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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Lindsay Rae on September 15, 2005, at 18:43:52
Hello,
Has anyone heard of "Serotonin Syndrome?"
I have been simultaneously taking Lexapro 10mg/daily and Phentermine 37.5 (a.k.a. Fastin, Adipex, etc.) for about a year and a half. Today when I went to the pharmacy, the owner told me that he could not fill both prescriptions because there was an error message on the computer monitor indicating that Lexapro, an SSRI, cannot be taken with Phentermine, which supposedly causes Serotonin to be released.
I have researched Meridia and found this to be true, but not Phentermine! Does anyone else know about this? Why don't they prescribe the Serotonin releasing diet pills for depression if they can supposedly "boost" the neurotransmitter?
Thanks!
Posted by mworkman on September 15, 2005, at 20:46:52
In reply to Diet Pills and Antidepressants Contraindicated?, posted by Lindsay Rae on September 15, 2005, at 18:43:52
They do both affect seriton(sp). There is a chance that they could cause negative effect. Talk to your doctor about it, and get the doc to write or call the pharmacy that you can take both.
Posted by Lindsay Rae on September 16, 2005, at 0:44:49
In reply to Re: Diet Pills and Antidepressants Contraindicated?, posted by mworkman on September 15, 2005, at 20:46:52
Supposedly there is a test to check levels, but it seems pointless to take them if the two meds cancel eachother out! Besides I always thought that antidepressants hold up the Serotonin so your brain will make more, so once you've been on them awhile, you already have it built up. Does that mean that all of the built up Serotonin rushes out all at once when I ingest the diet pill in the morning? It kind of makes sense, since I slowly get more anxious and eventually break down in the afternoon and take the Lexapro and 1mg Xanax, which brings me back to 'normal.'
I am hoping Dr. Bob will say something about this!
Posted by Declan on September 16, 2005, at 2:05:35
In reply to Re: Diet Pills and Antidepressants Contraindicated?, posted by Lindsay Rae on September 16, 2005, at 0:44:49
Phentermine is pretty demanding stuff. Like amphetamine without the mood elevation. I'm not surprised you get more anxious as the drug is slowly released into your system. (If it is the same formulation I used).
But I was in my 20's when I used it. Out of the question now.
Declan
Posted by med_empowered on September 16, 2005, at 2:39:09
In reply to Re: Diet Pills and Antidepressants Contraindicated?, posted by Declan on September 16, 2005, at 2:05:35
hey! phentermine is part of the "old school" diet pill generation, as is phendimetrazine (bontril) and the much less used Didrex (benzfetamine). These drugs are a lot like amphetamines...they tend to be elevate mood less and cause less intense withdrawal, and there's less of a problem with abuse. Anyway, the deal is...combining most stimulants with an antidepressant does raise some potential problems (serotonin syndrome would be a potential complication, for instance), but its not necessarily a bad thing if the combo is managed properly. Lots of docs RX "PhenPro" combos (Phentermine plus an SSRI) to help combat depression (which may contribute to obesity and inactivity), boost the effects of the stimulant, and (possibly) boost the antidepressant by providing some stimulation. To offer a comparison..its pretty common for people with ADHD to take ritalin, adderall, or dexedrine along with an anti-depressant, and its also commmon for people with some forms of depression to a stimulant along with their antidepressant, or for bipolars to use stimulants for mood-elevation and mood-stability, so on and so forth. So...I don't know what the pharmacy's deal is, but you should be able to have them give you your meds if you talk to your doc about it...your combo isn't all that unusual although, like i said, you are running into some additional risks. By the way...phentermine also made me *really* anxious (and nauseous. and it gave me cotton mouth). Phendimetrazine (in my case, 105mgs Bontril-SR) was an absolute godsend; it reduced my appetite, gave a bit of a boost to my mood, but didn't make me go crazy(er). Good luck!
Posted by Declan on September 16, 2005, at 3:38:05
In reply to Re: Diet Pills and Antidepressants Contraindicated, posted by med_empowered on September 16, 2005, at 2:39:09
Phenmetrazine (Preludin) was lovely stuff. Unlike phentermine. Dunno about phendimetrazine. All those non euphoric diet pills are a waste of space IMO.
Declan
Posted by darkhorse on September 16, 2005, at 3:44:22
In reply to Diet Pills and Antidepressants Contraindicated?, posted by Lindsay Rae on September 15, 2005, at 18:43:52
> Hello,
>
> Has anyone heard of "Serotonin Syndrome?"
>
> I have been simultaneously taking Lexapro 10mg/daily and Phentermine 37.5 (a.k.a. Fastin, Adipex, etc.) for about a year and a half. Today when I went to the pharmacy, the owner told me that he could not fill both prescriptions because there was an error message on the computer monitor indicating that Lexapro, an SSRI, cannot be taken with Phentermine, which supposedly causes Serotonin to be released.
