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Thread: Anyone had serotonin syndrome?

  1. #1
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    Question Anyone had serotonin syndrome?

    There are lots of drugs that are 'contraindicated' to be used together, due to the small, but sometimes deadly, risk of serotonin syndrome/serotonin storm.

    I'm just wondering if anyone has ever had this happen? Or know anyone who has?

    It's something that you can check on a few on line databases, where you tap in two or more drugs and it gives you a big red DON'T MIX THESE type of warning.

    I've been on a prescribed SSRI for ten years and that was for depression. I take a lower dose now but I also have another health condition which leaves me very fatigued and disrupts sleep. My doctor has given me low dose amitryptiline to help sleep, but officially there's a possibility of interaction.

    Anyway, I take other drugs which I find helpful, such as those with stimulant properties usually prescribed for obesity. These are the ones I don't discuss with my doctor.

    I know the doctors can't prescribe me what I take, as it would get them in trouble for using contraindicated drugs, but I choose to carry on because the risk seems worth it to me on a personal level.

    I guess I'm just wondering if this serotonin syndrome thing has ever happened to anyone since I've read it's rare?


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    It's a rare but life-threatening condition. I've had it and was hospitalized. I had altered mental status (this is a sign of a SERIOUS problem), hyperthermia, tremors, high blood pressure, and agitation. The ER doctors put down "serotonin syndrome". But at the hospital the MRI of my head was clean, and there are no diagnostic tests for serotonin syndrome only a constellation of symptoms to recognize once everything else is ruled out, but the hospital docs gave me an equally serious diagnosis of "encephelopathy" (brain disease) which didn't rule out the serotonin syndrome but didn't confirm it either.

    I was taking prozac at the highest dose, buspar at the highest dose, and tramadol at the highest dose. All effect serotonin levels. I was also illegally, wrongly and against medical advice taking ADHD meds (adderall) to help with school which the docs didn't know about, though I'm sure their tox screen showed it.

    Trust me, Serotonin syndrome is no fun. Come clean to your docs about what you're on. They'd rather that happen than NOT know and something bad happen to you.
    Helpful naynay, slick76 Rated helpful

  3. #3
    Quote Originally Posted by Della View Post
    There are lots of drugs that are 'contraindicated' to be used together, due to the small, but sometimes deadly, risk of serotonin syndrome/serotonin storm.

    I'm just wondering if anyone has ever had this happen? Or know anyone who has?

    It's something that you can check on a few on line databases, where you tap in two or more drugs and it gives you a big red DON'T MIX THESE type of warning.

    I've been on a prescribed SSRI for ten years and that was for depression. I take a lower dose now but I also have another health condition which leaves me very fatigued and disrupts sleep. My doctor has given me low dose amitryptiline to help sleep, but officially there's a possibility of interaction.

    Anyway, I take other drugs which I find helpful, such as those with stimulant properties usually prescribed for obesity. These are the ones I don't discuss with my doctor.

    I know the doctors can't prescribe me what I take, as it would get them in trouble for using contraindicated drugs, but I choose to carry on because the risk seems worth it to me on a personal level.

    I guess I'm just wondering if this serotonin syndrome thing has ever happened to anyone since I've read it's rare?
    It is relatively rare but I don't believe it is worth the risk without discussing interaction potential with your doctor. Self-medicating while knowing adverse reaction risks are involved can be a tricky road to go down. You are gambling with your health.
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    Post drug interactions/ off label uses/doctors

    Quote Originally Posted by QVC1212 View Post
    It's a rare but life-threatening condition. I've had it and was hospitalized. I had altered mental status (this is a sign of a SERIOUS problem), hyperthermia, tremors, high blood pressure, and agitation. The ER doctors put down "serotonin syndrome". But at the hospital the MRI of my head was clean, and there are no diagnostic tests for serotonin syndrome only a constellation of symptoms to recognize once everything else is ruled out, but the hospital docs gave me an equally serious diagnosis of "encephelopathy" (brain disease) which didn't rule out the serotonin syndrome but didn't confirm it either.

    I was taking prozac at the highest dose, buspar at the highest dose, and tramadol at the highest dose. All effect serotonin levels. I was also illegally, wrongly and against medical advice taking ADHD meds (adderall) to help with school which the docs didn't know about, though I'm sure their tox screen showed it.

