![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by mattz on March 5, 2004, at 23:09:55
Hi, first post so go gentle on me. ;)
I'm confused about what I have read about serotonin syndrome. First of all, I should make it clear that I do know that using SSRIs and MAOIs is considered a big no no, with documented cases of severe reactions, some of which have lead to fatal consequences. I also know that some of the TCAs and other more stimulating drugs can be relatively safely used with the MAOIs. However, what I would like to know is if the likelihood of getting serotonin syndrome for an SSRI/MAOI or another strongly serotoninergic combination of drugs, is directly related to how depressed you are in the first place - i.e. natural levels of serotonin deficiency?
What are the initial symptoms of serotonin syndrome? Presumably there is some degree of euphoria before the more severe side effects set in? In other words, if you start using very small tapered dosages of an MAOI to add to an SSRI, might it be possible to predict an excess of serotonin, before anything too dramatic happens?
Finally, is there ever a case for using an SSRI (or Clomipramine for that matter) in combination with an MAOI? - and by that, I mean a non-reversible MAOI. What about in the case of someone with severe treatment resistant depression, who has tried all forms of antidepressants and and other related drug combinations? If so, then should it be used before or after ECT?
I should also add that I'm not going to use the information received to my question above as an aid to self medicating in any way.
Thanks a lot,
Mattz
Posted by linkadge on March 6, 2004, at 9:03:58
In reply to Confused about Serotonin Syndrome, posted by mattz on March 5, 2004, at 23:09:55
I do think that it strongly depends on how much serotonin is in the synapse in the first place.
There are a few receptors which when activated too much cause the symptoms of serotonin syndrome. The 5-ht2a receptor is one of them. Blockade of this receptor has been shown to ameliorate the symptoms of the syndrome.
As far as warning goes sometimes there is none at all. I have had the syndrome many times. About 5, one of which was close to life threatening.
The first time I felt euphoric, and then within one hour I felt powerfully dysphoric, and frankly psychotic. The initial symptoms for me have been an almost psychotic confusion. It really just feels like you are loosing touch with reality. No hallucinations or anything but just a "sudden change in mental status". Powerful and sudden surges of adreneline, profuse sweating, headache, constant diareah, rigid muscles, dialated puples, the works.
The worst part is that each time I have experienced it, I never though that it was what it was. I always thought It was some sort of panic attack, which would have fit some of the symptoms but not the shivering , and rigid muscles, etc.
I really cannot say what you should look for because It always seemed to happen so suddenly. In the literature this seems to be similar. I would look for sudden changes in body temperature, either freezing or boiling, almost like hot flashes or something. Every time I have had it I have had one thought pop into my head. It was like "boom" like a sudden overwhealming sense of guilt, over something small, large whatever, like all of a sudden it was judgment day. It was the worst experience I have ever had. Worse than the depths of my depression. The reason I know it was not a relapse or something was because you go from feeling perfectly normal, to hell awefull within an hour or so, and slowly perhaps 8 hours later it leaves and you feel perfectly normal again.
I think that no drug is guarenteed to cause it.
I always keep some atypical antipsychotic handy because if it happens, these drugs can quickly reverse it by blocking the 2a receptors.
Linkadge
Posted by linkadge on March 6, 2004, at 9:08:55
In reply to Re: Confused about Serotonin Syndrome, posted by linkadge on March 6, 2004, at 9:03:58
When it is over, you feel absolutely amazing. YOu feel better than you have in years, truly well.
THere have been quite a few case reports of people dropping all medicine after the syndrome and going into remission for quite a while.
Linkadge
Posted by Questionmark on March 7, 2004, at 7:17:34
In reply to One other thing, posted by linkadge on March 6, 2004, at 9:08:55
> When it is over, you feel absolutely amazing. YOu feel better than you have in years, truly well.
>
> THere have been quite a few case reports of people dropping all medicine after the syndrome and going into remission for quite a while.
>
>
> Linkadge
That's weird. The few times i've experienced it (two quite mild; one mild to moderate), i felt quite euphoric DURing the experience (with the considerable muscle tension, hypereflexia, and *physical* anxiety-- though psychological confidence). And then AFter it subsided was when i felt much more depressed for awhile. Don't know if i've ever had what can be adequately termed serotonin "syndrome," technically, but i'm certain it was at least serotonin overload). Just wanted to add that-- esp so someone won't go trying to give themselves serotonin syndrome purposely so they can feel better afterward. Also, serotonin syndrome may very well be neurotoxic to serotonergic cells, as well as potentially damaging to the kidneys, muscles, and heart.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.