>
> I have researched Meridia and found this to be true, but not Phentermine! Does anyone else know about this? Why don't they prescribe the Serotonin releasing diet pills for depression if they can supposedly "boost" the neurotransmitter?
>
> Thanks!I took both Prozac and Meredia up to 20mg a day with no problem at all except a rapid increase in aggression and depression.I had the same effects when taking Meredia alone.I think Meredia is a less potent serotonin inhibitor. I mean people do take Prozac with the extremly potent serotonion inhibitor Anafranil for OCD.
Posted by Lindsay Rae on September 16, 2005, at 8:59:10
In reply to Re: Diet Pills and Antidepressants Contraindicated? » Lindsay Rae, posted by darkhorse on September 16, 2005, at 3:44:22
>" I took both Prozac and Meredia up to 20mg a day with no problem at all except a rapid increase in aggression and depression.I had the same effects when taking Meredia alone.I think Meredia is a less potent serotonin inhibitor. I mean people do take Prozac with the extremly potent serotonion inhibitor Anafranil for OCD."
>
>No, the two diet drugs, Meridia and Phentermine, do not work the same way, as they do not have the same chemical properties. Meridia's accompanying literature is the only one of the diet pills that mentions Serotonin at all. I work at a mental health/substance abuse facility and have discussed this with both the pdocs and nurses, and all were surprised by the way Meridia is said to effect Serotonin release, as this is not a common property for a diet pill.
Anyway, here is a quote from Dr. Anchors, who uses the Phen-pro approach for dieting and has even gotten certain pharmacies to remove this 'uwarranted' warning:
In a message dated 9/16/2005 3:31:48 AM Eastern Daylight Time, lindsay_rae_8@hotmail.com writes:
I have been taking 37.5mg of Phentermine along with 10mg Lexapro for a year and a half, but just today was told by my pharmacist (he "just noticed") that he could not give me the Phentermine because of the contraindication. When I asked what he meant, he showed me his monitor display which stated, "Error...Combination may cause fatal Serotonin Syndrome..."
The pharmacist is wrong. Go to Rite Aid pharmacy if it's in your area. I got them to remove the warning from their system. Mike Steelman, president of the American Society of Bariatric Physicians, said he would take over and with the authority of the ASBP get the other pharmacists to remove the baseless warning from their system. So far Dr. Steelman has not produced results, an example of how an individual can get things done when a committee cannot. I may have to take the job back and do it myself.
Dr. Anchors>
Posted by Lindsay Rae on September 16, 2005, at 9:06:14
In reply to Re: Diet Pills and Antidepressants Contraindicated, posted by Declan on September 16, 2005, at 3:38:05
> Phenmetrazine (Preludin) was lovely stuff. Unlike phentermine. Dunno about phendimetrazine. All those non euphoric diet pills are a waste of space IMO.
> DeclanDeclan, do they still administer Phenmetrazine (Preludin), or was it banished along with Qualudes? LOL!
I should also mention that for four years I have been taking Methadone for pain, reducing slowly, and Xanax 1mg/daily for anxiety. Perhaps the combination of all four meds, although taken substantially far apart, do not jibe well together? No problems so far, and my doc does twice yearly blood tests to check liver/kidney function.
Posted by med_empowered on September 16, 2005, at 13:51:50
In reply to Re: Diet Pills and Antidepressants Contraindicated, posted by Lindsay Rae on September 16, 2005, at 9:06:14
hey! I don't think phenmetrazine was banned per se, but I don't think its actually used anymore...the abuse problems with Preludin popped up pretty quickly, so I think it may have been taken off the market volunatarily. Bontril (phendimetrazine) seems to work well because it breaks down into phenmetrazine; apparently, phendimetrazine itself has absolutely no actions on the body; only when it is metabolized into phenmetrazine does the stuff start to work. The overall result is a little bit of mood elevation, less anxiety/nausea than phentermine, and a "smoother" medication overall. It is a schedule III substance, I guess because the FDA had been burned by the Preludin thing already...however, the overall consensus seems to be that it really isn't any more or less likely to be abused than phentermine or other schedule IV substances. Good luck!
Posted by linkadge on September 16, 2005, at 17:04:04
In reply to Re: Diet Pills and Antidepressants Contraindicated, posted by med_empowered on September 16, 2005, at 13:51:50
I would certainly be cautious about the combination.
