Psycho-Babble Medication Thread 269894

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how serious is serotonin syndrome?

Posted by cybercafe on October 16, 2003, at 4:23:45

i want to cut a couple days off my MAOI washout period and i'm wondering what i'm risking with the possibility of serotonin syndrome

i was thinking of taking my first dose in the local emergency room, ... if i develop SS or hyperpyrexia do the doctors just put some ice on your forehead and after a couple hours you feel all better?

 

Re: how serious is serotonin syndrome? » cybercafe

Posted by Liligoth on October 16, 2003, at 6:27:29

In reply to how serious is serotonin syndrome?, posted by cybercafe on October 16, 2003, at 4:23:45

> i want to cut a couple days off my MAOI washout >period and i'm wondering what i'm risking with >the possibility of serotonin syndrome

cybercafe I think you will be risking your life with serotonin syndrome. It's not a minor event. It's only a couple of days extra, wait the full washout period! It's not worth it.
pls take care

 

Re: how serious is serotonin syndrome?

Posted by djmmm on October 16, 2003, at 7:57:38

In reply to Re: how serious is serotonin syndrome? » cybercafe, posted by Liligoth on October 16, 2003, at 6:27:29

> > i want to cut a couple days off my MAOI washout >period and i'm wondering what i'm risking with >the possibility of serotonin syndrome
>
> cybercafe I think you will be risking your life with serotonin syndrome. It's not a minor event. It's only a couple of days extra, wait the full washout period! It's not worth it.
> pls take care
>
>

serotonin syndrome is most often a minor event, it depends on the medications combined and your own "personal" response. Most cases of serotonin syndrome are mild and resolve themselves. I switched to a MAOI (from a serotonin drug) in just a couple of days, and I switched between two MAOIs within the same day. It really depends on you.

If you are considering taking off a couple days of the traditional MAOI wash-out period; I would first talk to your Dr. about it...like the extensive no-no food list, the "wash-out" period is a little excessive.

 

Re: how serious is serotonin syndrome? » cybercafe

Posted by Sebastian on October 16, 2003, at 12:40:06

In reply to how serious is serotonin syndrome?, posted by cybercafe on October 16, 2003, at 4:23:45

You will be alright! Have you tried any yet? Maybe that will give you a sence of what to expect. WARNING: I know nothing about MAIO's but seems to be the case with any other med.

 

Re: how serious is serotonin syndrome?

Posted by T_R_D on October 16, 2003, at 12:40:48

In reply to how serious is serotonin syndrome?, posted by cybercafe on October 16, 2003, at 4:23:45

> i want to cut a couple days off my MAOI washout period and i'm wondering what i'm risking with the possibility of serotonin syndrome
>
> i was thinking of taking my first dose in the local emergency room, ... if i develop SS or hyperpyrexia do the doctors just put some ice on your forehead and after a couple hours you feel all better?

If you can go the distance of the washout, don't risk it. I've suffered from Serotonin Syndrome before and it's not pretty.

 

Re: how serious is serotonin syndrome?

Posted by cybercafe on October 16, 2003, at 13:13:56

In reply to Re: how serious is serotonin syndrome?, posted by T_R_D on October 16, 2003, at 12:40:48

> > i want to cut a couple days off my MAOI washout period and i'm wondering what i'm risking with the possibility of serotonin syndrome
> >
> > i was thinking of taking my first dose in the local emergency room, ... if i develop SS or hyperpyrexia do the doctors just put some ice on your forehead and after a couple hours you feel all better?
>
> If you can go the distance of the washout, don't risk it. I've suffered from Serotonin Syndrome before and it's not pretty.


what was it like? just uncomfortable, or was your life actually in danger?

 

Re: how serious is serotonin syndrome?

Posted by stjames on October 16, 2003, at 13:41:21

In reply to Re: how serious is serotonin syndrome?, posted by djmmm on October 16, 2003, at 7:57:38

serotonin syndrome is most often a minor event,

I don't call death & autonomic NS disfunction
a "minor" event. I think your advise is dangerious.

 

Re: how serious is serotonin syndrome?

Posted by cybercafe on October 17, 2003, at 4:21:20

In reply to Re: how serious is serotonin syndrome?, posted by stjames on October 16, 2003, at 13:41:21

> serotonin syndrome is most often a minor event,
>
> I don't call death & autonomic NS disfunction
> a "minor" event. I think your advise is dangerious.

sorry guys i know this is a question for my doc but he has disappeared (!)

i know it can cause coma, hyperpyrexia (is that easily treatable?), and rhabdonolysis but i just don't know how common they are ...

especially considering that it's only the difference between a 10 day and a 14 day washout
... i'm imagining that if taking an MAOI and SSRI at the same time would produce serious effects, after a 10 day washout they would be much less serious? any have personal experience to share?

