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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Judy on May 10, 1999, at 17:55:04
I've seen many references here to Seratonin Syndrome but haven't been able to pin down a complete explanation as to what it is.
Could someone enlighten me?
Posted by Elizabeth on May 11, 1999, at 15:26:15
In reply to Seratonin Syndrome?, posted by Judy on May 10, 1999, at 17:55:04
Yeah. It's a toxic reaction that is usually only seen when serotonergic/serotomimetic drugs are combined. The most dangerous combination is an SSRI (or Effexor, possibly a couple other drugs like Demerol) mixed with an MAOI. More rarely it has been reported with various other combinations (e.g. two SSRIs used together). If you're on an SSRI, you should not use an MAOI, and you probably ought to avoid certain other drugs such as dextromethorphan as well.
The symptoms are rather varied, making it hard to identify the central serotonin syndrome if you don't already know what somebody has ingested. Some of the symptoms:
sweating (very heavy - clothes soaked thorough)
dilated pupils
fever, may progress to malignant hyperthermia
fluctuating vital signs (sometimes hypertension followed by a "crash" leading to shock)
nausea/vomiting
diarrhea
shivering
tremor
muscular rigidity
myoclonus
hyperreflexia
confusion
disorientation
agitation
delirium
seizuresNote that there is a spectrum of serotonin-mediated symptoms, so if you have, say, excessive sweating and dilated pupils, but none of the more severe symptoms, that's not "serotonin syndrome." Again, it's just a difference of degree; you can have some of these symptoms and it's just a nuisance, but full-blown serotonin syndrome is a medical emergency.
Posted by Judy on May 11, 1999, at 17:39:07
In reply to Re: Seratonin Syndrome?, posted by Elizabeth on May 11, 1999, at 15:26:15
Thank you for a very thorough explanation. I have taken MAOI's and know the dangers of mixing them with SSRI's, tyramine and dextromethorphan et al; but I never heard the 'Seratonin Syndrome' term used before.
Where do you come by all this knowledge - have you studied psychopharmacology, or is it info learned out of years of desperation and self-preservartion like most of mine is?
I appreciate it. Thank you.
Posted by Leonora on May 11, 1999, at 18:09:47
In reply to Re: Seratonin Syndrome? Thanks, Elizabeth, posted by Judy on May 11, 1999, at 17:39:07
> I learned about it the hard way-through experience; 60 mgs. of Prozac, Buspar, some sleep drug that didn't make me sleep, self prescribed Melatonin, and that was all she wrote.
I've since seen in print never to mix Melatonin and Prozac. I first went about ten days with very little sleep then finally became delusional and hysterical at work. I teach no less. Aren't all kids sure that their teachers are crazy anyway? Thank goodness a kid who had had a similar experience recognized it and got me to her house where her mom got my relatives. A frigtening experience. I still ended up at the Psych. hospital for a week. Be careful all.
Posted by Elizabeth on May 11, 1999, at 23:47:00
In reply to Re: Seratonin Syndrome? Thanks, Elizabeth, posted by Judy on May 11, 1999, at 17:39:07
> Where do you come by all this knowledge - have you studied psychopharmacology, or is it info learned out of years of desperation and self-preservartion like most of mine is?
I think at first it was a defense mechanism to try to cope with my illness. Then I just kept reading about it because it's cool!
Also, I've had serotonin syndrome.
Posted by Laurie on May 12, 1999, at 20:26:35
In reply to Re: Seratonin Syndrome? Thanks, Elizabeth, posted by Elizabeth on May 11, 1999, at 23:47:00
Maybe you guys can help me here. I was put on Prozac last December for PMS. Two weeks after starting it I woke up with a burning head, neck and shoulders. It never completely went away. Since then I have been put back on antidepressants twice (Prozac again and Pamelor, both very low doses). Both times the burning spread head to toe and was excruciating. I'm now stuck with this pain and am on Neurontin, which only helps somewhat. Obviously I'm hypersensitive to anything that affects my serotonin levels, but what could this be? Neuros keep telling me I have a headache (definately not, I know from experience) and my internist believes the connection but can't explain it. I'm stuck with chronic pain, trying to raise my 3 small children. Any insight?
Posted by Elizabeth on May 14, 1999, at 10:51:31
In reply to Re: Seratonin Syndrome? Thanks, Elizabeth, posted by Laurie on May 12, 1999, at 20:26:35
Laurie,
Huh, I don't know. That's not a serotonin syndrome thing. It might be an allergic reaction. Nortriptyline doesn't actually affect serotonin much.
Did you have a fever or anything, any other symptoms?
-elizabeth
Posted by Laurie on May 14, 1999, at 16:11:41
In reply to burning?, posted by Elizabeth on May 14, 1999, at 10:51:31
> Laurie,
>
> Huh, I don't know. That's not a serotonin syndrome thing. It might be an allergic reaction. Nortriptyline doesn't actually affect serotonin much.
>
> Did you have a fever or anything, any other symptoms?
>
> -elizabethElizabeth,
No fever or anything. It started on Prozac, worsened the second time I took it, and did it on the nortyp, too. It subsides after the drugs work their way out of my system, but never disappears. Actually, parasthesia is listed as a side effect, but mine won't go away. Three times, to me, does not make a coincidence. Just wonder if it'll ever go away.
