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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 Brainbeard on July 21, 2009, at 4:50:17
I'm on sertraline (Zoloft) 25mg since a short while. I also take a little (5-20mg) ziprasidone (Geodon) and 15mg (3x5) of Buspar.
I have chronic dental pain that for the bigger part can't be treated or can't be treated yet (while for a big part the causes ARE visible on x-rays). It's complicated, but all you need to know is: I have pain. Since paracetamol (Tylenol) sometimes doesn't take care of this pain, and an NSAID like Ibuprofen is contra-indicated because of drastically increased upper gastrointestinal bleeding risk with an SSRI (although my low dose of Zoloft might prevent that), I asked my doc to prescribe something else for the pain. I mentioned codeine, tramadol and gabapentine. He agreed to prescribe Tramadol. 'It's no problem to take it with an SSRI', he said over the phone. I didn't feel like engaging in a pharmacological discussion once more, so I just agreed, while I knew of course that this isn't true.
Now, my question (yes, we're approaching the question now) is - I know that there have been cases reported of serotonin syndrome when SSRIs were mixed with Tramadol. I also learned that the seizure threshold can be lowered dramatically by combining Tramadol and an SSRI, and I know of at least one (informal) case report. I probably should have discussed this with my doc, but I was already happy that he even prescribed anything.
So, my question is: has anyone succesfully combined Tramadol with an SSRI?
Thanks.
Posted by bleauberry on July 21, 2009, at 5:11:12
In reply to Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 21, 2009, at 4:50:17
As you are apparently aware, combining tramadol and ssri is a risky idea. Serotonin toxicity syndrome is a real risk with this, as is as an increased risk of heightened side effects.
I would be more inclinced to try something known for both pain and depression. I am assuming depression is a factor here since zoloft is on board? Or anxiety? Both? Either way, doesn't matter, what med is routinely prescribed for both pain and depression and anxiety and has a track record of dependability spanning half a century? Nortriptyline. What med happens to partner very well with zoloft? Nortriptyline.
That's where I would start. I can say from experience that pains which were helped only minimally by Advil or Tylenol, and minimally by tramadol, vanished within about 36 hours of starting a tiny 5mg dose of nortriptyline.
Zoloft+nortriptyline makes a whole lot more sense to me than zoloft+tramadol. Though nortriptyline is classified as an antidepressant, most people who take use it for pain instead.
I would put tramadol on the shelf for another day if this approach does not work out. Try simpler and safer first.
The other thing with tramadol is the significant risk of becomiing tolerant, needing higher doses, and eventually suffering horrible withdrawals if and when you ever need to decrease the dose or get off it. Even stopping it after being on it just a week or two is quite unpleasant.
I think it would be easy to go the nortriptyline route. Your doc could probably agree to that on the phone and call it in to your pharmacy. I think most doctors would be a whole lot more comfortable with that than tramadol.
Taking the lowest effective dose is a good strategy, so you might find that a simple half of a 10mg capsule is enough. If not, most people seem to end up in the 25mg to 50mg range, with a few in the 100mg to 150mg range. At askapatient.com it is apparent that low supposedly subtherapeutic doses of nortriptyline provide considerable improvement in about 70% to 80% of cases.
Posted by Brainbeard on July 21, 2009, at 9:53:03
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by bleauberry on July 21, 2009, at 5:11:12
> I am assuming depression is a factor here since zoloft is on board? Or anxiety? Both?
Yup, OCD and depression, basically.
>Either way, doesn't matter, what med is routinely prescribed for both pain and depression and anxiety and has a track record of dependability spanning half a century? Nortriptyline. What med happens to partner very well with zoloft? Nortriptyline.
It's an excellent suggestion. I didn't mention it, but actually I have been using low doses of both amitriptyline and imipramine up till now, but I thought of leaving them behind for any risk of QT-prolongation together with the Geodon, plus they're causing me pretty bothersome sunlight sensitivity (eyes, photophobia). A low dose (even 6mg) of amitriptyline does help some for the pain, and as you know, amitriptyline's active metabolite is nortriptyline.. So in a way, I'm already on nortriptyline, BUT the drug itself may have less side-effects. I've been on nortr. before and I don't think it caused me any light sensitivity.
