![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by artist on April 5, 2004, at 8:53:57
thanks loads for all the replys. some of you seem very informed. it seems the ectasy and effexor won't mix.just out of intrest what does seratonin poisening do? is it fatal?
Posted by linkadge on April 5, 2004, at 10:08:58
In reply to effexor and ectasy, posted by artist on April 5, 2004, at 8:53:57
Yes it is potentially fatal, not to mention very neurotoxic. You're trying to get better from a mental illness, not make it worse.
Linkadge
Posted by scott-d-o on April 5, 2004, at 12:07:19
In reply to effexor and ectasy, posted by artist on April 5, 2004, at 8:53:57
> thanks loads for all the replys. some of you seem very informed. it seems the ectasy and effexor won't mix.just out of intrest what does seratonin poisening do? is it fatal?
no need to worry about serotonin syndrome from this combination. ecstasy (3,4-methylenedioxyamphetamine) releases serotonin via reversing the action of the serotonin transporter (SERT), causing it to release serotonin into the synapse instead of taking it up into the cell like it normally does. effexor would almost entirely block any serotonin release induced by mdma, via it's occupation of the SERT. however, the supposed neurotoxicity of mdma is believed to be caused by excess dopamine at serotonin terminals. this seems to be a bunch of b/s thou and doesn't occur when the compound is used at common "recreational" doses.
Posted by King Vultan on April 5, 2004, at 12:08:50
In reply to effexor and ectasy, posted by artist on April 5, 2004, at 8:53:57
> thanks loads for all the replys. some of you seem very informed. it seems the ectasy and effexor won't mix.just out of intrest what does seratonin poisening do? is it fatal?
Serotonin syndrome is thought to be related to overstimulation of serotonin receptors, particularly the 1A receptor from what I have read. It has the potential to be fatal, but I don't know exactly what the mortality rate is.Todd
Posted by PsychoSage on April 5, 2004, at 13:04:30
In reply to Re: effexor and ectasy, posted by scott-d-o on April 5, 2004, at 12:07:19
> > thanks loads for all the replys. some of you seem very informed. it seems the ectasy and effexor won't mix.just out of intrest what does seratonin poisening do? is it fatal?
>
> no need to worry about serotonin syndrome from this combination. ecstasy (3,4-methylenedioxyamphetamine) releases serotonin via reversing the action of the serotonin transporter (SERT), causing it to release serotonin into the synapse instead of taking it up into the cell like it normally does. effexor would almost entirely block any serotonin release induced by mdma, via it's occupation of the SERT. however, the supposed neurotoxicity of mdma is believed to be caused by excess dopamine at serotonin terminals. this seems to be a bunch of b/s thou and doesn't occur when the compound is used at common "recreational" doses.Wait a second. Is this hypothetical or official information from NIDA?
It doesn't make sense whatsoever. We often through around our imperfect interpretations of studies and medical information, but I think when it comes to this particular issue where no doctor is accountable then we have to raise the bar here and not confuse neurotoxic rhetoric from the government with serotonin syndrome which is not a principal argument from anyone who wants to scare American youth away from ecstacy.
If you think the warnings about serotonin syndrome here are influenced by flawed neurotoxicity research then you are entirely wrong.
I am not keen on neuroscience specifics, but an agonist and a reuptake inhibitor do not cancel each other out.
Specific Drug interactions and Serontonin syndrome:
http://www.currentpsychiatry.com/2003_05/0503_serotonin.asp
Posted by rod on April 5, 2004, at 16:17:14
In reply to Re: effexor and ectasy -LINK » scott-d-o, posted by PsychoSage on April 5, 2004, at 13:04:30
> > > thanks loads for all the replys. some of you seem very informed. it seems the ectasy and effexor won't mix.just out of intrest what does seratonin poisening do? is it fatal?
> >
> > no need to worry about serotonin syndrome from this combination. ecstasy (3,4-methylenedioxyamphetamine) releases serotonin via reversing the action of the serotonin transporter (SERT), causing it to release serotonin into the synapse instead of taking it up into the cell like it normally does. effexor would almost entirely block any serotonin release induced by mdma, via it's occupation of the SERT. however, the supposed neurotoxicity of mdma is believed to be caused by excess dopamine at serotonin terminals. this seems to be a bunch of b/s thou and doesn't occur when the compound is used at common "recreational" doses.
>
> Wait a second. Is this hypothetical or official information from NIDA?
>
> It doesn't make sense whatsoever. We often through around our imperfect interpretations of studies and medical information, but I think when it comes to this particular issue where no doctor is accountable then we have to raise the bar here and not confuse neurotoxic rhetoric from the government with serotonin syndrome which is not a principal argument from anyone who wants to scare American youth away from ecstacy.
>
> If you think the warnings about serotonin syndrome here are influenced by flawed neurotoxicity research then you are entirely wrong.
>
> I am not keen on neuroscience specifics, but an agonist and a reuptake inhibitor do not cancel each other out.
>
> Specific Drug interactions and Serontonin syndrome:
> http://www.currentpsychiatry.com/2003_05/0503_serotonin.asp<nerd mode turned on>
Scott-d-o is perfectly right. Thats what current science knows about this. I have a good paper, but ist a pdf and i dont have a link and the copy and paste function does not work whyever. But here is something similar good:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12404538
"..Citalopram markedly reduced most of the subjective effects of MDMA, including positive mood, increased extraversion and self-confidence. Cardiovascular and adverse effects of MDMA were also attenuated by citalopram.."And about your link. this person was taking Lithium plus Phenelzine (Nardil MAOI). Thats a really bad idea
And MDMA is not a direct serotonin agonist. It does not dock and tickle the receptor directly. Like Scott-d-o said, it causes the release, which gets blocked by an SSRI.
<nerd mode turned off>
Dont waste your money. It wont work. And dont risk anything, cause you never really know what you actually get... It just doesnt make sense to take a drug which is known to cause or worsens various mental disorders, if one already has problems and takes a medication to treat this.
Roland
Posted by linkadge on April 5, 2004, at 16:18:42
In reply to Re: effexor and ectasy -LINK » scott-d-o, posted by PsychoSage on April 5, 2004, at 13:04:30
Correct me if I'm wrong, but a reputake inhibitor could potentially increase the toxicity caused by MDMA.
MDMA causes serotonin to be released from the terminals, and a reputake inhibitor would stop it from being metabolised. This would equal an increased level at the synapse.
Whats wrong with you anyway? I mean really. All of us here are trying to get better from a mental illness. If you're on an antidepressant that means you were depressed at one point. Just cause you're feeling better doesn't mean its time to go ahead and start abusing your brain. Forget the theory, it's just plain a bad idea.
Linkadge
Posted by scott-d-o on April 5, 2004, at 16:22:54
In reply to Re: effexor and ectasy -LINK » scott-d-o, posted by PsychoSage on April 5, 2004, at 13:04:30
> >
> > no need to worry about serotonin syndrome from this combination. ecstasy (3,4-methylenedioxyamphetamine) releases serotonin via reversing the action of the serotonin transporter (SERT), causing it to release serotonin into the synapse instead of taking it up into the cell like it normally does. effexor would almost entirely block any serotonin release induced by mdma, via it's occupation of the SERT. however, the supposed neurotoxicity of mdma is believed to be caused by excess dopamine at serotonin terminals. this seems to be a bunch of b/s thou and doesn't occur when the compound is used at common "recreational" doses.
>
> Wait a second. Is this hypothetical or official information from NIDA?
>It's based primarily on personal knowledge of pharmacology/biochemistry and testimonials from people who have had experiences with such combinations.