    Trust me, Serotonin syndrome is no fun. Come clean to your docs about what you're on. They'd rather that happen than NOT know and something bad happen to you.
    That sounds hideous Sorry you had to go through that. Thanks for posting because I really hadn't heard of anyone getting this syndrome before

    *This post was auto-merged. The following text was added 32 minutes after the last post:*

    Quote Originally Posted by alumni View Post
    It is relatively rare but I don't believe it is worth the risk without discussing interaction potential with your doctor. Self-medicating while knowing adverse reaction risks are involved can be a tricky road to go down. You are gambling with your health.
    I take your point, and appreciate the words of caution, thanks.

    I perhaps should elaborate a bit, and this isn't directed at either of the two people who've kindly responded to my question. Just my experience.

    My usual doc wasn't around and I wanted a sleeping med (amitriptyline) which is the only drug in the UK that NICE (the big reasearch boys) have authorized for use in CFS/M.E. patients.

    The doctor thought it was a great idea - by the way, my experience of UK doctors is that you do your own research and then go in and tell them what to prescribe you, whilst making them think that it's really their idea ). She thought it was a great idea, until this fairly young doctor checked the interactions and realised she couldn't prescribe it due to contraindicated serotonin syndrome possibilites

    I went back to my usual doctor (a partner in the practice) after a few weeks, and he prescribed me both drugs straightaway. I had already reduced the SSRI anyway so that may have helped, but this experience illustrates that weighing up adverse interactions with conraindicated drugs against possible patient benefits is dependent on much more than just science. My best guess is that the other doctor had her hands tied by the potential consequences of prescribing contraindicated drugs - it may have harmed her career to do anything outside the rules. My usual doctor, however, doesn't have that issue, so he was able to act within the bounds of his long years of experience.

    Anyway, I have gone off on a slight tangent there. I'd be too embarrassed to tell my doctor I take certain meds sometimes to alleviate the distress of my health condition, but I don't do it daily and I have had pause for thought now that someone has told me serotonin syndrome has happened to them.
    Last edited by Della; 04-26-2011 at 12:21 PM.
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  5. I was once taking Savella for fibromyalgia and a psychiatrist I had never seen before prescribed me Lexapro he said it was fine for me to take them together. It was not fine, on the third day of taking the Lexapro I started feeling like I was not on this planet. I was at a county fair and I started feeling faint, sicker than I've ever been and I was dripping with sweat, I mean serious unhuman sweating. I had to be taken to the hospital. I really had a early/mild case but I'd never felt so much like I was just dying. The E.R. suspected serotonin syndrome right away when my husband told them about my meds. Needless to say I found a different psych.
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    I mixed prozac and phentermine together which was a bad idea, I had the shakes, my whole body felt like it was on fire, started to get blurred vision and felt out of it. I reckon I was also in the early stages of serotonin syndrome, stupidly I did not go to hospital as I didn't want a lecture from the docs so stopped taking the Prozac (carried on with phen) and within a day or so I was back to normal. depressed but thin. My advice to anyone thinking about it is don't risk it (unless you get the all clear from your doc).
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    @Della
    I've done the same sort of mixing and not had any negative effects (that I'm aware of). Perhaps I've just been lucky. However, everyone's different and I would never recommend that others try it.
    Helpful naynay Rated helpful

  8. #8
    another one that a lot of people (even the docs) don't think to mention is any of the triptans used for migraines..these flood your brain with serotonin and should be avoided or taken with caution with other serotonin agonists.

  9. #9
    I might be taking Paxil if my anxiety is not abated and/or my Dr. wants me to stop the tranq.

    I already have studied how interactions can happen. Even some caution to tell the Dr. and pharmacist if you are taking an herbal supplement, all otc medications (cold medicine), etc...

    Also, the contrindicated drug, herbal supplement or otc drugs should be out of your system for a few weeks before you start the a/d medication. Again, here, ask the Dr. and pharmacist about this.
    Helpful naynay Rated helpful