Linkadge
Posted by darkhorse on September 19, 2005, at 4:42:32
In reply to Re: Diet Pills and Antidepressants Contraindicated?, posted by Lindsay Rae on September 16, 2005, at 8:59:10
>
>
> >" I took both Prozac and Meredia up to 20mg a day with no problem at all except a rapid increase in aggression and depression.I had the same effects when taking Meredia alone.I think Meredia is a less potent serotonin inhibitor. I mean people do take Prozac with the extremly potent serotonion inhibitor Anafranil for OCD."> No, the two diet drugs, Meridia and Phentermine, do not work the same way, as they do not have the same chemical properties. Meridia's accompanying literature is the only one of the diet pills that mentions Serotonin at all. I work at a mental health/substance abuse facility and have discussed this with both the pdocs and nurses, and all were surprised by the way Meridia is said to effect Serotonin release, as this is not a common property for a diet pill.
I did not say that Meredia and phentermine work the same way.I only said that the NE/5HT/DA reuptake inhibitor Sibutramine (Meredia/Reductil) was safe to take with the 5HT reuptake inhibitor Flioxetine (Prozac).(The Serotonin Syndrome)BTW, I took the DA/NE reuptake-releaser Phentermine with Prozac too and is a totally different drug than Meredia.
Also do not forget that the diet pill that was removed from the market Dexfenfluramine affected serotonin (Which I tried)
Regards,
Dark Horse.
Posted by Lindsay Rae on September 19, 2005, at 10:38:57
In reply to Re: Diet Pills and Antidepressants Contraindicated, posted by linkadge on September 16, 2005, at 17:04:04
Darkhorse,
I hope I didn't come across as a know-it-all! I realize now that the subject line I created was broader than what I was actually describing. I thought you were substituting Meridia for Phentermine in a direct comparison.
Plus I was so irritated by the conflicting answers from supposed MDs about the safety of the combination, seeing as I have been taking them together for 18 months! The Web MD responses were the textbook warning about Serotonin Syndrome, while the seemingly intelligent, well-known Dr. Anchors actually recommends the "Phen-Pro Plan," and even warns that pharmacists may have this false warning pop up when you try to get them simultaneously. I donn't know who to believe on this possibly life or death situation, and I have a 3-year-old to take care of on my own.
About Meridia, though, I may have read wrong, but is it a SSRI and Norepinephrine RI, or does it stimulate these chemicals, therore releasing them quickly rather than performing the funcion of keeping them from being being taken back up, therefore creating more of the chemicals. I thought Meridia just rushed their release, but I could be wrong!! :)
Thanks,
Lindsay
Posted by med_empowered on September 19, 2005, at 11:24:22
In reply to Re: Phentermine with Lexapro----Darkhorse!, posted by Lindsay Rae on September 19, 2005, at 10:38:57
hey! You all might remember this...a little while back, Public Citizen, or some other consumer advocacy group, called for meridia to be pulled off the shelves (I think permanently, but maybe pending further data collection). According to them, Meridia's cost was not at all justified by its rather disappointing safety profile; apparently, the clinical trials waaaay underestimated the likelihood of adverse events (serotonin syndrome being one of them). According to some data, Meridia may not be more effective or much safer than, say, phentermine or phendimetrazine. That said...the Phen-Pro combo is kind of scary, to me at least, but I guess I did similar stuff (tofranil+cymbalta+60mgs Adderall) and lots of people with treatment-resistant or atypical depression or ADHD end up on amphetamines plus antidepressants, so I guess the important thing is to monitor everything closely and keep a look out for potential problems. From what I understand, SSRIs are safer to mix with stimulants than TCAs; in my experience, the TCA+amphetamine combo jumpstarts both meds, but makes the cardiovascular system go awry. SSRIs/atypical ADs aren't as big a problem, although there is considerable variation from person to person; there are case reports of people developing Serotonin Syndrome after mixing SSRIs with *coffee* (presumably they drank a good bit, but still...creepy).
Posted by Lindsay Rae on September 19, 2005, at 12:37:28
In reply to Meridia, posted by med_empowered on September 19, 2005, at 11:24:22
Wow Med_Emp, that's crazy!
If I were to develop this Syndrome, I would notably feel the symptoms, right? I mean, if I'm on the lookout or notice feeling dizzy, passing out*, fever, chills, etc., I could be tested for it, right? The pharmacist said they only approve the combo in instances where levels are being taken. As far as I know, there are no tests for Serotonin levels, which is why the concept of AD's is so enigmatic. If they could actually take Serotonin levels, or even Dopamine, Norepiniphrine, Gaba, etc., psychiatry would be a breakthrough science rather than a trial-by-error science based on theories and test cases!BTW, isn't Cymbalta relatively new, or at least as far as Ely Lilly Reps are trained, only about six months into being heavily marketed? It is comparable to Effexor (about which I've read so many horrific withdrawal stories)? I spoke to one rep Cymbalta, who assured me that most everyone stabilzed on the same dose (about 60mg).
The reason for the delay is said to be the incident during the trials, in which a small female hung herself right on the Ely Lilley clinical testing site.
*passing out would alert me anyway...lol.
This is the end of the thread.
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