> It doesn't make sense whatsoever. We often through around our imperfect interpretations of studies and medical information, but I think when it comes to this particular issue where no doctor is accountable then we have to raise the bar here and not confuse neurotoxic rhetoric from the government with serotonin syndrome which is not a principal argument from anyone who wants to scare American youth away from ecstacy.
>I wasn't trying to equate serotonin syndrome with mdma neurotoxicity. the poster was seeking information regarding the risks involved in consuming such compounds, and I provided that. I don't claim to have a ph.d so you can take my information for whatever it's worth to you.
> If you think the warnings about serotonin syndrome here are influenced by flawed neurotoxicity research then you are entirely wrong.
>this is a misinterpretation, the neurotoxicity matter was just additional information I was providing the poster about the risks involved.
> I am not keen on neuroscience specifics, but an agonist and a reuptake inhibitor do not cancel each other out.
>obviously not, because mdma is not a direct agonist. as explained in my previous post, it works by reversing the reuptake carrier and causing it to release 5-HT/DA/NE instead of transporting it back into the cell. thus the receptors are agonised by the endogenous monoamine, not the compound itself. hopefully this will clear things up:
lets take a look at the function of the serotonin transporter:
normal conditions: serotonin transporter takes up released serotonin from the synapse and stores it back inside the cell (sort of like recycling.)
ssri: serotonin transporter is blocked (doesn't do anything). released serotonin is allowed to hang around outside the cell and find a receptor or get broken down/metabolized by MAO-A.
mdma: binds onto serotonin transporter and *reverses* it's normal function. instead of taking serotonin up from the synapse, 5-HT is taken up from within the cell and released out into the extracellular space, kinda like taking reuptake inhibition one step further, by not just blocking reuptake but also pointing it in the opposite direction.
mdma + ssri: ssri is blocking serotonin transporter, mdma cannot "knock" ssri off to bind to it and reverse its function. result: nothing, not a very fun trip.
by the way, amphetamine and methamphetamine work the same way except they function mostly at the dopamine and norepinephrine transporters. methamphetamine is slightly serotonergic as well.
> Specific Drug interactions and Serontonin syndrome:
> http://www.currentpsychiatry.com/2003_05/0503_serotonin.aspnotice, the drug interaction cited is taking mdma with a maoi, NOT a ssri. This is a whole different matter and I can definitely see how such a combination could cause serotonin syndrome.
scott
Posted by scott-d-o on April 5, 2004, at 16:40:59
In reply to Re: effexor and ectasy -LINK, posted by linkadge on April 5, 2004, at 16:18:42
> Correct me if I'm wrong, but a reputake inhibitor could potentially increase the toxicity caused by MDMA.
>
> MDMA causes serotonin to be released from the terminals, and a reputake inhibitor would stop it from being metabolised. This would equal an increased level at the synapse.
>exhaustingly explained in another post in this thread. reuptake transporters don't metabolize serotonin; monoamine oxidase-A (MAO-A) does. for the answer to why ssri's attenuate mdma-induced 5-HT release, see my other post.
> Whats wrong with you anyway? I mean really. All of us here are trying to get better from a mental illness. If you're on an antidepressant that means you were depressed at one point. Just cause you're feeling better doesn't mean its time to go ahead and start abusing your brain. Forget the theory, it's just plain a bad idea.
>What's wrong with me? I apologize for trying to clear up all the misinformation being passed around here. I think people would rather hear the real deal instead of a "just say no" response plagued with false information. I'm not advocating mdma's use, I was merely setting the record straight. He's going to do whatever he wants with his brain regardless of your scare tactics and misinformation. I happen to believe human beings are intelligent and capable enough to make these types of decisions regarding their own body.
scott
Posted by linkadge on April 5, 2004, at 18:52:22
In reply to Re: effexor and ectasy -LINK, posted by scott-d-o on April 5, 2004, at 16:40:59
You will have to excuse my concern, a relative and close friend of mine just died from the use of MDMA. Unlike what many are led to believe, this drug wasn't made illegal to spoil people's fun.
I'm sure that *most* people are smart enought to make a decision such as this however, clearly people can gain a false sence of security from their believed knowledge of the workings of the brain.
I also take personal offence when somebody comes on a board designed for support and rehabilitation to ask a question as reckless as this.
My main point is this. Somebody shouldn't base their decision to take an illicit and potentially lethal drug based on theory or scientific probability. What we should really be focusing on here is how to heal the brain, not get high and avoid the consequences.
My 2 cents.
Linkadge
Posted by PsychoSage on April 5, 2004, at 19:17:47
In reply to Re: effexor and ectasy -LINK, posted by scott-d-o on April 5, 2004, at 16:40:59
> > Correct me if I'm wrong, but a reputake inhibitor could potentially increase the toxicity caused by MDMA.
> >
> > MDMA causes serotonin to be released from the terminals, and a reputake inhibitor would stop it from being metabolised. This would equal an increased level at the synapse.
> >
>
> exhaustingly explained in another post in this thread. reuptake transporters don't metabolize serotonin; monoamine oxidase-A (MAO-A) does. for the answer to why ssri's attenuate mdma-induced 5-HT release, see my other post.
>
> > Whats wrong with you anyway? I mean really. All of us here are trying to get better from a mental illness. If you're on an antidepressant that means you were depressed at one point. Just cause you're feeling better doesn't mean its time to go ahead and start abusing your brain. Forget the theory, it's just plain a bad idea.
> >
>
> What's wrong with me? I apologize for trying to clear up all the misinformation being passed around here. I think people would rather hear the real deal instead of a "just say no" response plagued with false information. I'm not advocating mdma's use, I was merely setting the record straight. He's going to do whatever he wants with his brain regardless of your scare tactics and misinformation. I happen to believe human beings are intelligent and capable enough to make these types of decisions regarding their own body.
>
> scottThe real deal is that I suffered from serotonin syndrome/amphetamine poisoning {however you want to look at it} twice in two weeks on different sides of the country with EFFEXOR, and I was on nothing else. Both times were with meth, and they were not from the same source. I was in the hospital both times. Embarrassingly, the second time was at my university's hospital.
I am indifferent as to whether MDMA causes direct or indirect
serotonin release. I watched a friend who was on prozac when she was unable to appreciate any of the pleasureable feelings from her pill, and she was kind of pissed. Then she became incredibly ill with the classic serotonin syndrome symptoms.An SSRI or an SNRI doesn't merely dampen the effects of a pill of E. Whether the pill becomes useless for recreational purposes and if the pill and the medication actually cause illness could be two situations along the same continuum which ultimately ends at fatal serotonin poisoning as far as I am concerned.
Anyways, if you choose to be risky, stop your meds for 1-2 weeks period.
Personally, I feel the bad information out there about ecstacy can be pretty well isolated.
http://www.maps.org/forum/2003/msg00573.html in this link is a full copy of the nytimes.com article and another link to the original article in the nytimes.com but sometimes an article may be archived and will require a fee to access it.
Posted by PsychoSage on April 5, 2004, at 19:57:30
In reply to Re: effexor and ectasy -LINK -nytimes.com, posted by PsychoSage on April 5, 2004, at 19:17:47
http://uuhsc.utah.edu/poison/healthpros/utox/Vol4_No4.pdf
looks to me like they both increase serotonin however you want to look at it.
I found the same information that is in this thread that says that it is a waste of money to roll on an SSRI on a website called bluelight that promotes drug experimentation, and it's heavily flawed. Some poster produced a lengthy list of potential drug interactions between psych and recreational drugs, and it's truly laughable.
Anyhow, it's true that a lot of serotonin syndrome cases resolve themselves, but it's still an unpleasant experience. You also don't want to be in that group of people who end up in a coma.