It won't be easy though to get a prescription. I'm a 'complicated' patient, already on the black list for 'experimentating with medication on his own account'.. I'm not sure if my doc will be happy if I suggest nortriptyline. Plus, I have actually seen at least two p-docs freak out over nortriptyline that I was taking 'on my own account' (I have only a couple of pills left) because of cardiac risks.. Which is overreacting, to be sure.
Thanks, anyway.
Posted by Phillipa on July 21, 2009, at 10:39:55
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 21, 2009, at 9:53:03
If it's dental pain getting it fixed right? I've heard of ultram with SSRI's. Must put it in med checker on google to see as I also haven't heard of Ibuphropen increasing gastro bleeding with SSRI. You're on a low dose of the SSRI also. Thanks for the info. Phillipa
Posted by Phillipa on July 21, 2009, at 12:10:32
In reply to Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 21, 2009, at 4:50:17
Well I'll be darned!!!! Per drug checker. Phillipa
Multi-Drug Interaction Checker
Patient RegimenULTRAM ORAL
ZOLOFT ORAL
InteractionsSevere Interaction
TRAMADOL/SSRI'S; DULOXETINE; VENLAFAXINE
Ultram Oral and Zoloft Oral may interact based on the potential interaction between TRAMADOL and SSRI'S; DULOXETINE; VENLAFAXINE.Tramadol/Selective Serotonin Reuptake Inhibitors; Duloxetine; Venlafaxine
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
MONOGRAPH TITLE: Tramadol/Selective Serotonin Reuptake Inhibitors;Duloxetine; Venlafaxine
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: The concurrent administration of tramadol and a selective serotonin reuptake inhibitor or the serotonin/norepinephrine reuptake inhibitors duloxetine or venlafaxine may result in additive blockade of serotonin reuptake, resulting in central serotonergic hyperstimulation. The combination may also lower the seizure threshold.The selective serotonin reuptake inhibitors and duloxetine may inhibit the metabolism of tramadol at CYP P-450-2D6, which may decrease its effectiveness by decreasing its transformation to its active metabolite.
CLINICAL EFFECTS: The concurrent administration may result in serotonin syndrome. Symptoms of serotonin syndrome may include irritability, altered consciousness, double vision, nausea, confusion, anxiety, hyperthermia, increased muscle tone, rigidity, myoclonus, rapid fluctuations in vital signs, and coma. Serotonin syndrome may result in death. Concurrent administration may also increase the risk of seizures and decrease the effectiveness of tramadol.
PREDISPOSING FACTORS: Predisposing factors include a history of seizures or epilepsy, a recognized risk for seizures (head trauma, metabolic disorders, alcohol, drug withdrawal, or infections of the central nervous system), or a genetic defect in CYP P-450-2D6.
PATIENT MANAGEMENT: If concurrent therapy is warranted, patients should be closely monitored for signs and symptoms of serotonin syndrome, seizure activity, and decreased tramadol effectiveness. Tramadol may need to be discontinued.The manufacturer of duloxetine states that concurrent use of tramadol is not recommended.(1)
DISCUSSION: There are several case reports of serotonin syndrome occurring following the addition of tramadol to a stable selective serotonin reuptake inhibitor regimen. The syndrome developed between 12 hours to 3 weeks after the initiation of tramadol therapy. The patients recovered after tramadol was discontinued.(2-12) One patient also developed mania.(2) Another patient developed nightmares and hallucinations after taking concurrent tramadol and paroxetine for 56 days.(13)A review of the 124 reports of seizures following tramadol therapy received by the FDA through July 31, 1996 revealed that 20 patients were receiving concurrent therapy with an selective serotonin reuptake inhibitor. (14)
The manufacturer of tramadol states that the risk of seizure is increased in patients receiving concurrent therapy with selective serotonin reuptake inhibitors.(15)
In a study in 16 healthy subjects, paroxetine (20 mg daily) decreased the formation of tramadol's active metabolite and tramadol effectiveness.(16)
There is one case report of serotonin syndrome with concurrent tramadol and venlafaxine.(17)
REFERENCES:1.Personal communication: Cymbalta (duloxetine HCl) concomitant opoid analgesic use. Eli Lilly and Company June, 2006.