 

Re: how serious is serotonin syndrome?

Posted by djmmm on October 17, 2003, at 6:44:10

In reply to Re: how serious is serotonin syndrome?, posted by stjames on October 16, 2003, at 13:41:21

> serotonin syndrome is most often a minor event,
>
> I don't call death & autonomic NS disfunction
> a "minor" event. I think your advise is dangerious.

What I stated is based on scientific fact..and according to statistics, most cases of serotonin syndrome ARE mild, and resolve spontaneously. Treatment for the vast majority of cases is considered "supportive"

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9255139&dopt=Abstract

Also, the only advice I gave was (and I quote MY own previous post):

"If you are considering taking off a couple days of the traditional MAOI wash-out period; I would first talk to your Dr. about it..."

I hardly consider that "dangerous"

 

Re: how serious is serotonin syndrome?

Posted by stjames on October 17, 2003, at 13:50:33

In reply to Re: how serious is serotonin syndrome?, posted by djmmm on October 17, 2003, at 6:44:10

"The serotonin syndrome is a hypersotonergic state which is a very dangerous and a potentially fatal side effect of serotonergic enhancing drugs which can have multiple psychiatric and non-psychiatric symptoms. It is a condition which has been on the rise since the 1960's when we began using more and more drugs which directly affect serotonin. This is a toxic condition which requires heightened clinical awareness in order to prevent, recognize, and treat the condition promptly. Promptness is vital because, as we just mentioned, the serotonin syndrome can be fatal and death from this side effect can come very rapidly. This syndrome is a toxic hyperserotonergic state whose rate of incidence is unknown, but is on the rise. The suspected cause of that increase is the introduction of the new selective serotonergic enhancing agents in clinical practice - the SSRIs. This disorder, brought on by excessive levels of serotonin, is difficult to distinguish from the neuroleptic malignant syndrome because the symptoms are so similar. The neuroleptic malignant syndrome is a serious condition brought on by the use of the neuroleptic drugs.

"The symptoms of the serotonin syndrome are: euphoria, drowsiness, sustained rapid eye movement, overreaction of the reflexes, rapid muscle contraction and relaxation in the ankle causing abnormal movements of the foot, clumsiness, restlessness, feeling drunk and dizzy, muscle contraction and relaxation in the jaw, sweating, intoxication, muscle twitching, rigidity, high body temperature, mental status changes were frequent (including confusion and hypomania - a "happy drunk" state), shivering, diarrhea, loss of consciousness and death. (The Serotonin Syndrome, AM J PSYCHIATRY, June 1991)

 

Re: how serious is serotonin syndrome?

Posted by stjames on October 17, 2003, at 14:06:05

In reply to Re: how serious is serotonin syndrome?, posted by stjames on October 17, 2003, at 13:50:33

http://www.cmaj.ca/cgi/content/full/169/6/543

CMAJ • September 16, 2003; 169 (6)
© 2003 Canadian Medical Association or its licensors

--------------------------------------------------------------------------------
Letters
--------------------------------------------------------------------------------
Correspondance

Serotonin syndrome: not a benign toxidrome
Sarah Garside* and Patricia I. Rosebush
*Clinical Scholar, Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ont. ; Associate Professor, Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ont.

Philippe Birmes and associates1 suggest that serotonin syndrome is a less serious condition than neuroleptic malignant syndrome (NMS), but this has not been our experience.2,3,4,5 In our prospective study of serotonin syndrome,4,5 6 of the 16 patients experienced disseminated intravascular coagulation (DIC), rhabdomyolysis and hypotension necessitating admission to the intensive care unit. Acute renal failure developed in 2 patients, and 1 patient died.

Table 2 in the article by Birmes and associates1 does not capture the key differences between NMS and serotonin syndrome. Both conditions can be fulminant, and patients may present with delirium, hyperthermia, rhabdomyolysis, dilated pupils, tachycardia, daphoresis, rigidity and blood pressure changes2,3,4,5 (see Table 1 with this letter). The main difference lies in the clinical gestalt: typically a patient with serotonin syndrome is agitated, speaks incoherently and has prominent myoclonus, whereas a patient with NMS is immobile, mute and staring. Although rhabdomyolysis is a complication of both toxidromes, DIC, seizures, ventricular tachycardia and severe hypotension are extremely rare in NMS.2


View this table:
[in this window]
[in a new window]
Table 1.