All I truly know from my experiences several years ago is that EFFEXOR +METH = my death. I was really ignorant because i knew what Serotonin Syndrome was, but I just equated it with MDMA. I avoided MDMA while I was on Zoloft, so I never knew that particular combination and its subsequent displeasure. I had no clue that meth was serotonergic also, and that contrast highlights the difference between it and cocaine.
I have plenty of experience with piling on the noradrenergic and dopaminergic fun stuff, and that did not do my body any good, but it did not make me emergency room material.
Lastly, for the layperson it makes simple sense. Effexor has been implicated in many serotonin toxicity cases with or without MDMA. MDMA has definitely been implicated in a lot of serotonin toxicity cases. If you take them together, I think they would kick your but.
Posted by PsychoSage on April 5, 2004, at 20:14:37
In reply to Re: effexor/E --MORE LINKS serotonin syndrome, posted by PsychoSage on April 5, 2004, at 19:57:30
> http://uuhsc.utah.edu/poison/healthpros/utox/Vol4_No4.pdf
>
> looks to me like they both increase serotonin however you want to look at it.
>
> I found the same information that is in this thread that says that it is a waste of money to roll on an SSRI on a website called bluelight that promotes drug experimentation, and it's heavily flawed. Some poster produced a lengthy list of potential drug interactions between psych and recreational drugs, and it's truly laughable.
>
> Anyhow, it's true that a lot of serotonin syndrome cases resolve themselves, but it's still an unpleasant experience. You also don't want to be in that group of people who end up in a coma.
>
> All I truly know from my experiences several years ago is that EFFEXOR +METH = my death. I was really ignorant because i knew what Serotonin Syndrome was, but I just equated it with MDMA. I avoided MDMA while I was on Zoloft, so I never knew that particular combination and its subsequent displeasure. I had no clue that meth was serotonergic also, and that contrast highlights the difference between it and cocaine.
>
> I have plenty of experience with piling on the noradrenergic and dopaminergic fun stuff, and that did not do my body any good, but it did not make me emergency room material.
>
> Lastly, for the layperson it makes simple sense. Effexor has been implicated in many serotonin toxicity cases with or without MDMA. MDMA has definitely been implicated in a lot of serotonin toxicity cases. If you take them together, I think they would kick your but.
actually, cocaine does have effects on serotonin I have just learned, but hat's not pertinent for most of us I hope.
Mechanisms of increased serotonergic activity and representative drugsIncreased synthesis
L-tryptophanDecreased metabolism
Monoamine oxidase inhibitors
Phenelzine
Tranylcypromine
Moclobemide
Selegiline
IocarboxazidSerotonin receptor agonism
Buspirone
Sumatriptan
Lysergic acid diethylamide (LSD)
LithiumIncreased serotonin release
Amphetamines
Amphetamine derivatives
Fenfluramine
Phentermine
3,3-methylenedioxymethamphet-
amine ("ecstasy")
CocaineInhibition of serotonin reuptak
Nonselective inhibitors
Tricyclic antidepressants
Meperidine
Dextromethorphan
Cocaine
Amphetamines and their derivatives
Selective inhibitors
Sertraline
Fluoxetine
NefazodonePerhaps this is what I experienced. Either way it was toxic, and I don't want to go back there. Serotonergic or sympathomimetic, it's asking for seizure, stroke, and coma.
http://www.findarticles.com/cf_0/m0BPG/12_17/96058312/p10/article.jhtml?term=prednisone+%2BAmine
Sympathomimetic poisoning syndrome
Substances that have mainly sympathetic stimulant activity are used
widely both in therapeutic and recreational settings. Catecholamines
are the main ingredient of over-the-counter cold remedies. Appetite
suppressants are mostiy sympathetic stimulants. Recreational use of
psychostimulant drugs, such as cocaine, and amphetamines and their
derivatives is widely prevalent. Amphetamines, methamphetamines and
so-called designer drugs have replaced cocaine as the recreational
drugs most frequently abused in the United States. Other illicit
substances with sympathomimetic activity include LSD and phencyclidine
(PCP).Cocaine acts predominantly by inhibiting the reuptake of
norepinephrine, serotonin, and dopamine into presynaptic vesicles. As
noted above, amphetamines and methamphetamines stimulate the release
and inhibit the reuptake of not only serotonin but also norepinephrine
and dopamine. Although they are chemically different, sympathomimetics
such as cocaine and amphetamines produce similar clinical
presentations.Hyperthermia is only one of the many systemic manifestations
associated with use of these drugs, especially in moderate to severe
poisoning. The mechanism of cocaine- and amphetamine-induced
hyperthermia is unknown, but most likely it is related to disruption
of thermoregulation by the CNS, excessive muscular activity, increased
metabolic activity; and elevated ambient temperature. The role of
ambient temperature has been shown in animal and human studies.Marzuk and colleagues (20) demonstrated an increase in mortality rate
from cocaine overdoses when the ambient temperature was 31[degrees]C
(88[degrees]F) or higher. Conversely, in rats given methamphetamine,
hyperthermia and death are prevented by a hypothermic environment.
(21)Patients with sympathomimetic poisoning syndrome usually are brought
to the ED agitated, confused, and combative. Seizure is not an
uncommon presenting symptom. Detection of hyperthermia is often
delayed while the patient is evaluated and airway, breathing, and
circulation are stabilized. The temperature can continue to rise as a
result of agitation and fighting of restraints. Hyperthermia is likely
a marker of severe poisoning and has been associated with the many
complications involving organ tissue damage, such as rhabdomyolysis,
renal failure, DIC, acidosis, and liver injury. (22)Diagnosis is suspected from the history of drug use and confirmed by
toxicology studies. In addition to agitation and delirium, patients
with this syndrome frequently are diaphoretic, with dilated but
reactive pupils. Bowel sounds usually are present and may be
hyperactive. Tremors and rigidity have been described. (22)
Differentiation of sympathomimetic poisoning syndrome from other drug
toxicities, such as serotonergic and anticholinergic toxicities, will
be aided by the medication history, but in the case of drug overdoses,
such information is frequently unavailable.As the patient is stabilized, aggressive cooling measures, including
sedation and, if necessary, neuromuscular relaxation, should be
instituted in the ED to stop continued increases in body temperature.
Nondepolarizing muscle relaxants and dantrolene have been used
successfully. Benzo-diazepines are used to treat delirium and
agitation. Seizures typically are not responsive to phenytoin and are
best treated with benzodiazepines. Tracheal intubation and mechanical
ventilation may be required for several days. Close monitoring for
organ system dysfunction is mandatory.
Posted by rod on April 6, 2004, at 15:36:28
In reply to Re: effexor and ectasy -LINK -nytimes.com, posted by PsychoSage on April 5, 2004, at 19:17:47
> ..Both times were with meth..
Im sorry if this happened to you, but no one is talking amount meth here. The substance discussed here is MDMA not meth. No one said its "safe" with any other drug than MDMA. Any i agree to a certain extend, that an SSRI does not block the effect of MDMA for 100%. It just greatly decreases it. And someone who takes an SSRI can be close to serotonin syndrom by the SSRI alone. Serotonin Syndrome also accurs with SSRI monotherapy in some individulas. And if such a person, close to serotonin syndrom due to SSRI, takes MDMA, the reduced increase in serotonin might be enough to result in serotonin syndrome, in my opinion. Thats at least an psausible explanation and might fit some cases.
And the study http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12404538
demonstates the theoretical interaction of MDMA and citalopram, an SSRI. And these people were taking pharmaceutical grade MDMA.
> ..from her pill, and she was kind of pissed. Then she became incredibly ill with the classic serotonin syndrome symptoms.As I said, you never really know what you get. What did she thought to take? Also meth, or E?