2.Gonzalez-Pinto A, Imaz H, De Heredia JL, Gutierrez M, Mico JA. Mania and tramadol-fluoxetine combination. Am J Psychiatry 2001 Jun;158(6):964-5.
3.Mahlberg R, Kunz D, Sasse J, Kirchheiner J. Serotonin syndrome with tramadol and citalopram. Am J Psychiatry 2004 Jun;161(6):1129.
4.Mittino D, Mula M, Monaco F. Serotonin syndrome associated with tramadol-sertraline coadministration. Clin Neuropharmacol 2004 May-Jun; 27(3):150-1.
5.Mason BJ, Blackburn KH. Possible serotonin syndrome associated with tramadol and sertraline coadministration. Ann Pharmacother 1997 Feb; 31(2):175-7.
6.Sauget D, Franco PS, Amaniou M, Mazere J, Dantoine T. Possible serotonergic syndrome caused by combination of tramadol and sertraline in an elderly woman. Therapie 2002 May-Jun;57(3):309-10.
7.Lange-Asschenfeldt C, Weigmann H, Hiemke C, Mann K. Serotonin syndrome as a result of fluoxetine in a patient with tramadol abuse: plasma level-correlated symptomatology. J Clin Psychopharmacol 2002 Aug; 22(4):440-1.
8.Kesavan S, Sobala GM. Serotonin syndrome with fluoxetine plus tramadol. J R Soc Med 1999 Sep;92(9):474-5.
9.Egberts AC, ter Borgh J, Brodie-Meijer CC. Serotonin syndrome attributed to tramadol addition to paroxetine therapy. Int Clin Psychopharmacol 1997 May;12(3):181-2.
10.Lantz MS, Buchalter EN, Giambanco V. Serotonin syndrome following the administration of tramadol with paroxetine. Int J Geriatr Psychiatry 1998 May;13(5):343-5.
11.John AP, Koloth R. Severe serotonin toxicity and manic switch induced by combined use of tramadol and paroxetine. Aust N Z J Psychiatry 2007 Feb; 41(2):192-3.
12.Llinares-Tello F, Escriva-Moscardo S, Martinez-Pastor F, Martinez-Mascaraque P. Possible serotoninergic syndrome associated with coadministration of paroxetine and tramadol. Med Clin (Barc) 2007 Mar 24; 128(11):438.
13.Devulder J, De Laat M, Dumoulin K, Renson A, Rolly G. Nightmares and hallucinations after long-term intake of tramadol combined with antidepressants. Acta Clin Belg 1996;51(3):184-6.
14.Kahn LH, Alderfer RJ, Graham DJ. Seizures reported with tramadol. JAMA 1997 Nov 26;278(20):1661.
15.Ultram (tramadol) US prescribing information. Ortho-McNeil Pharmaceutical, Inc. September, 2006.
16.Laugesen S, Enggaard TP, Pedersen RS, Sindrup SH, Brosen K. Paroxetine, a cytochrome P450 2D6 inhibitor, diminishes the stereoselective O-demethylation and reduces the hypoalgesic effect of tramadol. Clin Pharmacol Ther 2005 Apr;77(4):312-23.
17.Venlafaxine + tramadol: serotonin syndrome. Prescrire Int 2004 Apr; 13(70):57.
Posted by Kimbersaur on July 22, 2009, at 1:38:14
In reply to Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 21, 2009, at 4:50:17
I think I took it with Cymbalta for a while, but I quit the Cymbalta. Now I am starting Pristiq (for OCD) but I really don't want to give up the Tramadol because it helps my tics. I guess I'd rather have tics than serotonin syndrome.