We agree with the mainstays of treatment suggested by Birmes and associates,1 but we also advise monitoring of vital signs, platelet count, muscle enzymes and myoglobin twice daily for at least 72 hours. We have serious concerns about the use of chlorpromazine and propranolol for serotonin syndrome. Both drugs decrease blood pressure, which will exacerbate the hard-to-treat hypotension that can occur in serotonin syndrome; in addition, chlorpromazine may precipitate NMS. An absolute contraindication for the use of propranolol is a history of asthma, which is difficult to elicit if the patient is delirious. Finally, it is important to advise patients taking serotonergic agents about the risks of this potentially serious and fulminant syndrome.

Sarah Garside Clinical Scholar Patricia I. Rosebush Associate Professor Department of Psychiatry and Behavioural Neuroscience McMaster University Hamilton, Ont.

References


Birmes P, Coppin D, Schmitt L, Lauque D. Serotonin syndrome: a brief review. CMAJ 2003; 168(11):1439-42.[Free Full Text]
Rosebush PI, Mazurek MF. Neuroleptic malignant syndrome: differential diagnosis, treatment and medical–legal implications. Essential Psychopharmacol 2003;5(3). In press.
Rosebush PI, Stewart T. A prospective analysis of 24 episodes of neuroleptic malignant syndrome. Am J Psychiatry 1989;146(6):717-25.[Abstract]
Garside S, Rosebush PI. The neuroimmunology of antidepressant medication: serotonin syndrome as a manifestation of the acute phase response [abstract]. Soc Neurosci 2001;27:1750.
Rosebush P, Garside S, Levinson A, Schroeder JA, Richards C, Mazurek M. Serotonin syndrome: a case series of 16 patients [abstract]. Ann Neurol 2002;52:554.

 

Re: how serious is serotonin syndrome?

Posted by T_R_D on October 17, 2003, at 15:47:13

In reply to Re: how serious is serotonin syndrome?, posted by cybercafe on October 16, 2003, at 13:13:56

Oh no! I was perfectly safe! Just very, very sick. Kind of like Effexor withdrawal but no "bran zaps." A really, really bad headache replaced those...achy joints, twitchy legs, my skin felt like it was crawling...and mentally, even though I was stable I *felt* slightly psychotic...not in the clinical sense...I can't really find another word that describes it... I certainly felt like I was becoming "unhinged" but not like slipping into a depression. It was a faster, more violent feeling...like WHAM! You're crazy!

Does that make sense :) I don't think I'm describing it very well and it was a long time ago...I've had so many experiences with meds over the years that they all tend to blur at times...haha

Take care,
Karen

 

Re: how serious is serotonin syndrome? » cybercafe

Posted by jerrympls on October 20, 2003, at 23:57:19

In reply to how serious is serotonin syndrome?, posted by cybercafe on October 16, 2003, at 4:23:45

> i want to cut a couple days off my MAOI washout period and i'm wondering what i'm risking with the possibility of serotonin syndrome
>
> i was thinking of taking my first dose in the local emergency room, ... if i develop SS or hyperpyrexia do the doctors just put some ice on your forehead and after a couple hours you feel all better?

This past weekend I experienced FULL THROTTLE the effects of serotonin syndrome due to mistakenly taking Nyquil with nardil. Within 15 mins, I was shaking so bad I could barely dial 911. I was almost incoherant on the phone. Luckily the Ambulance was here in 2 mins. I couldn't stop shaking - VIOLENT shaking and sweating. They zipped me to the ER and pu tme ICU and gave me ativan to stop the tremors and shaking and gave me adequate doses of Periactin - which is really an antihistamaine - but it reverses the serotonin syndrome somehow. After about 2-3 hours of non-stop shaking - almost to the point of falling out of the bed many times - they thought I had kidney failure because I couldn't urinate.

So i stayed overnight and they continued the meds and stopped me cold turkey on Nardil. The only thing I felt was some brain zaps from stopping th Nardil so quickly. they kept me on Ativan and Periactin for a day then restarted me on Nardil and sent me home.

It was a HORRIBLE HORRIBLE HORRIBLE experience and frightening to say the least.I didn't know the human body could shake so violently.

So, for all you MAOI "users" out there - be VERY CAREFUl of over the counter meds - like cough meds (dextromethorphan) and Sudafed. I just wasn't thinking when I took some. I will be MUCH MUCH MUCH more cautious in the future.

Hope this helps

Jerry

 

HOW FAST does serotonin syndrome set in?

Posted by cybercafe on October 21, 2003, at 6:00:05

In reply to Re: how serious is serotonin syndrome? » cybercafe, posted by jerrympls on October 20, 2003, at 23:57:19

i just took some parnate at 5:23 am today (1.5 hours ago) and am wondering how long would it take for serotonin symdrome to set in?