> Effexor has been implicated in many serotonin toxicity cases with or without MDMA. MDMA has definitely been implicated in a lot of serotonin toxicity cases. If you take them together, I think they would kick your but.
As it has been said before: "serotonin increase by MDMA alone" + "Serotonin increase by SSRI alone" =! (does not equal) "Serotonin increase by SSRI and MDMA coadministered". Its "Serotonin increase by SSRI alone" + "a tiny bit more".
And your links *dont* mention anything about (SSRI or Effexor) + MDMA = Death
I think we have a tiny problem about comunication here...
Roland
Posted by PsychoSage on April 6, 2004, at 18:35:51
In reply to Re: effexor and ectasy -LINK -nytimes.com » PsychoSage, posted by rod on April 6, 2004, at 15:36:28
> > ..Both times were with meth..
>
> Im sorry if this happened to you, but no one is talking amount meth here. The substance discussed here is MDMA not meth. No one said its "safe" with any other drug than MDMA. Any i agree to a certain extend, that an SSRI does not block the effect of MDMA for 100%. It just greatly decreases it. And someone who takes an SSRI can be close to serotonin syndrom by the SSRI alone. Serotonin Syndrome also accurs with SSRI monotherapy in some individulas. And if such a person, close to serotonin syndrom due to SSRI, takes MDMA, the reduced increase in serotonin might be enough to result in serotonin syndrome, in my opinion. Thats at least an psausible explanation and might fit some cases.
>
> And the study http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12404538
> demonstates the theoretical interaction of MDMA and citalopram, an SSRI. And these people were taking pharmaceutical grade MDMA.
>
>
> > ..from her pill, and she was kind of pissed. Then she became incredibly ill with the classic serotonin syndrome symptoms.
>
> As I said, you never really know what you get. What did she thought to take? Also meth, or E?
>
> > Effexor has been implicated in many serotonin toxicity cases with or without MDMA. MDMA has definitely been implicated in a lot of serotonin toxicity cases. If you take them together, I think they would kick your but.
>
> As it has been said before: "serotonin increase by MDMA alone" + "Serotonin increase by SSRI alone" =! (does not equal) "Serotonin increase by SSRI and MDMA coadministered". Its "Serotonin increase by SSRI alone" + "a tiny bit more".
>
> And your links *dont* mention anything about (SSRI or Effexor) + MDMA = Death
>
> I think we have a tiny problem about comunication here...
>
> Roland
MDMA is an amphetamine derivative 3,4-MethylenedioxymMETHamphetamine (MDMA)!!! IT IS A METH ANALOGUE, see far below.DUH!!!!! What a Denialist argument we have here.
It's common knowledge that anything that promotes serotonin that is taken with anything else that does so can cause serotonin syndrome.
http://www.maps.org/mdma/protocol/review6.pdf
Medical Emergencies and Adverse Events in Ecstasy Users {includes serotonin syndrome}:
Signs and symptoms of ecstasy intoxication documented in these reports are similar to those of amphetamines.
Mechanisms of serotonin syndrome.
(1) Increased doses of L-tryptophan will proportionally in-
crease 5-hydroxytryptamine (5-HT or serotonin) formation.(2) Amphetamines and other drugs increase
the release of stored serotonin.(3) Inhibition of serotonin metabolism by monoamine oxidase (MAO) inhibitors will increase presynaptic 5-HT concentration.
(4) Impairment of 5-HT transport into the presynaptic neuron by uptake blockers (e.g., selective serotonin reuptake inhibitors, tricyclic antidepressants) increases synaptic 5-HT concentration.
(5) Direct serotonin agonists can stimulate postsynaptic 5-HT
receptors.(6) Lithium increases postsynaptic receptor responses. Adapted with permission from Elsevier
Science (Critical Care Clinics 1997;13[4]:763-83)
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202764.html
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking venlafaxine, it is especially important that your health care professional know if you are taking the following:
Buspirone (e.g., BuSpar) orBromocriptine (e.g., Parlodel) or
Certain tricyclic antidepressants (amitriptyline [e.g., Elavil], clomipramine [e.g., Anafranil], or imipramine [e.g., Tofranil]) or
Dextromethorphan (cough medicine) or
Levodopa (e.g., Sinemet) or
Lithium (e.g., Eskalith) or
Meperidine (e.g., Demerol) or
Nefazodone (e.g., Serzone) or
Pentazocine (e.g., Talwin) or
Selective serotonin reuptake inhibitors (fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft]) or
Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
Sumatriptan (e.g., Imitrex) or
Tramadol (e.g., Ultram) or
Trazodone (e.g., Desyrel) or
Tryptophan—Using these medicines with venlafaxine may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome; symptoms of this syndrome include confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching; if you experience these symptoms contact your doctor as soon as possible
http://www.mja.com.au/public/issues/176_05_040302/prior_letter_fm.html
Serotonin toxicity with therapeutic doses of dexamphetamine and venlafaxine
http://www.health.gov.au/tga/adr/aadrb/aadr0402.htm#3Serotonin syndrome
Serotonin syndrome is caused by excessive central nervous system and peripheral serotonergic activity. It most commonly occurs with a combination of serotonergic agents, but may also occur with a single agent. A combination of agents increasing serotonin by different mechanisms, such as by inhibition of serotonin uptake and serotonin metabolism, is associated with a high risk of the syndrome.1 Table 1 lists agents which have been associated with serotonin syndrome.http://www.dartmouth.edu/~dapa/mdma.html
http://www.show.scot.nhs.uk/gghb/adtc/Medicines%20update/issue2.htm
Since ecstasy is pro-serotonergic, it may also be involved in pharmacodynamic drug-drug interactions when other pro-serotonergic drugs are combined with it, leading to a central serotonin syndrome
The amphetamine derivative (+/-)-3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is a popular recreational drug among young people, particularly those involved in the dance culture. MDMA produces an acute, rapid enhancement in the release of both serotonin (5-HT) and dopamine from nerve endings in the brains of experimental animals. It produces increased locomotor activity and the serotonin behavioral syndrome in rats. Crucially, it produces dose-dependent hyperthermia that is potentially fatal in rodents, primates, and humans.
Death by Ecstasy: The Serotonin Syndrome? Mueller PD., et al., Annals of Emergency Medicine,1998 Sept, Part I, 32(3), pg 377-380.
Serotonin syndrome, a condition in which there is central serotonin receptor hyperstimulation has been described since the 1950s. Classic findings of severe serotonin syndrome include hypothermia, mental status changes, autonomic instability, and altered muscle tone or rigidity. A number of medications have been implicated in the induction of serotonin syndrome, including those that reduce metabolism (ie, monoamine oxidase inhibitors), increase production (ie L-tryptophan), or inhibit uptake of serotonin (ie. Fluoxetine, clomipramine, meperidine, dextromoethorphan, pentazocine, fenfluramine). MDMA has been shown in animal models to cause massive release of serotonin from pre synaptic vesicles and inhibit its uptake. The following case illustrates that MDMA can induce a toxidrome consistent with severe serotonin syndrome. A 20 year old woman was brought to the emergency department unresponsive and cyanotic. She had ingested 2 tablets of MDMA within the previous 4 hours. She had a negative past medical history, was taking no medications, and had not been previously treated with any antidepressants or other prescription medications. History of previous use of MDMA or other illicit drugs was not available. Toxicological analysis of blood and urine indicated the presence of MDMA. No other toxic substances were present except acetaminophen, barbiturate and benzodiazepine used during treatment in the hospital. Initial anxiety, nausea, tachycardia, and elevated blood pressure are followed by relaxation, euphoria, and feelings of enhanced emotional insight. Tolerance to the psychoactive properties of MDMA develops rapidly with loss of the ability to evolve the desired response with repeated doses within several hours; instead, sympathomemetic effects predominate resulting in anxiety, dysphoria and paranoia. There have been multiple case reports in the medical literature of MDMA-induced morbidity and mortality that fit the diagnostic criteria for serotonin syndrome. This is being increasingly recognized in the medical literature. The Poison Information Services in London has also summarized severe complications and fatalities associated with MDMA use, many of which fit the diagnostic criteria for severe serotonin syndrome. Most cases of toxicity appear to be idiosyncratic and are not associated with massive overdose. Since MDMA has only about one tenth the stimulant effect of amphetamine on the central nervous system, excessive sympathetic stimulation by MDMA seems unlikely in these cases.
http://165.112.78.61/Meetings/MDMA/MDMAAbs1.htmlOverview of MDMA-Induced Persistent Neurotoxicity: Preclinical Perspective
Glen R. Hanson, D.D.S., Ph.D.
