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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 41. This is the beginning of the thread.
Posted by SLS on August 29, 2010, at 6:19:45
I recently had to discontinue lithium after adding Nardil to my treatment regime. It seems that the combination of these two drugs produced a mild to moderate serotonin syndrome. Symptoms included diaphoresis, hyperreflexia, ataxia, and hypertonia (especially of the lower back muscles). In addition, I experienced urinary retention that was non-reactive to bethanechol. All of these things disappeared upon the discontinuation of lithium. My rationale for deciding upon lithium as an offending agent was that the pro-serotonergic properties of lithium (serotonin release) acted synergistically with those of Nardil. I had no such problem with the combination of Parnate and lithium.
- Scott
Posted by angels78 on August 29, 2010, at 6:53:56
In reply to Nardil + lithium = serotonin syndrome, posted by SLS on August 29, 2010, at 6:19:45
What dose of nardil are you on?
Posted by SLS on August 29, 2010, at 9:04:34
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by angels78 on August 29, 2010, at 6:53:56
> What dose of nardil are you on?
My treatment regime comprises:
Nardil 90mg
nortriptyline 150mg
Lamictal 100mg
Abilify 10mg
- Scott
Posted by Phillipa on August 29, 2010, at 12:59:02
In reply to Re: Nardil + lithium = serotonin syndrome » angels78, posted by SLS on August 29, 2010, at 9:04:34
Scott I'm really sorry to hear this. Could the lamictal contributed to it? I didn't think lithium could react in this way. Hoping you are feeling better now. So no more lithium? Phillipa
Posted by Maxime on August 29, 2010, at 13:48:56
In reply to Nardil + lithium = serotonin syndrome, posted by SLS on August 29, 2010, at 6:19:45
Aw, damn. I am really sorry to hear that. What is hypertonia? Guess I could look it up ...
Posted by SLS on August 29, 2010, at 14:05:47
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by Phillipa on August 29, 2010, at 12:59:02
> Scott I'm really sorry to hear this. Could the lamictal contributed to it? I didn't think lithium could react in this way. Hoping you are feeling better now. So no more lithium? Phillipa
For now, I must stay off lithium in order to stay on Nardil.
- Scott
Posted by SLS on August 29, 2010, at 14:09:57
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by Maxime on August 29, 2010, at 13:48:56
> Aw, damn. I am really sorry to hear that. What is hypertonia? Guess I could look it up ...
Hypertonia is a state of excessive contracture and spasm of muscles. It affected my lower back most, but it also affected my gait when I walked. My legs were too tight to walk smoothly.
- Scott
Posted by Maxime on August 29, 2010, at 15:13:48
In reply to Re: Nardil + lithium = serotonin syndrome » Maxime, posted by SLS on August 29, 2010, at 14:09:57
> > Aw, damn. I am really sorry to hear that. What is hypertonia? Guess I could look it up ...
>
> Hypertonia is a state of excessive contracture and spasm of muscles. It affected my lower back most, but it also affected my gait when I walked. My legs were too tight to walk smoothly.
>
>
> - ScottThat sounds like me! It is worse in the morning that throught the day, but it is always there. I walk like a cave woman and I sound like an elephant when I come down stairs. But mine didn't start after a med changes or anything. It just happened along with pain I feel throughout my body.
Do you take any meds for it like a muscle relaxant? That's what I feel would help me.
Posted by Roslynn on August 29, 2010, at 16:31:29
In reply to Nardil + lithium = serotonin syndrome, posted by SLS on August 29, 2010, at 6:19:45
Scott,
I'm sorry you had to go through this. Are you feeling better? Dumb question, but did you have to go to the ER?
Also, what was your dose of lithium and will you be okay without it?
Roslynn
> I recently had to discontinue lithium after adding Nardil to my treatment regime. It seems that the combination of these two drugs produced a mild to moderate serotonin syndrome. Symptoms included diaphoresis, hyperreflexia, ataxia, and hypertonia (especially of the lower back muscles). In addition, I experienced urinary retention that was non-reactive to bethanechol. All of these things disappeared upon the discontinuation of lithium. My rationale for deciding upon lithium as an offending agent was that the pro-serotonergic properties of lithium (serotonin release) acted synergistically with those of Nardil. I had no such problem with the combination of Parnate and lithium.