Posted by Brainbeard on July 22, 2009, at 13:41:22
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Kimbersaur on July 22, 2009, at 1:38:14
> I think I took it with Cymbalta for a while, but I quit the Cymbalta. Now I am starting Pristiq (for OCD) but I really don't want to give up the Tramadol because it helps my tics. I guess I'd rather have tics than serotonin syndrome.
So you haven't had any problems combining like that? Serotonin syndrome tends to happen with sudden changes in serotonergic tone, i.e. in the beginning of treatment or while raising doses. Once you've stabilized there shouldn't be much to worry about.
Posted by Kimbersaur on July 22, 2009, at 21:17:14
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 22, 2009, at 13:41:22
> > I think I took it with Cymbalta for a while, but I quit the Cymbalta. Now I am starting Pristiq (for OCD) but I really don't want to give up the Tramadol because it helps my tics. I guess I'd rather have tics than serotonin syndrome.
>
> So you haven't had any problems combining like that? Serotonin syndrome tends to happen with sudden changes in serotonergic tone, i.e. in the beginning of treatment or while raising doses. Once you've stabilized there shouldn't be much to worry about.Yeah, I didn't have any problem with combining it with Cymbalta. I haven't started the Pristiq yet. I'm still trying to decide whether to stop the tramadol first or not. I'm only on 100mg and I'm not going to go on a high dose of Pristiq so I might just go for it.
Posted by Brainbeard on July 23, 2009, at 3:31:02
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Kimbersaur on July 22, 2009, at 21:17:14
> Yeah, I didn't have any problem with combining it with Cymbalta. I haven't started the Pristiq yet. I'm still trying to decide whether to stop the tramadol first or not. I'm only on 100mg and I'm not going to go on a high dose of Pristiq so I might just go for it.
If you keep the tramadol on board, I'd go up very slowly with the venlafaxine. I'm considering opening a tramadol capsule and dividing the contents over a couple of capsules, so I can slowly go up and see if I'm OK.
Posted by Kimbersaur on July 23, 2009, at 16:32:51
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 23, 2009, at 3:31:02
> > Yeah, I didn't have any problem with combining it with Cymbalta. I haven't started the Pristiq yet. I'm still trying to decide whether to stop the tramadol first or not. I'm only on 100mg and I'm not going to go on a high dose of Pristiq so I might just go for it.
>
> If you keep the tramadol on board, I'd go up very slowly with the venlafaxine. I'm considering opening a tramadol capsule and dividing the contents over a couple of capsules, so I can slowly go up and see if I'm OK.
>
>How will I know if I am not okay? I think the Pristiq only comes in one dose. I actually don't think I'm on very much tramadol - 100mg Ultram ER. I really want to be on both. Good luck with dividing the capsules. I hope it works out for both of us.
Posted by Brainbeard on July 23, 2009, at 16:54:54
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Kimbersaur on July 23, 2009, at 16:32:51
> How will I know if I am not okay? I think the Pristiq only comes in one dose.
What is it, a pill, a capsule? Cut it to pieces, open it, divide and conquer. Or is it ER? That would complicate matters. Google 'serotonin syndrome' and you will know what to keep in mind. I think popping a benzo could help a great deal if you experience anything like SS. Benzo's have anti-serotonergic action, I think, as well as anticonvulsant (anti-seizure) action. Good to have at hand.
Posted by Phillipa on July 23, 2009, at 19:32:47
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 23, 2009, at 16:54:54
As far as I know it's an extended version of effexor come in 50mg and l00mg. But people are saying it doesn't feel or act like effexor it's better. Phillipa
Posted by Kimbersaur on July 24, 2009, at 2:31:26
In reply to Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 21, 2009, at 4:50:17
I talked to my doctor today and she said that she has a lot of patients on Ultram with an SSRI and it is no problem.