Advances
The potential neurotoxic properties of amphetamine-related drugs were suggested by observations in the rat of Gibb and Koda (JPET 185 [1973] 42) and Seiden et al. (Drug Alcoh Depend 1 [1976] 215) that high-dose methamphetamine (METH) treatment causes persistent deficits in the dopamine (DA) system associated with the basal ganglia. Gibb and Hotchkiss (JPET 214 [1980] 257) later reported that similar METH administrations also cause similar long-term declines in the serotonin (5HT) systems associated with the frontal cortex, striatum, and hippocampus. These findings suggested that heavy METH use can be neurotoxic to critical systems in the brain associated with memory, information processing, and motor functions. Because MDMA is a METH analogue, its effects on DA and 5HT systems have also been studied. Moderate-to-high doses of MDMA cause METH-like long-term deficits in brain 5HT, but not DA systems. These persistent serotonergic effects appear to be (1) at least partially mediated by MDMA-related stimulation of DA systems, (2) linked to production of free radicals, (3) dependent on the serotonin transporters, and (4) facilitated by hyperthermia. However, reactive MDMA metabolites do not appear to be necessary for this neurotoxic effect of MDMA. These preclinical findings in rat predict that, in humans, MDMA substantially enhances the activity of DA systems and is a potential neurotoxin to some 5HT systems.
Posted by PsychoSage on April 6, 2004, at 19:49:04
In reply to Re: effexor and ectasy -LINK -nytimes.com » PsychoSage, posted by rod on April 6, 2004, at 15:36:28
> > ..Both times were with meth..
>
> Im sorry if this happened to you, but no one is talking amount meth here. The substance discussed here is MDMA not meth. No one said its "safe" with any other drug than MDMA. Any i agree to a certain extend, that an SSRI does not block the effect of MDMA for 100%. It just greatly decreases it. And someone who takes an SSRI can be close to serotonin syndrom by the SSRI alone. Serotonin Syndrome also accurs with SSRI monotherapy in some individulas. And if such a person, close to serotonin syndrom due to SSRI, takes MDMA, the reduced increase in serotonin might be enough to result in serotonin syndrome, in my opinion. Thats at least an psausible explanation and might fit some cases.
>
> And the study http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12404538
> demonstates the theoretical interaction of MDMA and citalopram, an SSRI. And these people were taking pharmaceutical grade MDMA.
>
>
> > ..from her pill, and she was kind of pissed. Then she became incredibly ill with the classic serotonin syndrome symptoms.
>
> As I said, you never really know what you get. What did she thought to take? Also meth, or E?
>
> > Effexor has been implicated in many serotonin toxicity cases with or without MDMA. MDMA has definitely been implicated in a lot of serotonin toxicity cases. If you take them together, I think they would kick your but.
>
> As it has been said before: "serotonin increase by MDMA alone" + "Serotonin increase by SSRI alone" =! (does not equal) "Serotonin increase by SSRI and MDMA coadministered". Its "Serotonin increase by SSRI alone" + "a tiny bit more".
>
> And your links *dont* mention anything about (SSRI or Effexor) + MDMA = Death
>
> I think we have a tiny problem about comunication here...
>
> RolandYour study involves people who are healthy and do not take SSRIs or effexor {SNRI} regularly. Naturally, who gets serotonin poisoning and who doesn't depends on how much serotonin is floating around there to begin with.
There is no evidence that a chronic SSRI user can avoid serotonin syndrome, and there is speculative information out there that suggests a regular SSRI user would have the opposite effect compared to a person who experienced neuroprotective qualities.
see here:
http://www.maps.org/forum/2002/msg00749.html
Patterns of use
and experiences
of recreational
pharmaceutical
drug use amongst
party drug usersPaul Dillon, Jan Copeland
and Michael GascoigneParty drug users, many of whom have become
disillusioned with, or tolerant to the effects of,
ecstasy appear to be looking for ways to
increase and/or lengthen their period of party
drug intoxication. The use of pharmaceutical
medications in conjunction with party drugs
appears to be increasing. These drugs may
be combined to increase the effect of the party
drug or may also be an attempt to negate
an undesirable side-effect of the party drug.
Some party drug users for example ascribe
to the myth that taking an anti-depressant with
ecstasy can reduce the potential neurotoxic
effects of MDMA.Such drug combinations may bring about a
variety of negative symptoms. For example,
several authors note that combining ecstasy
and SSRI anti-depressants (such as Prozac
or Luvox) can easily bring about serotonin
syndrome, which can prove to be a fatal side-effect.Look at this dialogue on one of those recreational drug discussion sites, which are replete with misinformation, yet I found a thread peppered with a little bit of sense. This is the first time I've ever read these threads, and now I know why I see the kind of posts on here:
Poster A:
What do you mean myth? MAOI's reduce the amount of monamine oxidase in the brain, which is responsible for "cleaning up" serotonin after it's served its purpose as a neurotransmitter.
Consider SSRI's. They inhibit the reuptake of 5-HT, causing massive amounts of serotonin to be unleashed in numerous vital areas of the brain.
Now combine those effects: way too serotonin and no way to get rid of it. Do that, and you'll experience serotonin syndrome very quickly.
[ Parent | Reply to This ]
Poster B:Do a bit more reading (none / 0) (#12)
on Thu Nov 14th, 2002"causing massive amounts of serotonin to be ...unleashed..."
SSRIs do no such thing. Seratonin reuptake refers to a phenonmenon where the transmitter (neuron emitting 5-HT) re-absorbs the Seratonin it's released before the receiver can, resulting in a "weak signal" (for lack of a better term.) Overall this increases average Seratonin levels slowly because now only receivers are doing absorption.Drugs like LSD and E, OTOH, cause the transmitter neurons to "dump" their reserves, resulting in a much higher seratonin level in a much shorter time. (LSD is only active for much less than an hour, the rest of the "trip" is from the flood of free-ranging neurochemicals like Seratonin which are being randomly received.)
You are correct that Seratonin Syndrome is a likely outcome. Unfortunately SS is unpredictable crap-shoot at best, which is why you get so many people claiming it's "harmless" because they haven't encountered SS. You might get away with it 9/10, 999/1000, or only 1/2 times -- you just can't predict who is going to be susceptible, nor how susceptible they are.
Poster C:on Fri Nov 15th, 2002
What about serotonergic drugs affecting the dopaminergic systems via changes in extraneuronal 5-HT?
Don't forget the dopamine Ds, pleez.
I agree about the SS crapshoot. Everybody's brain is "wired" differently. Just because one guy on erowid, or whatever, had 3 posts about it, doesn't mean it is harmless.
I would not want to mix SSRIs and MAOIs. Plus, I think the man-made MAOIs are a little more potent than the tree bark you're advocating.
