply to Re: Serontonin Syndrome experiences???????, posted by blueberry1 on December 18, 2006, at 16:27:36
Oh Blueberry! I think they say now not to take St. John's Wort with an SSRI! I'm glad you're ok.> I think I had serotonin syndrome once. Maybe I've been on the edge of it several times.
>
> The time I am pretty sure of was a month into adding 600mg-900mg st johns wort to ongoing 20mg prozac+5mg zyprexa. St johns wort worked real well for a short time, pooped out, and then I upped the dose to 1200mg. That was trouble. I got chilled, very foggy, dizzy, shakey, and was hit with a deeper depression than I had had in years. I waited it out which took about a day, and then promptly weaned off st johns wort.
>
> Symptoms of serotonin syndrome vary so much. I think it is tricky to diagnose. But one thing for sure is that whatever symptoms they are, they feel very serious and scary.
Posted by Phillipa on December 18, 2006, at 21:30:08
In reply to Re: Serontonin Syndrome experiences??????? » blueberry1, posted by laima on December 18, 2006, at 17:42:21
Definitely ICU. Love Phillipa
Posted by SLS on December 19, 2006, at 5:50:32
In reply to Re: Serontonin Syndrome experiences??????? » blueberry1, posted by laima on December 18, 2006, at 17:42:21
I don't know how helpful this is.
Serotonin Syndrome
Mental status changes
Confusion (51%)
Agitation (34%)
Hypomania (21%)
Anxiety (15%)
Coma (29%)Cardiovascular
Sinus tachycardia (36%)
Hypertension (35%)
Hypotension (15%)Gastrointestinal
Nausea (23%)
Diarrhea (8%)
Abdominal pain (4%)
Salivation (2%)Motor Abnormalities
Myoclonus (58%)
Hyperreflexia (52%)
Muscle rigidity (51%)
Restlessness (48%)
Tremor (43%)
Ataxia/incoordination (40%)
Shivering (26%)
Nystagmus (15%)
Seizures (12%)Other
Diaphoresis (45%)
Unreactive pupils (20%)
Tachypnea (26%)
Hyperpyrexia (45%)
Posted by psychobot5000 on December 20, 2006, at 17:19:41
In reply to Re: Serontonin Syndrome experiences???????, posted by SLS on December 19, 2006, at 5:50:32
As you can see from SLS's post, serotonin syndrome is an unpredictable mess. I have heard it termed a 'hyperpyretic crisis,' but this seems too specific to me. After all, according to SLS's numbers, fever only happens 45% of the time.
I have read of serotonin syndrome begin successfully treated with remeron/mirtazapine, thought. However, I don't think there's any standard treatment, and I would not care to take remeron in such a crisis unless I were very confident my practicioner knew what he was doing--it messes with too much stuff, though I assume its 5HT receptor antagonism is what apparently stops the serotonin syndrome. I wouldn't want to gamble, though.
Also, a google search suggests mirtazapine is blamed for inducing serotonin syndrome in some cases.
Posted by psychobot5000 on December 20, 2006, at 17:23:02
In reply to Serontonin Syndrome experiences???????, posted by UgottaHaveHope on December 18, 2006, at 12:47:08
> Anyone have any to share? Are there meds to take in case you accidentially mix a MAOI with something you shouldnt? What does it feel like? How do you know if something is wrong?
http://en.wikipedia.org/wiki/Serotonin_syndrome
That's the URL of the wikipedia article, which has symptoms organized into three categories and other good information.
They also say:
There is no antidote to the condition itself, but emergency medical clinicians can administer cyproheptadine or methysergide to control the symptoms.[15] Doing so is important as the symptoms can in severe cases be potentially life threatening.
Posted by fuchsia on December 21, 2006, at 6:17:57
In reply to Re: Serontonin Syndrome experiences???????, posted by SLS on December 19, 2006, at 5:50:32
Scott
So do you think you could get only the mental symptoms (or be aware of only the mental symptoms) and the restlessness? And therefor be diagnosed as bipolar II? I just found out I am a 'poor metabolizer' in the P450 2D6 department.
fuchsia
Posted by SLS on December 21, 2006, at 6:51:24
In reply to Re: Serontonin Syndrome experiences??????? » SLS, posted by fuchsia on December 21, 2006, at 6:17:57
> Scott
>
> So do you think you could get only the mental symptoms (or be aware of only the mental symptoms) and the restlessness? And therefor be diagnosed as bipolar II?I guess it is possible, but I would think that there would be other aspects of altered mental status that would be evident along with hypomania. Confusion and delirium often occur. As others have wisely commented, though, the presentation of serotonin syndrome is variable. Not only will different individuals react differently to the same drug, but the same individual will react differently to different drugs. My reaction to Parnate + Effexor was much more intense than that of Nardil + imipramine. Fortunately, my self-experiment with the former did not elicit hyperpyrexia. It did, however, produce delirium and muscle rigidity.
> I just found out I am a 'poor metabolizer' in the P450 2D6 department.
How did you determine this?
- Scott
Posted by yxibow on December 21, 2006, at 13:28:53
In reply to Re: Serontonin Syndrome experiences??????? » fuchsia, posted by SLS on December 21, 2006, at 6:51:24
Partial mild serotonin syndrome. Combination of Robaxin and additional polypharmacy. Robaxin probably upregulated one of the medications and caused heat flashes and some headaches I think -- I dont think pulse changes but I don't recall. Subclinical, and just adjusted the Robaxin down. Older medications like methocarbamol haven't really been challenged through P450 and do create such issues.
