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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by BRC on June 30, 2009, at 16:38:06
Hi,
I posted a few days ago about how my psydoc increased my Remeron to 60mg and I was wondering if that was too high of a dose.
I take Cymbalta 60mg and Lyrica 300mg for neuropothy. I take Luvox 200mg, Klonopin 4mg, and now the increased 60mg Remeron for OCD, Depression, and anxiety.
Several posters raised a very valid concern that the Cymbalta, Luvox, and Remeron could cause Serotonin Syndrome. I have been on some form of a SSRI's and other AD's going on ten years now. Doc's have always augmented my meds.
I have always been aware of Serotonin Syndrome. But I thought that it was an acute or sudden life or death kind of thing only. But I began to research it a little more and the line between what I assumed were side effects to my meds and Serotonin Syndrome became a little blurry.
So, I was hopping some of you could set me straight. In my research I found that Serotonin Syndrome can cause brisk reflexes (especially in the lower limbs), minor muscle twitches, and a sense of agitation or restlessness.
I have three doctors I see at least every three months. My psychiatrist, nuerologist, and primary care doctor. They are all aware of my medical history and my meds.
My nuerologist always preforms a physical exam in which I always exhibit brisk reflexes in my legs and feet. He attributes it to the tumor in my spine. My primary doctor always does blood work in which everthing comes back fine. I talk to my psychiatrist and tell him of my need to stay busy (can't sit still). He attributes it to my OCD.
So, are the doctor's right or am I experiencing Serotonin Syndrom? I am confussed as to whether the symptoms of Serotonin Syndrome are acute and go away quickly. Or can they be constant?
My symptoms are constant and I just assume they were the side effects of my meds? Could I be wrong.?
Sorry for such a long, confusing post. Just wanted to get as much prudent information in so people could come to a conclusion.
BRC
Posted by Phillipa on June 30, 2009, at 16:53:11
In reply to Serotonin Syndrome or Just Side Effects?, posted by BRC on June 30, 2009, at 16:38:06
I don't know three docs? Sounds like your're well convered will leave to experts. Phillipa
Posted by Larry Hoover on June 30, 2009, at 19:11:53
In reply to Serotonin Syndrome or Just Side Effects?, posted by BRC on June 30, 2009, at 16:38:06
> So, are the doctor's right or am I experiencing Serotonin Syndrom? I am confussed as to whether the symptoms of Serotonin Syndrome are acute and go away quickly. Or can they be constant?
Serotonin syndrome is an acute illness. Your doctors are properly monitoring you. They do a differential diagnosis every time they see you, from the sounds of things.
> My symptoms are constant and I just assume they were the side effects of my meds? Could I be wrong.?
It's unlikely that you're wrong. Your medical conditions and the effects of the medication are congruent with your symptoms.
It's important to self-monitor for changes in symptoms, but I urge you to try to be less vigilant with respect to the chronic symptoms. So long as you remain stable in that regard, I'd say all is as well as can be expected.
Regards,
Lar
Posted by yxibow on June 30, 2009, at 23:15:33
In reply to Serotonin Syndrome or Just Side Effects?, posted by BRC on June 30, 2009, at 16:38:06
> Hi,
>
> I posted a few days ago about how my psydoc increased my Remeron to 60mg and I was wondering if that was too high of a dose.
>
> I take Cymbalta 60mg and Lyrica 300mg for neuropothy. I take Luvox 200mg, Klonopin 4mg, and now the increased 60mg Remeron for OCD, Depression, and anxiety.
>
> Several posters raised a very valid concern that the Cymbalta, Luvox, and Remeron could cause Serotonin Syndrome. I have been on some form of a SSRI's and other AD's going on ten years now. Doc's have always augmented my meds.
>
> I have always been aware of Serotonin Syndrome. But I thought that it was an acute or sudden life or death kind of thing only. But I began to research it a little more and the line between what I assumed were side effects to my meds and Serotonin Syndrome became a little blurry.
>
> So, I was hopping some of you could set me straight. In my research I found that Serotonin Syndrome can cause brisk reflexes (especially in the lower limbs), minor muscle twitches, and a sense of agitation or restlessness.
And quite often psychosis, disassociation, amnesia like effects, etc. People with strong SS, sadly are not even aware that they have it. If you're aware of electric shocks, twitching, minor fever, you probably have sub-clinical SS, at best.
> I have three doctors I see at least every three months. My psychiatrist, nuerologist, and primary care doctor. They are all aware of my medical history and my meds.That is important - yes, I have multiple doctors who have seen me over time as well.
> My nuerologist always preforms a physical exam in which I always exhibit brisk reflexes in my legs and feet. He attributes it to the tumor in my spine. My primary doctor always does blood work in which everthing comes back fine. I talk to my psychiatrist and tell him of my need to stay busy (can't sit still). He attributes it to my OCD.
Blood monitoring every so often on polypharmacy, the standard of care is usually 6 months, is a good thing.
As for the need to stay busy -- it could be a combination of all of your medications causing akathisia, which is rare but possible even with non-antipsychotic agents.
I doubt it is serotonin syndrome. But it is something, and you have the right to get to the bottom of it.
> So, are the doctor's right or am I experiencing Serotonin Syndrom? I am confussed as to whether the symptoms of Serotonin Syndrome are acute and go away quickly. Or can they be constant?Not constant.
Acute to very acute. Hospitalization is basically a must. Cyproheptadine is usually a first line defense, supportive care and some other agents may be used. Fever can be very high and heroic efforts are used to calm it.
> My symptoms are constant and I just assume they were the side effects of my meds? Could I be wrong.?
Its not terribly possible to have true clinical Serotonin Syndrome constantly. You would be, constantly in an ICU.
As said before, you may have multiple clashing side effects, sub-clinical SS or over amounts of serotonergic agents -- I have experienced electric shocks before, and mild odd fever events.
Constancy sounds more like a side effect, and the constant nature really sounds like something akin to multi-drug induced akathisia or restless leg syndrome.
> Sorry for such a long, confusing post. Just wanted to get as much prudent information in so people could come to a conclusion.
Not a problem -- that's my conclusion, others may have different opinions.But I still think that monitoring of things is important and I'm not discounting that -- having a neurological problem means EEGs or neurological exams every so often on a standard of care basis, and liver tests for polypharmacy typically every 6 (maybe 3) months.
-- tidings
Jay
Posted by BRC on July 1, 2009, at 17:52:00
In reply to Re: Serotonin Syndrome or Just Side Effects? » BRC, posted by yxibow on June 30, 2009, at 23:15:33
Posted by BRC on July 1, 2009, at 17:56:26
In reply to Re: Serotonin Syndrome or Just Side Effects? » BRC, posted by yxibow on June 30, 2009, at 23:15:33
Just wanted to say thanks to Jay and the above posters for the time you devoted to my question.
You took my questions broke them down one by one with clear and concise answers.
Thanks for you kindness.
BRC
This is the end of the thread.
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