BTW, what kind of educational background do you have? You seem to know your sh&*, and I'm looking for some guidance in my intellectual pursuits.
Posted by djmmm on April 6, 2004, at 20:54:20
In reply to Super LINKAGE - ecstasy+effexor is a NO-NO, posted by PsychoSage on April 6, 2004, at 18:35:51
....and on the other hand...
The mechanisms involved in the long-lasting neuroprotective effect of fluoxetine against MDMA ('ecstasy')-induced degeneration of 5-HT nerve endings in rat brain
Effect of GBR 12909 and fluoxetine on the acute and long term changes induced by MDMA ('ecstasy') on the 5-HT and dopamine concentrations in mouse brain.
Disruption of the discriminative stimulus effects of S(+)-3,4-methylenedioxymethamphetamine (MDMA) by (+/-)-MDMA neurotoxicity: protection by fluoxetine.
also interesting...Alpha-lipoic acid prevents 3,4-methylenedioxy-methamphetamine (MDMA)-induced neurotoxicity.
Attenuation of 3,4-methylenedioxymethamphetamine (MDMA) induced neurotoxicity with the serotonin precursors tryptophan and 5-hydroxytryptophan
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7934616
The monoamine oxidase-B inhibitor L-deprenyl protects against 3,4-methylenedioxymethamphetamine-induced lipid peroxidation and long-term serotonergic deficitshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7538579
Ascorbic acid prevents 3,4-methylenedioxymethamphetamine (MDMA)-induced hydroxyl radical formation and the behavioral and neurochemical consequences of the depletion of brain 5-HT.
Posted by PsychoSage on April 7, 2004, at 0:00:26
In reply to Re: Super LINKAGE - ecstasy+effexor is a NO-NO, posted by djmmm on April 6, 2004, at 20:54:20
Okay, I am sorry if I went off on the neurotoxicity tangent, but the whole point of some people's abuse of SSRI's is to counteract the consequences of the abuse of ecstasy which is not quite the same thing as MDMA all the time.
THE ISSUE HERE IS EFFEXOR AND E. NOT NEUROTOXICITY OR NEURODEGENERATION. SEROTONIN SYNDROME IS THE ISSUE!
SEROTONIN SYNDROME CAN BE MILD OR FATAL!
THE ISSUE IS NOT WHETHER OR NOT PROZAC CAN RESTORE SEROTONIN LEVELS.
Rational people contend that serotonin syndrome of varying degrees {just like drunkenness can occur in varying degrees}
can occur when an SSRI or SNRI like Effexor is taking in conjunction with MDMA or street ecstasy.Were these MICE on SSRI therapy before they were given the SSRI with the MDMA?
What are the side effects for Mice who are on SSRI therapy before they have any MDMA when they take a dose of MDMA and the SSRI?
They can't be the same for SSRI abstinent mice. One dose of an SSRI versus many doses over many months which produce a steady state will be the difference between night and day.
Neurodegeneration and serotonin syndrome are TWO DIFFERENT THINGS. Isn't neurodegeneration aided by dopamine concentrations? An SSRI can block out the good feelings of MDMA and inhibit the explosion of serotonin but not block dopamine production.
I pasted your NIH database study link below, and I have added some links and comments above it:
ACUTE Hyperthermia is a symptom of serotonin syndrome last time I checked. see table 1:
http://www.currentpsychiatry.com/images/pdf/CP%200503%20Tables%20and%20Charts/Serotonin/CP503ST1.pdf
Since then, case reports have described serotonin syndrome with many drug combinations, including nonpsychotropics and illicit drugs. Using an irreversible MAOI with a serotonergic agent is the most toxic reported combination, but any drug or combination that increases serotonin can, in theory, cause serotonin syndrome (Table 2). A clinical scale3 is being developed to define and identify this potentially dangerous state, but no consensus has emerged on diagnostic criteria.
Look at the list of drugs here {table 2} and tell me if Effexor or ecstasy {MDMA} are in there.
http://www.currentpsychiatry.com/images/pdf/CP%200503%20Tables%20and%20Charts/Serotonin/CP503ST2.pdf
6. Neither fluoxetine or fluvoxamine altered MDMA-induced ACUTE HYPERTHERMIA. 7. These data demonstrate that fluoxetine produces long-lasting protection against MDMA-induced neurodegeneration, an effect apparently related to the presence of the drug and its active metabolite inhibiting the 5-HT transporter. Fluoxetine does not alter the metabolism of MDMA or its rate of cerebral accumulation.
Effect of GBR 12909 and fluoxetine on the acute and long term changes induced by MDMA ('ecstasy') on the 5-HT and dopamine concentrations in mouse brain.
However, GBR 12909 (10 mg/kg, i.p.) not only failed to prevent the acute effects induced by MDMA (30 mg/kg x 3, i.p.) on dopamine metabolism 30 min later, but in fact potentiated them. The 5-HT uptake inhibitor, fluoxetine (10 mg/kg, i. p.) failed to prevent both the acute and long term dopaminergic deficits.*** so, a dopamine reuptake inhibitor doesn't prevent the effects of MDMA even though MDMA produces dopamine. that was just an interesting thing to find. Prozac does not take care of dopaminergic deficits, so it really doesn't take care of those post ecstasy blues does it? THIS STUDY SAYS PROZAC DOES NOTHING FOR MDMA caused DOPAMINE DAMAGE!****
** By title alone this means nothing because it doesn't relate to serotonin syndrome**Alpha-lipoic acid prevents 3,4-methylenedioxy-methamphetamine (MDMA)-induced neurotoxicity.
Attenuation of 3,4-methylenedioxymethamphetamine (MDMA) induced neurotoxicity with the serotonin precursors tryptophan and 5-hydroxytryptophan
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7934616
*****we know that tryptophan increases serotonin levels, and it is great if serotonin levels can be increased or stablized because MDMA is neurotoxic!***
The monoamine oxidase-B inhibitor L-deprenyl protects against 3,4-methylenedioxymethamphetamine-induced lipid peroxidation and long-term serotonergic deficits
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7538579
****deprenyl's metabolite is like l or d methamphetamine; i am not sure of the significance of that but it is no wonder it is being studied for meth addiction treatment***
3,4-Methylenedioxymethamphetamine (MDMA)-induced serotonergic neurotoxicity was assessed in the striatum, hippocampus and frontal cortex of rats by using [3H]paroxetine binding to label serotonin (5-HT) uptake sites and 5-HT and 5-hydroxyindoleacetic acid (5-HIAA) levels as markers of serotonergic function. MDMA (40 mg/kg) induced a significant decrease in both [3H]paroxetine binding Bmax and 5-HT and 5-HIAA levels 7 days after treatment.
***MDMA screws with paroxetine. Okay, that is what I gather.****
The monoamine oxidase-B inhibitor L-deprenyl (2 mg/kg) administered 30 min before MDMA blocked these decreases.
***deprenyl saves serotonin receptors I gather**
MDMA (40 mg/kg) also maximally increased the formation of thiobarbituric acid reactive substances (an indicator of lipid peroxidation) 12 hr after treatment in all three brain regions studied. This increase in malondialdehyde formation was also blocked by pretreatment with L-deprenyl. Tryptophan hydroxylase (TPH) activity was also significantly reduced 18 hr after MDMA. L-Deprenyl reversed this decrease in TPH activity.
*** go deprenyl!***
Another experiment confirmed that a significant fraction of [3H]dopamine uptake into hippocampal synaptosomes was blocked by 500 nM fluoxetine, a selective 5-HT uptake inhibitor.