 

Re: HOW FAST does serotonin syndrome set in? » cybercafe

Posted by Sebastian on October 21, 2003, at 21:31:11

In reply to HOW FAST does serotonin syndrome set in?, posted by cybercafe on October 21, 2003, at 6:00:05

I would guess when your body has had enough, and you start feeling sick. Probably when the med is at peak concentration for a long enough time, when ever that is. All you have to do is stop taking it when simptoms set in. If you don't think you can handle the effects you stop.

Hows Abilify? What meds are you taking?

Sebastian

 

Re: HOW FAST does serotonin syndrome set in?

Posted by cybercafe on October 22, 2003, at 0:15:59

In reply to Re: HOW FAST does serotonin syndrome set in? » cybercafe, posted by Sebastian on October 21, 2003, at 21:31:11

> I would guess when your body has had enough, and you start feeling sick. Probably when the med is at peak concentration for a long enough time, when ever that is. All you have to do is stop taking it when simptoms set in. If you don't think you can handle the effects you stop.
>
> Hows Abilify? What meds are you taking?

hey Sebastian, long time no chat ....

i started taking parnate before my washout was up, but have been okay ..... i tried combining some ritalin with the parnate, and my blood pressure went up 15 - 20 points... so i will probably try to hunt down my doc before trying it again

abilify is great, no real side effects, maybe less need for sleep ? ... with parnate i could really use a sleeping pill

i also need a benzo but have run out a while ago .... ug

i guess i should say that i go out and hang out with people and pass as normal so i can't really complain :)

how are you doing?

 

Re: HOW FAST does serotonin syndrome set in? » cybercafe

Posted by Sebastian on October 22, 2003, at 12:24:03

In reply to Re: HOW FAST does serotonin syndrome set in?, posted by cybercafe on October 22, 2003, at 0:15:59

Still trying to break my social phobia. Chating on the dating service, lots. Going to the gym, but still have a hard time trying to get know people in person. That 'was' so not me.

 

Re: HOW FAST does serotonin syndrome set in?

Posted by cybercafe on October 22, 2003, at 22:04:23

In reply to Re: HOW FAST does serotonin syndrome set in? » cybercafe, posted by Sebastian on October 22, 2003, at 12:24:03

> Still trying to break my social phobia. Chating on the dating service, lots. Going to the gym, but still have a hard time trying to get know people in person. That 'was' so not me.

go out with a friend who wants to do the same (chat up other groups of people)

found any free dating services?

in an attempt to stay on topic: i hope the downregulation i went through with celexa means parnate will work faster for me -- i'd hate to have to wait 3 months again!

 

Re: HOW FAST does serotonin syndrome set in? » cybercafe

Posted by Sebastian on October 23, 2003, at 12:40:46

In reply to Re: HOW FAST does serotonin syndrome set in?, posted by cybercafe on October 22, 2003, at 22:04:23

I've tried the free dating service, but had not good results, or any for that mater. The other two pay ones work much better. I have one person shating through email, so that is free. There was another through email, but not interesting. Just need to wait till someone wants to hang out.

How long have you switched AD's. What one do you take now. What is different, sleepiness? Do you miss the Celexa? Was there any withdraw?

 

Re: HOW FAST does serotonin syndrome set in?

Posted by cybercafe on October 23, 2003, at 14:32:58

In reply to Re: HOW FAST does serotonin syndrome set in? » cybercafe, posted by Sebastian on October 23, 2003, at 12:40:46

> I've tried the free dating service, but had not good results, or any for that mater. The other two pay ones work much better. I have one person shating through email, so that is free. There was another through email, but not interesting. Just need to wait till someone wants to hang out.

yeah... that's cool man :) i wish you the best of luck


> How long have you switched AD's. What one do you

switched ADs about a month ago (started decreasing Celexa)

>take now. What is different, sleepiness? Do you

i'm taking the MAOI parnate now..... it causes less sleep instead of more ...

plus i don't think it blunts your emotions like celexa

>miss the Celexa? Was there any withdraw?

yeah i had to go without an antidepressant for 10 days. doesn't sound like much.. but even when i started decreasing celexa i felt the depression come back and more anxiety........ (celexa is really good for anxiety, i think) .... on the bright side, my sex drive went way way up when i decreased it .......

now my only problems are blood pressure... did you find abilify raised your blood pressure? ...... i think i might go back on low dose zyprexa if that is the case

 

Re: HOW FAST does serotonin syndrome set in?

Posted by Sebastian on October 24, 2003, at 20:06:34

In reply to Re: HOW FAST does serotonin syndrome set in?, posted by cybercafe on October 23, 2003, at 14:32:58

I have no idea. The thought never crossed my mind. And I never tested my presure.


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