Posted by Brainbeard on July 24, 2009, at 3:53:10
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI? » Brainbeard, posted by Phillipa on July 23, 2009, at 19:32:47
> As far as I know it's an extended version of effexor come in 50mg and l00mg. But people are saying it doesn't feel or act like effexor it's better. Phillipa
I indeed came across an article yesterday which pointed out that there are intriguing chemical similarities between tramadol and Efexxor. Stahl has said that Geodon is like a mini-Effexor; tramadol, on the other hand, might be like a 'super-Effexor'... (With a 'super' withdrawal syndrome..)
> I talked to my doctor today and she said that she has a lot of patients on Ultram with an SSRI and it is no problem.
That sounds like good news. If these patients are not in a persistent vegetative state, at least. ;)
I might post a new thread for the following question, but does any of you guys know if there are people who have been taking tramadol long-term (I mean for years on end) without losing effectiveness and without having to up the dose to astronomical levels?
Posted by Kimbersaur on July 24, 2009, at 20:53:29
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 24, 2009, at 3:53:10
> > As far as I know it's an extended version of effexor come in 50mg and l00mg. But people are saying it doesn't feel or act like effexor it's better. Phillipa
>
> I indeed came across an article yesterday which pointed out that there are intriguing chemical similarities between tramadol and Efexxor. Stahl has said that Geodon is like a mini-Effexor; tramadol, on the other hand, might be like a 'super-Effexor'... (With a 'super' withdrawal syndrome..)
>
> > I talked to my doctor today and she said that she has a lot of patients on Ultram with an SSRI and it is no problem.
>
> That sounds like good news. If these patients are not in a persistent vegetative state, at least. ;)
>
> I might post a new thread for the following question, but does any of you guys know if there are people who have been taking tramadol long-term (I mean for years on end) without losing effectiveness and without having to up the dose to astronomical levels?I've been on it for a year and I think I'm going to have to up the dose soon.
Posted by SLS on July 24, 2009, at 23:33:42
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 24, 2009, at 3:53:10
Unfortunately, I don't know anyone who has done well on tramadol long-term.
Out of curiosity, have you ever combined Geodon with an SRI like Effexor or Lexapro?
- Scott
Posted by SLS on July 24, 2009, at 23:36:11
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI? » Brainbeard, posted by SLS on July 24, 2009, at 23:33:42
> Unfortunately, I don't know anyone who has done well on tramadol long-term.
>
> Out of curiosity, have you ever combined Geodon with an SRI like Effexor or Lexapro?Gee, I guess I should have read the other posts first.
Have you ruled out the use of Geodon as a possibility?
- Scott
Posted by SLS on July 24, 2009, at 23:57:51
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by SLS on July 24, 2009, at 23:36:11
> > Unfortunately, I don't know anyone who has done well on tramadol long-term.
> >
> > Out of curiosity, have you ever combined Geodon with an SRI like Effexor or Lexapro?
>
> Gee, I guess I should have read the other posts first.
>
> Have you ruled out the use of Geodon as a possibility?It is Stephen Stahl's contention that too low of a dosage of Geodon can be counterproductive and produce activation, agitation, anxiety, and dysphoria. He recommends 40mg as the average effective dose when treating depression. I couldn't find the article he wrote about this, though. A friend of mine dose better on 80mg than on 40mg in combination with Lexapro and Wellbutrin.
- Scott
Posted by Brainbeard on July 25, 2009, at 2:40:37
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by SLS on July 24, 2009, at 23:57:51
> It is Stephen Stahl's contention that too low of a dosage of Geodon can be counterproductive and produce activation, agitation, anxiety, and dysphoria. He recommends 40mg as the average effective dose when treating depression. I couldn't find the article he wrote about this, though. A friend of mine dose better on 80mg than on 40mg in combination with Lexapro and Wellbutrin.
I can't see why low dose Geodon would be counterproductive - though I might indeed be experiencing it for a fact. I'm on 25mg of Zoloft, 15mg of Buspar, 6mg of amitriptyline, 12.5mg of imipramine, and 5-20mg of Geodon. I haven't read anywhere what you say Stahl says. I've only read that he says a low dose might be too activating, not that it could cause dysphoria or anxiety.