  10. #10
    @Alternate
    I'd be less concerned about serotonin syndrome and have more of an issue with starting Paxil. Of all the anti-depressants it's one of the least popular over here now (UK) due to side effects and withdrawal. There are other gentler SSRIs which won't have the effect of completely moving your sex drive and leaving you feeling as though you're going through cold turkey when you eventually decide to come off it
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    Quote Originally Posted by Aliceinwonderland View Post
    I mixed prozac and phentermine together which was a bad idea, I had the shakes, my whole body felt like it was on fire, started to get blurred vision and felt out of it. I reckon I was also in the early stages of serotonin syndrome, stupidly I did not go to hospital as I didn't want a lecture from the docs so stopped taking the Prozac (carried on with phen) and within a day or so I was back to normal. depressed but thin. My advice to anyone thinking about it is don't risk it (unless you get the all clear from your doc).
    I'll +1 Alice's statement even though I am mixing an SSRI and phentermine. Hopefully (although I doubt it always happens) the prescribing doc would tell you what to watch out for. They also would (hopefully) know the right dosages of each. I had a physical a couple of weeks ago and I took my supplements (I take about 4 or 5 a day) with me for the doc to look at to see if there was anything in my mix that might be bad.
    Helpful Della Rated helpful
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  12. #12
    I've had it and it was terrifying! Tremors, sweats and the worst thing, frightening hallucinations which sent me to the hospital. I was on Effexor and had back surgery, the back doctor prescribed Meperidine- He knew I was taking Effexor which is a no no. Now I always do my own research before taking any drug - Doctors don't know it all!

    As someone said, Serotonin Syndrome is not pleasant- one of worst experiences of my life. Be careful.
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  13. #13
    @jholden40 actuallly I was on that for a situational depression and it worked, it also helped with the anxiety. I actually w/d from it in a few weeks (was later told that was way fast). I have the prescription filled and ready. I was planning on taking a much lower dosage this time. Other than weight gain (whcih I lost) had no side effects. A benzo w/d is far worse than a Paxil w/d.

    Do you mind naming others you recommend. I have heard that Lexapro is mild but good.

    I don't want Cymbalta or Prozac, but those do work for others.

    And not to off topic the thread - whatever I decide to take I will make sure I check out everything and ask what can be combined safely with the a/d.
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  14. #14
    @Alternate
    Citalopram (Celexa) is a popular choice (i took it and found it effective) as is Remeron (Mirtazapine) - the latter being a different type of anti-d to the SSRIs. Remeron is also used to augment treatment with SSRIs like Paxil, Celexa, Prozac, etc., if the SSRI doesn't work by itself. Personally I didnt get on with Remeron but it's increasingly popular ...
    Helpful Alternate, naynay, slick76 Rated helpful
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  15. #15
    Celexa, thanks, @jholden40 for that suggestion.
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    As I've mentioned before, my dad's a doctor who's retiring soon. I've only ever heard him talk about a person presenting with Serotonin Syndrome, whom he (my dad) immediately referred to hospital. The combination of of drugs he was taking was Trazadone and Buspar (Buspirone). Serotonin Syndrome, is much less common the Neuroleptic Malignant Syndrome, which can occur through, usually chronic longer-term use of anti-psychotics, although there are occasions when NMS occurs abruptly.

    Less than one in a thousand people who combine drugs capable of provoking SS end up with it. The problem with SS is that in many cases the symptoms can begin in a very subtle manner and escalate from there. Often things like hot flushes/sweats, myoclonic jerks, slight increase in heart rate is over-looked. From there the situation can deteriorate at varying degrees of speed. The point at which people notice something is really "wrong" is often when they notice a very elevated heart-rate, and an increase in body temperature which can lead to serious hyperpyrexia. Also at this point myoclonic jerks are accompanied by highly over-reactive reflexes, akathisia (a sense of inner restlessness and agitation) and profuse sweating. This when people usually seek medical attention, or medical attention is sought on their behalf.

    The problem is, by the stage mentioned above, it's a struggle to pull an individual "back down" again if the patient is mentally incoherent and unable to relay what drugs they take. The symptoms of severe SS include Hypertensive Crisis (an increase in blood pressure that could lead to organ failure or heart damage), shock, temperature rises well above 41 degrees Celsius, mania, muscle wasting, and metabolic acidosis.

    However, if it can be established quickly that symptoms are that of SS (and not NMS (which share very similar symptoms profiles but their treatment profiles differ in several ways)), then the usual course of action is to rid the body as quickly as possible of the offending drugs and to administer an antiserotonergic medication to "cancel out" the reinforcing effect that the two (or more) serotonin-activating drugs are having on the body. If this is done successfully, the success rate is very high and the mortality is very low (much lower than NMS which has a considerably higher mortality rate). The real danger is if a person doesn't realise their illness is SS, and puts it down to the flu, or something similar. I think this would be unlikely, as the symptoms of SS are so peculiar and pronounced that at some stage most mentally stable people would realise that something was deeply wrong.

    Anyway, sorry for waffling

    TTFN

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