>
>
> - Scott
Posted by atypical on August 29, 2010, at 18:43:45
In reply to Nardil + lithium = serotonin syndrome, posted by SLS on August 29, 2010, at 6:19:45
SLS,
In the back of my mind I had thought that Lithium might not be a good combo with Nardil because of its serotonin activities. I've been on 60mg Nardil and 900mg Lithium for a year or so now and have not had any problems. Perhaps the 90mg dose of Nardil caused it? I was on 75mg for a few weeks without any serotonin syndrome issues.
Atypical
Posted by SLS on August 29, 2010, at 18:47:16
In reply to Re: Nardil + lithium = serotonin syndrome, posted by Roslynn on August 29, 2010, at 16:31:29
Hi Roslynn.
> I'm sorry you had to go through this. Are you feeling better?
Yes. Thanks.
> but did you have to go to the ER?
Luckily, the reaction was not so severe as to require a trip to the hospital.
> Also, what was your dose of lithium
300mg per day.
> and will you be okay without it?
It is hard to tell. Lithium was helping a little, but not enough to justify its continuation in light of the hyperserotonergic state it produced. I had wanted to continue on lithium for its purported neurotrophic properties.
It's always something.
- Scott
Posted by emmanuel98 on August 29, 2010, at 19:42:11
In reply to Re: Nardil + lithium = serotonin syndrome » Roslynn, posted by SLS on August 29, 2010, at 18:47:16
Are you sure it's the litium and not the abilify. I was told that abilify and an MAOI are absolutely contra-indicated. My p-doc told me this after attending a workshop on AAPs and MAOIs
Posted by angels78 on August 29, 2010, at 23:27:37
In reply to Re: Nardil + lithium = serotonin syndrome » angels78, posted by SLS on August 29, 2010, at 9:04:34
Dang Scott
Your able to tolerate the side effects at 90mg of Nardil? How's your weight coming along?
Posted by SLS on August 30, 2010, at 5:00:06
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by angels78 on August 29, 2010, at 23:27:37
> Dang Scott
> Your able to tolerate the side effects at 90mg of Nardil?I doubt that I could have tolerated that much Nardil 20 years ago when I was still somewhat responsive to medications in general. It feels as if I have become tolerant of both the antidepressant effects and unwanted side effects at the same time.
> How's your weight coming along?
Oh, just fine.
:-(
I had gained 50 pounds due to Abilify. Nardil is not making it any easier to control intake or prevent further weight gain. I am very tempted to discontinue Abilify. I would most likely feel worse immediately upon discontinuation. I just hope that this would be a temporary depressive rebound.
- Scott
Posted by SLS on August 30, 2010, at 5:11:16
In reply to Re: Nardil + lithium = serotonin syndrome, posted by emmanuel98 on August 29, 2010, at 19:42:11
> Are you sure it's the litium and not the abilify.
Yes. Theory aside, it was a matter of logic. I had been taking Abiify for quite a few years without untoward effect except for weight gain. The hyperserotonergic symptoms did not appear until I added the Nardil. The last time I was taking Nardil and Abilify together and without lithium, I had no problem. It was an educated guess to pinpoint the lithium as the culprit as it was the only variable, and the knowledge that lithium was a serotonin releaser. Discontinuing the lithium has resulted in an immediate resolution of the problematic symptoms.
> I was told that abilify and an MAOI are absolutely contra-indicated.
I don't know why this would be.
> My p-doc told me this after attending a workshop on AAPs and MAOIs
I am considering discontinuing Abilify. I'll post the results.
- Scott
Posted by ed_uk2010 on August 30, 2010, at 15:06:11
In reply to Re: Nardil + lithium = serotonin syndrome » emmanuel98, posted by SLS on August 30, 2010, at 5:11:16
Hi Scott,
Do you think it's definitely Abilify which is causing your weight gain, not Nardil or nortriptyline?
