Posted by Lou Pilder on March 5, 2015, at 20:01:44 [reposted on March 14, 2015, at 22:17:25 | original URL]
In reply to Re: SSRI withdrawal symptoms really scare me!, posted by Robert_Burton_1621 on March 4, 2015, at 19:57:37
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> > Mirtazapine has been used to treat serotonin syndrome.
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> > I feel, from my perspective, that it is better to take into consideration well-evidenced information by people who have expertise in this particular area, than to rely reflexively on sites like drugs.com, but that is of course a matter for you and your doctors.
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> Just a quick note to supply support for the statement that mirtazapine "has been used" to treat serotonin toxicity. This statement did not, of course, imply that mirtazapine is the optimal treatment for serotonin toxicity or that it is in any way habitually used to treat symptoms along the spectrum of serotonin toxicity. Its 5HT2 antagonism may be a plausible mechanism whereby it has been used to treat ST, though I suspect that given that the potency of this antagonism is not among the highest, then the extent to which it was reported effectively to treat ST may have been proportionate to the degree of severity of the symptoms which were treated.
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> Note that when I stated that it is erroneous to assert that the combination of mirtazapine with venlafaxine causes a *major* risk of serotonin toxicity, this applied only to any causal role of mirtazapine, not to that of venlafaxine. It also did not imply that mirtazapine has no potential for side-effects which are not related to serotonin-toxicity.
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> Here are citations to work arguing for, and perhaps demonstrating: (1) the negligible serotonergic effect of mirtazapine; (2) the unlikelihood that it can induce serotonin toxicity; and (3) the fact that it has been used as a treatment for serotonin toxicity or symptoms of serotonin-induced side-effects.
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> This is, to be sure, simply information I have sourced; my mentioning it carries no expert assessment of its definitiveness. That goes without saying. But it is possible to apply our own general critical intelligence to such information to assess whether it is likely to be worthy of consideration when we make any decisions about medication *with our doctor*. Drawing participants' attention to relevant information is intended to support the decision-making process they engage in with their clinicians. In my experience, some clinicians will not do any research themselves and patients are therefore, particularly if their conditions are long-standing and refactory, obliged through necessity to undertake research themselves. But given that most of us are not experts, the results of our research can mostly only be to expand the stock of information about which we are in a position to notify our clinicians. That can often be (though in those cases where clinicians are not receptive, usually is not) an empowering thing which *supports* and motivates our treatment under clinical supervision.
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> (1)
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> "A systematic review of the serotonergic effects of Mirtazapine: implications for its dual action status," Human Psychopharmacology: Clinical and Experimental (2006) 21, pp 117-25.
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> "Mirtazapine: not a dual action antidepressant?" Australian and New Zealand Journal of Psychiatry (2004) 38, pp 266-7.
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> "Mirtazapine enhances frontocortical dopaminergic and corticolimbic adrenergic, but not serotonergic, transmission by blockade of alpha2-adrenergic and serotonin2C receptors: a comparison with citalopram," Eur J Neurosci, (2000) 12(3), pp 1079 - 95.
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> (2)
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> "Mirtazapine: unable to induce serotonin toxicity?" Clinical Neuropharmacology, (2003) 26, pp 288-9.
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> "A Review of Serotonin Toxicity Data: Implications for the Mechanisms of Antidepressant Drug Action," Biological Psychiatry, (2006) 59, pp 1046-51.
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> "Adverse reactions to mirtazapine are unlikely to be serotonin toxicity," Clin. Neuropharmacology, (2003) 26, pp 287-288.
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> "Mirtazapine overdose is unlikely to cause major toxicity," Clin Toxicology(Phila), (2014) 52(1), pp 20-4.
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> (3)
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> "Mirtazapine as treatment for serotonin syndrome," Pharmacopsychiatry, (1996) 29(2), 81.
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> An authority refers to the above case study as "unsurprising, as [mirtazapine] is a 5-HT2A antagonist. Indeed, there is substantial evidence that 5-HT2A antagonists are effective treatments for [serotonin toxicity]": see Human Psychopharmacology: Clinical & Experimental, (2006) 21, pp 117-25, at p 122. The study is also referred to without criticism in Clinical Neuropharmacology (2003) 26(6), pp 288-9 at p 288.
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> "Mirtazapine abolishes hyperthermia in an animal model of serotonin syndrome," Neuroscience Letters, (2010) 482(3), 216-9.
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> "The effects of mirtazapine and fluoxetine on hyperthermia induced by 3,4-methylenedioxymethamphetamine (MDMA) in rats," Neuroscience Letters, (2011) 499(1), pp 24-7.
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> Considers mianserin: "Role of 5-HT(2) receptors in the tryptamine-induced 5-HT syndrome in rats," Behavioural Pharmacology (2002) 13(4), pp 313-8.
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> Considers mianserin: "Functional subsensitivity of 5-HT2A and 5-HT2C receptors mediating hyperthermia following acute and chronic treatment with 5-HT2A/2C receptor antagonists," Psychopharmacology, (1997) 130(2), pp 144-51.
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> 5-HT2A antagonists: "Potent serotonin (5-HT)(2A) receptor antagonists completely prevent the development of hyperthermia in an animal model of the 5-HT syndrome," Brain Research, (2001) 890(1), pp 23-31.
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> Friends,
It is written here,[...it is better to take into consideration well-evidenced information by people who have expertise..than to rely..on sites like drugs.com...].
Now wait a minute. let us examine what this statement could mean.
The statement says that it is {better}. Here we have two things compared, and one is better. A generally accepted understanding of the slang expression, put down, involves comparing two things and saying that one is superior to the other or that one is inferior to the other. With that in mind, let us go on and the poster writes,[...well-evidenced information by people who have expertise...]. Does that mean that the people from drugs.com do not have expertise or use well-evidenced information in the area in question as to the combining of the two drugs could increase the aspect of getting serotonin syndrome exponentially? They got it from those some place, so could not those have the expertise and well-evidenced information to state that there is the great risk of serotonin syndrome from taking the combination of the two drugs? If not, why not?
You see, readers, there is a Great Deception going on of which I am prevented from posting here about due to the prohibitions posted to me here by Mt. Hsiung. Mr. Hsiung also states that posters are to be civil at all times and that being supportive takes precedence, but he can leave an uncivil or unsupportive statement to be seen as civil or supportive because in his thinking it will be good for his community as a whole to do so. This puts me at a great disadvantage to offer support and education here, which is the goal of this forum.
You see, the site drugs.com is highly actuated and I know of no adverse reviews of the site. If they list adverse reactions from interactions of drugs, and they were reckless, do you not think that there would be challenges to what they say? I know of no challenges to the site's interaction feature. In fact, I see the same list of interactions on other sites. This could mean that there is well-evidenced information being presented. I am asking that readers not to accept any statements that could be construed to be defamatory about the site drugs.com as fact here, for to ignore the consequences of taking drugs together, could cost you your life.
Lou
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poster:Lou Pilder
thread:1077523
URL: http://www.dr-bob.org/babble/20150223/msgs/1077527.html