** i have read that serotonin increase in SSRIs causes dopamine decrease or something-- is that related to this? is that why SSRIs make us apathetic?*****
These data suggest that the deamination by monoamine oxidase-B of excessive dopamine within the 5-HT terminal generates hydrogen peroxide that may lead to membrane lipid peroxidation, and perhaps other oxidative insults, resulting in selective 5-HT terminal degeneration subsequent to MDMA treatment.*** so dopamine rips up the serotonergic areas??? so if MAO-B is inhibited by deprynel than the by-product of MAO-B can not hurt 5-HT terminals??
WHAT DOES THIS SAY ABOUT SEROTONIN SYNDROME??????? NOTHING!!****Ascorbic acid prevents 3,4-methylenedioxymethamphetamine (MDMA)-induced hydroxyl radical formation and the behavioral and neurochemical consequences of the depletion of brain 5-HT.
MDMA-induced 5-HT neurotoxicity has been proposed to involve oxidative stress due to increased formation of hydroxyl radicals. Recently, MDMA-induced 5-HT neurotoxicity has been shown to be accompanied by a suppression of behavioral and neurochemical responses to a subsequent injection of MDMA.
*** this is interesting!!! so hypothetically, MDMA and an SSRI can cause 5HT neurotoxicity, but the SSRI that is left working and subsequent doses increase or stabilize 5HT levels.an SSRI supposedly blocks the effects of MDMA. according to the above, when 5-HT is at toxic levels, MDMA can not be felt.
So, in actuality a person on an SSRI and MDMA is really on the threshold of serotonin syndrome. COULD THAT BE MORE TRUE than the idea an SSRI BLOCKS out MDMA as if nothing were taken into the body??!??!?!?****
I think it is obvious here that people see the word "protective", and they think there is my excuse to use the SSRI or ignore the possibility of serotonin syndrome which once again appears in varying degrees from MILD to FATAL.
Posted by rod on April 7, 2004, at 5:31:16
In reply to Super LINKAGE - ecstasy+effexor is a NO-NO, posted by PsychoSage on April 6, 2004, at 18:35:51
> > > ..Both times were with meth..
> >
> > Im sorry if this happened to you, but no one is talking amount meth here. The substance discussed here is MDMA not meth. No one said its "safe" with any other drug than MDMA. Any i agree to a certain extend, that an SSRI does not block the effect of MDMA for 100%. It just greatly decreases it. And someone who takes an SSRI can be close to serotonin syndrom by the SSRI alone. Serotonin Syndrome also accurs with SSRI monotherapy in some individulas. And if such a person, close to serotonin syndrom due to SSRI, takes MDMA, the reduced increase in serotonin might be enough to result in serotonin syndrome, in my opinion. Thats at least an psausible explanation and might fit some cases.
> >
> > And the study http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12404538
> > demonstates the theoretical interaction of MDMA and citalopram, an SSRI. And these people were taking pharmaceutical grade MDMA.
> >
> >
> > > ..from her pill, and she was kind of pissed. Then she became incredibly ill with the classic serotonin syndrome symptoms.
> >
> > As I said, you never really know what you get. What did she thought to take? Also meth, or E?
> >
> > > Effexor has been implicated in many serotonin toxicity cases with or without MDMA. MDMA has definitely been implicated in a lot of serotonin toxicity cases. If you take them together, I think they would kick your but.
> >
> > As it has been said before: "serotonin increase by MDMA alone" + "Serotonin increase by SSRI alone" =! (does not equal) "Serotonin increase by SSRI and MDMA coadministered". Its "Serotonin increase by SSRI alone" + "a tiny bit more".
> >
> > And your links *dont* mention anything about (SSRI or Effexor) + MDMA = Death
> >
> > I think we have a tiny problem about comunication here...
> >
> > Roland
>
>
> MDMA is an amphetamine derivative 3,4-MethylenedioxymMETHamphetamine (MDMA)!!! IT IS A METH ANALOGUE, see far below.
>
> DUH!!!!! What a Denialist argument we have here.Wait a moment
I know that its an analogue. Which doesnt neccesarily mean they all have the same mechanism of action. I actually dont know about the exact mechanisms of Methamphetamine.
But obviously you know what its detailed mode of action is. So how does it work? Have any links? Does it also reverse the Serotonin transporter?
I can not read anywhere that it has the same effect on sert like MDMA...
Close structural relation does not mean anythig.
Trimipramine in an close analogue of imipramine. But they are quite different.
Trimipramine can be combined with an MAOI without major problems, while imipramine is a big no no.
Trimipramine:
5-(3-dimethylamino-2-methylpropyl)-10,11-dihydro-5H-dibenz (b,f) azepine acid maleate
Imipramine:
5-[3-( Dimethylamino)propyl]-10,11- ihydro-5H-dibenz [b,1-azepine] Monohydrochloride.
Similar, but...> It's common knowledge that anything that promotes serotonin that is taken with anything else that does so can cause serotonin syndrome.
>Did I doubt that?? In my last post I said it is indeed possible!!
look above:
"Any i agree to a certain extend, that an SSRI does not block the effect of MDMA for 100%. It just greatly decreases it. And someone who takes an SSRI can be close to serotonin syndrom by the SSRI alone. Serotonin Syndrome also accurs with SSRI monotherapy in some individulas. And if such a person, close to serotonin syndrom due to SSRI, takes MDMA, the reduced increase in serotonin might be enough to result in serotonin syndrome, in my opinion."And if I would be mean I would say: DUH!! you didnt read my post at all...
Also scott-d-o said it only *attenuates* the increase of 5-ht by MDMA.
And you dont need to post so much information about serotonin toxicity. No one neglect its existence. But you seem to rufuse to accept the scientific facts about mdma and SSRI interaction.
Just the theory. Which does not say its in any case safe.im done here.
good bye
> http://www.maps.org/mdma/protocol/review6.pdf
>
> Medical Emergencies and Adverse Events in Ecstasy Users {includes serotonin syndrome}:
>
> Signs and symptoms of ecstasy intoxication documented in these reports are similar to those of amphetamines.
>
>
>
> Mechanisms of serotonin syndrome.
>
> (1) Increased doses of L-tryptophan will proportionally in-
> crease 5-hydroxytryptamine (5-HT or serotonin) formation.
>
> (2) Amphetamines and other drugs increase
> the release of stored serotonin.
>
> (3) Inhibition of serotonin metabolism by monoamine oxidase (MAO) inhibitors will increase presynaptic 5-HT concentration.
>
> (4) Impairment of 5-HT transport into the presynaptic neuron by uptake blockers (e.g., selective serotonin reuptake inhibitors, tricyclic antidepressants) increases synaptic 5-HT concentration.
>
> (5) Direct serotonin agonists can stimulate postsynaptic 5-HT
> receptors.