Posted by Mary on May 14, 1999, at 22:47:11
In reply to burning?, posted by Elizabeth on May 14, 1999, at 10:51:31
I too had burning while on a accidental mixture of paxil and Zoloft ( dumb pharmacist), it felt like a friction burn in my brain. Very hard to describe to someone unless they have had it. I had the syndrome, and was very close to a full blown emergency case. Lucky for me it was discovered in time. Best to you. Mary
Posted by Laurie on May 15, 1999, at 11:54:38
In reply to Re: burning?, posted by Mary on May 14, 1999, at 22:47:11
> I too had burning while on a accidental mixture of paxil and Zoloft ( dumb pharmacist), it felt like a friction burn in my brain. Very hard to describe to someone unless they have had it. I had the syndrome, and was very close to a full blown emergency case. Lucky for me it was discovered in time. Best to you. Mary
Mary,
I've had it for five months with no resolution. Did yours ever go away? I'm taking neurontin for it which only helps marginally. Thanks -- nice to know I'm not the only one. The neurologists keep telling me it's coincidence; obviously it's not after three times with the same effect.
Posted by Elizabeth on May 16, 1999, at 1:03:34
In reply to Re: burning?, posted by Mary on May 14, 1999, at 22:47:11
> I too had burning while on a accidental mixture of paxil and Zoloft ( dumb pharmacist), it felt like a friction burn in my brain. Very hard to describe to someone unless they have had it. I had the syndrome, and was very close to a full blown emergency case. Lucky for me it was discovered in time. Best to you. Mary
Mary,
You described it before in these terms also:
"burning of my head (like a carpet burn to the back of my head inside)."To me that is suggestive of hypertensive crisis, which can be a complicaton of CSS. It feels like a sharp tingling, like my hair is standing on end. The tingling forms a ring on my head, like a halo. Then the back of my head starts to ache, as though I've been hit with something. Other symptoms: nausea, sensitivity to light, dilated pupils, sweating, fever, neck stiffness. The main one, though, is the very severe headache.
Posted by paul on June 2, 1999, at 10:26:15
In reply to Re: burning?, posted by Elizabeth on May 16, 1999, at 1:03:34
Is this a risk? (Elizabeth?)
If not, is there really anything to be gained by combining these two?
Thanks.
Posted by paul on June 2, 1999, at 10:31:00
In reply to Zoloft + 5htp = serotonin syndrome?, posted by paul on June 2, 1999, at 10:26:15
> Is this a risk? (Elizabeth?)
>
> If not, is there really anything to be gained by combining these two?
>
> Thanks.By the way, I take 100 milligrams of Zoloft every day.
Also, can you elaborate (or direct me to more information) on the SSRI/dextromethorphan connection? I've never heard of this.
Thanks again.
Posted by Elizabeth on June 2, 1999, at 12:07:15
In reply to Re: Zoloft + 5htp = serotonin syndrome?, posted by paul on June 2, 1999, at 10:31:00
Basically, don't take cough syrups containing dextromethorphan if you're on SSRIs. This is a double whammie...SSRIs inhibit the metabolism of DXM, and DXM is also serotonergic in some way or other. There have been actual reports of interactions, including some quite severe ones.
I don't know about 5-HTP, although I wouldn't use it myself....
Posted by Mary on June 3, 1999, at 16:44:16
In reply to Re: burning?, posted by Laurie on May 15, 1999, at 11:54:38
Laurie:
The burning went away, but the movement problems still exist. I hope that horrible feeling and pain goes away soon for you because I remember how bad it felt. Good luck. Mary
Posted by Joan on April 3, 2000, at 10:42:07
In reply to Re: burning?, posted by Mary on June 3, 1999, at 16:44:16
> Laurie:
>
> The burning went away, but the movement problems still exist. I hope that horrible feeling and pain goes away soon for you because I remember how bad it felt. Good luck. MaryI have a "burning" that started on the right side of my head back of my right ear, but now has extended to the whole right side of my head. It is intermittant and not excruciating, just annoying. It believe it started when I was on Prozac. I am now on Zoloft.
The doctor hasn't come up with any explanation. Sometimes it feels sinus related. Has anyone else had this symptom? Joan
Posted by David D on October 31, 2000, at 12:37:57
In reply to Re: burning?, posted by Mary on May 14, 1999, at 22:47:11
I have read many of these threads. I was surfing to find an answer to my sweating,irregular body temp. It goes up n down along with Blood Pressure. I get a numbness in my cheeks. Ya weird huh?? Been taking parnate for 3 years and have varied the dose with some sucess. I have never had a Blood Pressure problem.The parnate was getting less effective but still working and then added dextostat to potentiate it. It worked but made these symtoms worse and can last for many days after getting off of all the meds.Any ideas???Thanks David
Posted by JahL on October 31, 2000, at 13:25:11
In reply to Re: Serotonin Syndrome..Parnate, posted by David D on October 31, 2000, at 12:37:57
> I have read many of these threads. I was surfing to find an answer to my sweating,irregular body temp. It goes up n down along with Blood Pressure. I get a numbness in my cheeks. Ya weird huh?? Been taking parnate for 3 years and have varied the dose with some sucess. I have never had a Blood Pressure problem.The parnate was getting less effective but still working and then added dextostat to potentiate it. It worked but made these symtoms worse and can last for many days after getting off of all the meds.Any ideas???Thanks David
Hi David.
What's Dextostat? How does it work?
Thanks,
Jah.
This is the end of the thread.
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