Posted by tecknohed on December 21, 2006, at 19:13:05
In reply to Serontonin Syndrome experiences???????, posted by UgottaHaveHope on December 18, 2006, at 12:47:08
I believe I've experienced this on two occasions. Maybe not full blown but bad enough.
The first was entirely my own fault. It was on the same day I had started a course of Seroxat (paroxetine). I ended up dropping 2 or 3 Es at a club. Obviously I felt various effects that were caused by E alone but I certainly 'felt' an over surge of serotonin. Felt like my head would burst, severe teeth chatter & cold sweats. The feeling kept getting stronger by the minute & for many hours. Cant recall everything. Though I'd never felt that from E alone before. My friends took the same pills & were fine.
Anyway, took myself to the A&E where I fell asleep in the waiting area and awoke some 12 hours later in a bed and connected to a blood pressure monitor (?) with a throbbing headache but thats all.The second time was when I switched from Nardil to Marplan. I was told, and was well aware that you're supposed to wait 14 days between stopping & starting such meds (yes, even between MAOIs) but I decided 9 days was enough. After just a couple of days on Marplan's starting dose it just felt too much. Much like the previous incident but more gradual of course. Also felt very hazy headed & drowsy with teeth chattering & grinding as well as insomnia & chills.
After a week Marplin had quite a stimulating effect (I guess by now Nardils prolonged effects had passed).
Posted by Karen44 on December 22, 2006, at 11:14:32
In reply to Re: Serontonin Syndrome experiences???????, posted by SLS on December 19, 2006, at 5:50:32
When I was on Parnate and a low dose antipsychotic to help with sleep (can't remember which one), I ended up with what my pdoc called a Serotonin Syndrome reaction. I was out of the country at the time and didn't know what to do and ultimately stopped the antipscychotic drug; I think it was Seroquel. The symptoms I developed and that got worse over a four to five day period included: confusion, slurred speech, nausea, vomiting, diarrhea, muscle rigidity, tremor, incoordiantion, dizziness, restlessness, and shivering. some symptoms were early on, and some came later. I finally quit the one medication when I started vomiting and was at the toliet all night. The symptoms subsided after I stopped the one med. My pdoc said it was unusual but likely that I had developed Serotonin Sydrome Reaction.
Karen44
> I don't know how helpful this is.
>
>
> Serotonin Syndrome
>
>
> Mental status changes
> Confusion (51%)
> Agitation (34%)
> Hypomania (21%)
> Anxiety (15%)
> Coma (29%)
>
> Cardiovascular
> Sinus tachycardia (36%)
> Hypertension (35%)
> Hypotension (15%)
>
> Gastrointestinal
> Nausea (23%)
> Diarrhea (8%)
> Abdominal pain (4%)
> Salivation (2%)
>
> Motor Abnormalities
> Myoclonus (58%)
> Hyperreflexia (52%)
> Muscle rigidity (51%)
> Restlessness (48%)
> Tremor (43%)
> Ataxia/incoordination (40%)
> Shivering (26%)
> Nystagmus (15%)
> Seizures (12%)
>
> Other
> Diaphoresis (45%)
> Unreactive pupils (20%)
> Tachypnea (26%)
> Hyperpyrexia (45%)
Posted by Karen44 on December 22, 2006, at 11:20:24
In reply to Re: Serontonin Syndrome experiences???????, posted by tecknohed on December 21, 2006, at 19:13:05
Sounds like you had a hypertensiv crisis. 20 plus years ago when on Parnate, I made a suicide attempt by downing a whole box of time released Contac medication. I ended up at the ER, stomach pumped, blood pressure off the charts, headache like I have never felt before, chills,and in cardiac intensive care unit. If I were to think of suicide again, this is definitely something NOT to do. It was a most horrible experience, and I did some slight damage to my heart. EVERYONE< DO NOT MESS AROUND WITH MAOI's.
Karen44
> I believe I've experienced this on two occasions. Maybe not full blown but bad enough.
>
> The first was entirely my own fault. It was on the same day I had started a course of Seroxat (paroxetine). I ended up dropping 2 or 3 Es at a club. Obviously I felt various effects that were caused by E alone but I certainly 'felt' an over surge of serotonin. Felt like my head would burst, severe teeth chatter & cold sweats. The feeling kept getting stronger by the minute & for many hours. Cant recall everything. Though I'd never felt that from E alone before. My friends took the same pills & were fine.
> Anyway, took myself to the A&E where I fell asleep in the waiting area and awoke some 12 hours later in a bed and connected to a blood pressure monitor (?) with a throbbing headache but thats all.
>
> The second time was when I switched from Nardil to Marplan. I was told, and was well aware that you're supposed to wait 14 days between stopping & starting such meds (yes, even between MAOIs) but I decided 9 days was enough. After just a couple of days on Marplan's starting dose it just felt too much. Much like the previous incident but more gradual of course. Also felt very hazy headed & drowsy with teeth chattering & grinding as well as insomnia & chills.
>
> After a week Marplin had quite a stimulating effect (I guess by now Nardils prolonged effects had passed).
Posted by fuchsia on December 23, 2006, at 5:59:15
In reply to Re: Serontonin Syndrome experiences??????? » fuchsia, posted by SLS on December 21, 2006, at 6:51:24
> > I just found out I am a 'poor metabolizer' in the P450 2D6 department.
>
> How did you determine this?
>My doctor ordered a blood test; it's a fairly new one here. According to this test both my CYP2D6 alleles are inactive and this means I am a poor metabolizer.
The enzyme cytochrome P450 2D6 metabolizes a huge number of drugs and many of them are psychotropic.If this interpretation of my results is correct I've been effectively poisoned many times over.
fuchsia
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