>
> (6) Lithium increases postsynaptic receptor responses. Adapted with permission from Elsevier
>
> Science (Critical Care Clinics 1997;13[4]:763-83)
>
>
>
> http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202764.html
>
>
> Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking venlafaxine, it is especially important that your health care professional know if you are taking the following:
> Buspirone (e.g., BuSpar) or
>
> Bromocriptine (e.g., Parlodel) or
>
> Certain tricyclic antidepressants (amitriptyline [e.g., Elavil], clomipramine [e.g., Anafranil], or imipramine [e.g., Tofranil]) or
>
> Dextromethorphan (cough medicine) or
>
> Levodopa (e.g., Sinemet) or
>
> Lithium (e.g., Eskalith) or
>
> Meperidine (e.g., Demerol) or
>
> Nefazodone (e.g., Serzone) or
>
> Pentazocine (e.g., Talwin) or
>
> Selective serotonin reuptake inhibitors (fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft]) or
>
> Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
>
> Sumatriptan (e.g., Imitrex) or
>
> Tramadol (e.g., Ultram) or
>
> Trazodone (e.g., Desyrel) or
>
> Tryptophan—Using these medicines with venlafaxine may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome; symptoms of this syndrome include confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching; if you experience these symptoms contact your doctor as soon as possible
>
> http://www.mja.com.au/public/issues/176_05_040302/prior_letter_fm.html
>
> Serotonin toxicity with therapeutic doses of dexamphetamine and venlafaxine
>
>
> http://www.health.gov.au/tga/adr/aadrb/aadr0402.htm#3
>
> Serotonin syndrome
>
>
> Serotonin syndrome is caused by excessive central nervous system and peripheral serotonergic activity. It most commonly occurs with a combination of serotonergic agents, but may also occur with a single agent. A combination of agents increasing serotonin by different mechanisms, such as by inhibition of serotonin uptake and serotonin metabolism, is associated with a high risk of the syndrome.1 Table 1 lists agents which have been associated with serotonin syndrome.
>
> http://www.dartmouth.edu/~dapa/mdma.html
>
> http://www.show.scot.nhs.uk/gghb/adtc/Medicines%20update/issue2.htm
>
> http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14709765&itool=iconabstr
>
> Since ecstasy is pro-serotonergic, it may also be involved in pharmacodynamic drug-drug interactions when other pro-serotonergic drugs are combined with it, leading to a central serotonin syndrome
>
>
>
>
> http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12869661&itool=iconabstr
>
> The amphetamine derivative (+/-)-3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is a popular recreational drug among young people, particularly those involved in the dance culture. MDMA produces an acute, rapid enhancement in the release of both serotonin (5-HT) and dopamine from nerve endings in the brains of experimental animals. It produces increased locomotor activity and the serotonin behavioral syndrome in rats. Crucially, it produces dose-dependent hyperthermia that is potentially fatal in rodents, primates, and humans.
>
>
> Death by Ecstasy: The Serotonin Syndrome? Mueller PD., et al., Annals of Emergency Medicine,
>
> 1998 Sept, Part I, 32(3), pg 377-380.
>
> Serotonin syndrome, a condition in which there is central serotonin receptor hyperstimulation has been described since the 1950s. Classic findings of severe serotonin syndrome include hypothermia, mental status changes, autonomic instability, and altered muscle tone or rigidity. A number of medications have been implicated in the induction of serotonin syndrome, including those that reduce metabolism (ie, monoamine oxidase inhibitors), increase production (ie L-tryptophan), or inhibit uptake of serotonin (ie. Fluoxetine, clomipramine, meperidine, dextromoethorphan, pentazocine, fenfluramine). MDMA has been shown in animal models to cause massive release of serotonin from pre synaptic vesicles and inhibit its uptake. The following case illustrates that MDMA can induce a toxidrome consistent with severe serotonin syndrome. A 20 year old woman was brought to the emergency department unresponsive and cyanotic. She had ingested 2 tablets of MDMA within the previous 4 hours. She had a negative past medical history, was taking no medications, and had not been previously treated with any antidepressants or other prescription medications. History of previous use of MDMA or other illicit drugs was not available. Toxicological analysis of blood and urine indicated the presence of MDMA. No other toxic substances were present except acetaminophen, barbiturate and benzodiazepine used during treatment in the hospital. Initial anxiety, nausea, tachycardia, and elevated blood pressure are followed by relaxation, euphoria, and feelings of enhanced emotional insight. Tolerance to the psychoactive properties of MDMA develops rapidly with loss of the ability to evolve the desired response with repeated doses within several hours; instead, sympathomemetic effects predominate resulting in anxiety, dysphoria and paranoia. There have been multiple case reports in the medical literature of MDMA-induced morbidity and mortality that fit the diagnostic criteria for serotonin syndrome. This is being increasingly recognized in the medical literature. The Poison Information Services in London has also summarized severe complications and fatalities associated with MDMA use, many of which fit the diagnostic criteria for severe serotonin syndrome. Most cases of toxicity appear to be idiosyncratic and are not associated with massive overdose. Since MDMA has only about one tenth the stimulant effect of amphetamine on the central nervous system, excessive sympathetic stimulation by MDMA seems unlikely in these cases.
>
>
> http://165.112.78.61/Meetings/MDMA/MDMAAbs1.html
>
> Overview of MDMA-Induced Persistent Neurotoxicity: Preclinical Perspective
> Glen R. Hanson, D.D.S., Ph.D.
>
>
> Advances
>
>
> The potential neurotoxic properties of amphetamine-related drugs were suggested by observations in the rat of Gibb and Koda (JPET 185 [1973] 42) and Seiden et al. (Drug Alcoh Depend 1 [1976] 215) that high-dose methamphetamine (METH) treatment causes persistent deficits in the dopamine (DA) system associated with the basal ganglia. Gibb and Hotchkiss (JPET 214 [1980] 257) later reported that similar METH administrations also cause similar long-term declines in the serotonin (5HT) systems associated with the frontal cortex, striatum, and hippocampus. These findings suggested that heavy METH use can be neurotoxic to critical systems in the brain associated with memory, information processing, and motor functions. Because MDMA is a METH analogue, its effects on DA and 5HT systems have also been studied. Moderate-to-high doses of MDMA cause METH-like long-term deficits in brain 5HT, but not DA systems. These persistent serotonergic effects appear to be (1) at least partially mediated by MDMA-related stimulation of DA systems, (2) linked to production of free radicals, (3) dependent on the serotonin transporters, and (4) facilitated by hyperthermia. However, reactive MDMA metabolites do not appear to be necessary for this neurotoxic effect of MDMA. These preclinical findings in rat predict that, in humans, MDMA substantially enhances the activity of DA systems and is a potential neurotoxin to some 5HT systems.
Posted by djmmm on April 7, 2004, at 9:19:42
In reply to The issue is SEROTONIN SYNDROME! READ your LINKS! » djmmm, posted by PsychoSage on April 7, 2004, at 0:00:26
The links I posted had everything to do with the original thread...my advice for you is to not take everything posted as a personal attack on your intelligence...I really didn't want to have to read your in-depth analysis of every link I posted, or a list of questions in response to studies I obviously had nothing to do with..
and I certainly don't need you reminding me of what the issue at hand is (the original thread)... I hate reading/responding to posts written in all caps..Your tone is offensive, try communicating with out "yelling" or people will start to question the meaning of your screenname.
Posted by Dr. Bob on April 8, 2004, at 21:30:17
In reply to Re: The issue is SEROTONIN SYNDROME! READ your LINKS!, posted by djmmm on April 7, 2004, at 9:19:42
> And if I would be mean I would say: DUH!! you didnt read my post at all...
>
> you seem to rufuse to accept the scientific facts about mdma and SSRI interaction.
>
> rod> Your tone is offensive, try communicating with out "yelling" or people will start to question the meaning of your screenname.
>
> djmmmPlease don't post anything that could lead others to feel accused or put down.
If you have any questions or comments about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
or redirect a follow-up to Psycho-Babble Administration.
Thanks,
Bob
Posted by rod on April 9, 2004, at 4:43:16
In reply to Re: please be civil » rod » djmmm, posted by Dr. Bob on April 8, 2004, at 21:30:17
Ok. My apologies.
I am sorry Dr. Bob,
I am sorry Psychosage.
My emotions gone wild a little on this.I hope we can forget about this "struggle", and be on friendly terms with each other again.
Roland
Posted by Dr. Bob on April 10, 2004, at 7:13:10
In reply to Sorry, posted by rod on April 9, 2004, at 4:43:16
This is the end of the thread.
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