I think it's probably a good idea to try to come off Abilify. You might feel temporarily worse but that could be followed by an improvement. I just wonder whether your energy levels might improve without the antipsychotic on board.
Posted by Roslynn on August 30, 2010, at 16:33:25
In reply to Nardil + lithium = serotonin syndrome, posted by SLS on August 29, 2010, at 6:19:45
Scott,
I'm sorry about the weight gain. I am fighting that too. Best of luck to you as you decrease the Abilify.
Roslynn
Posted by morgan miller on August 30, 2010, at 17:18:04
In reply to Re: Nardil + lithium = serotonin syndrome » emmanuel98, posted by SLS on August 30, 2010, at 5:11:16
Scott, have you ever thought about just taking a small amount of lithium orotate once or twice a day for the continued neuroprotection? You may even still get some subtle mood stabilizing benefit from it. I don't think this will interact with Nardil the way 600 mg of lithium carbonate did.
Morgan
Posted by SLS on August 30, 2010, at 17:19:25
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by ed_uk2010 on August 30, 2010, at 15:06:11
Hi Ed.
> Do you think it's definitely Abilify which is causing your weight gain, not Nardil or nortriptyline?
Yes. Substituting desipramine for nortriptyline didn't help with the weight gain. Neither did swapping Parnate for Nardil. I was very much dismayed that I did not lose any of the 50 extra pounds when I switched to Parnate and desipramine. The weight gain did not occur immediately upon initiating Abilify therapy. It was a latent effect that emerged insidiously. It seems that this is not an uncommon phenomenon from what I see on Psycho-Babble.
> I think it's probably a good idea to try to come off Abilify. You might feel temporarily worse but that could be followed by an improvement.
Okay. I'll do it. Let's see what happens.
> I just wonder whether your energy levels might improve without the antipsychotic on board.
Actually, one of the reasons I remained on Abilify for so long is that it increased my mental energy and motivation.
- Scott
Posted by SLS on August 30, 2010, at 17:24:46
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by morgan miller on August 30, 2010, at 17:18:04
> Scott, have you ever thought about just taking a small amount of lithium orotate once or twice a day for the continued neuroprotection? You may even still get some subtle mood stabilizing benefit from it. I don't think this will interact with Nardil the way 600 mg of lithium carbonate did.
>
> Morgan
You are probably right. I'll give it some thought. I might attempt to discontinue Abilify first.
- Scott
Posted by morgan miller on August 30, 2010, at 17:25:04
In reply to Re: Nardil + lithium = serotonin syndrome » ed_uk2010, posted by SLS on August 30, 2010, at 17:19:25
Scott, how about just trying a lower dose, maybe 2 or 3 mg, of Abilify, at least for a few months.
Morgan
Posted by SLS on August 30, 2010, at 17:31:06
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by morgan miller on August 30, 2010, at 17:25:04
> Scott, how about just trying a lower dose, maybe 2 or 3 mg, of Abilify, at least for a few months.
>
> MorganMy main concern with Abilify is weight gain and elevated triglycerides. So far, I haven't seen any evidence that weight gain with Abilify is dosage related. I'll try to taper slowly.
Thanks.
- Scott
Posted by morgan miller on August 30, 2010, at 17:45:53
In reply to Re: Nardil + lithium = serotonin syndrome » morgan miller, posted by SLS on August 30, 2010, at 17:31:06
Good luck!
Posted by SLS on August 30, 2010, at 17:50:35
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by morgan miller on August 30, 2010, at 17:45:53
> Good luck!
Thanks.
- Scott
Posted by morgan miller on August 30, 2010, at 18:07:47
In reply to Re: Nardil + lithium = serotonin syndrome » morgan miller, posted by SLS on August 30, 2010, at 17:50:35
Oh yeah I forgot to mention that if you do try lithium orotate, Vitamin Research Products, they evidently have one of the more reliable high quality lithium orotate products out there.
Morgan
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