In my case, however, even low doses of Geodon are quite sedating during the first part of the day, regardless of wether I take it in the morning or the evening before!Geodon's sedation is probably due to it alpha-something stuff. At low doses, its SNRI-profile won't come into play much, I guess. At higher doses, it will. But then its D2-antagonism will also become significant, and I'm not sure wether I would want that. I'm a spiritual person, essentially (trying to follow Jesus Christ (with very mixed results)), and I'm afraid that D2-antagonism might compromise spiritual sensitivity.
Oh boy, this thread is going way off topic..
Posted by SLS on July 25, 2009, at 6:16:54
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 25, 2009, at 2:40:37
> > It is Stephen Stahl's contention that too low of a dosage of Geodon can be counterproductive and produce activation, agitation, anxiety, and dysphoria. He recommends 40mg as the average effective dose when treating depression. I couldn't find the article he wrote about this, though. A friend of mine dose better on 80mg than on 40mg in combination with Lexapro and Wellbutrin.
>
> I can't see why low dose Geodon would be counterproductive - though I might indeed be experiencing it for a fact. I'm on 25mg of Zoloft, 15mg of Buspar, 6mg of amitriptyline, 12.5mg of imipramine, and 5-20mg of Geodon. I haven't read anywhere what you say Stahl says. I've only read that he says a low dose might be too activating, not that it could cause dysphoria or anxiety.I apologize for intruding on your thread, but I saw an opportunity to help.
Yes, my memory of Stahl's statements is flawed. I found the source I was thinking of. It wasn't anxiety and dysphoria that low-dosage (20mg) Geodon causes, but, rather, the activation and agitation. Still, it is something you may not want in a drug treatment. Perhaps this is only applicable to schizophrenia. If the low dosage is optimal for your condition, I guess that is all that matters. Perhaps this drug is useful for depression at the lower dosage if all you are looking for is 5-HTc blockade.
http://cme.medscape.com/viewarticle/484929
"Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating â' at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
- Stephen Stahl
Anyway, back to tramadol.
- Scott
Posted by Brainbeard on July 25, 2009, at 11:50:02
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI? » Brainbeard, posted by SLS on July 25, 2009, at 6:16:54
> Anyway, back to tramadol.
>
>
> - ScottTwo things, before we get back to tramadol:
a) That link doesn't work. You're probably referring to the page I tried to indirectly link to elsewhere: (Quoting myself) 'There is a nice presentation by Stahl on the web where he explains how 5HT2A and -C-antagonism result in increased dopamine release. I can't give a direct link because it seems to be a subscription page; nevertheless, when you follow the following link and click on the first search result, you do end up in the presentation: http://www.google.nl/search?hl=nl&safe=active&rlz=1B3GGGL_nlNL255NL258&q=Schizophrenia%3A+From+Circuits+to+Symptoms+Presented+by+Stephen+M.+Stahl&btnG=Zoeken&meta='
b) Stahl is confused about the type of 5HT2 antagonism. Since Geodon has much more affinity for the 5HT2A than the 5HT2C-receptor, he must have meant 5HT2*A* rather than -C antagonism.
5HT2A-antagonism is indeed all I'm looking for - but the bargain comes with several other mechanisms at least, it seems. I tried low dose Prozac as a 5HT2C-antagonist (see Stahl also, same link), but it gave me rapid weight gain.
Ceteram censeo tramadol scribendam esse.
(If that was a grammatically and syntaxically correct Latin phrase, someone buy me a beer.)
Posted by SLS on July 25, 2009, at 12:31:06
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 25, 2009, at 11:50:02
> Ceteram censeo tramadol scribendam esse.
Nihil est.
- Scott
Posted by Brainbeard on July 25, 2009, at 16:10:35
In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by SLS on July 25, 2009, at 12:31:06
> Nihil est.
>
>
> - ScottSuper. (For any non-Latinheads out there: Latin for 'super').
This is the end of the thread.
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