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Serotonin syndrome » KaraS

Posted by ed_uk on April 11, 2005, at 9:49:01

In reply to Re: *Serontonin Syndrome* - Ted and Ed » ed_uk, posted by KaraS on April 10, 2005, at 17:59:45

Hi Kara!

>I guess it's a risk to try them together but not a huge risk.

I agree. It would be important to start with a very low dose of selegiline and to increase very gradually, you could break a selegiline tablet into little pieces. If there were any signs of the SS at a low dose you would know not to increase.

I wouldn't recommend taking selegiline with a high dose of........

....any SSRI, Effexor, clomipramine, imipramine or Cymbalta. If at all possible, it would be safest to avoid combining selegiline with any of these drugs.

>And then just watch very carefully for signs of serotonin syndrome. Make sense?

Yes, it would be important to know the symptoms of the SS so that you could identify them quickly and easily. The SS comes in many varieties, it can be mild, moderate, severe or life-threatening.... depending partly on the degree to which serotonin levels have been elevated.

Mild SS-like symptoms are common in people treated with SSRIs alone..... for example: excessive sweating, exaggerated reflexes, tremor, diarrhea, muscle tension, agitation, jaw clenching etc.

If you start with a very low dose of selegiline and increase very gradually, you should be able to spot the symptoms of SS in their mild form- this would tell you not to increase the dose any further.

If you were on an SSRI, Effexor, clomipramine, imipramine or Cymbalta, it would make sense to drastically lower the dose before adding selegiline. You could then cautiously increase the dose again (if necessary) while carefully watching for symptoms.

>Actually, I bet that trimipramine would probably be the safest as it is considered one of the safest TCAs to combine with MAOIs.

Yes, I can't imagine the SS occuring with trimipramine + low-dose of selgiline.

I don't think you're on an SSRI at the moment are you? I thought you were just taking 25mg doxepin and nothing else? Doxepin would probably be a lot safer than an SSRI but you would still need to be very cautious. Serious reactions seem to be very rare but they do occur!

Ed xx


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