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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by PaulB on August 16, 2001, at 14:29:32
One of the things that crops up in the books I have been reading on 5-HTP, I have been experimenting with is how dangerous it is to combine it with another antidepressant although, of course, there are numerous drugs that could precipitate such an episode.
I guess I had what you might call a serotonin syndrome when I first tried 5-HTP a few weeks ago. I was real sick, teeth non-stop chattering, hypomanic. I was using under guidance, in that I told my doctor I was going to use it. By the time I arrived at the local hospital(30 minutes)I was fine. I had another attmept with the 5-HTP at a lower dosage than recommended but getting only moderate effects for typical anxiety and depression problems, but it is helping. Scared to increase dose, not satisfied with current dosage effect, what to do?
Thanks for any input.
PaulB
Posted by Elizabeth on August 17, 2001, at 3:48:17
In reply to How serious is serotonin syndrome, posted by PaulB on August 16, 2001, at 14:29:32
> I guess I had what you might call a serotonin syndrome when I first tried 5-HTP a few weeks ago. I was real sick, teeth non-stop chattering, hypomanic.
The chattering teeth are a big telltale sign. I'm glad it was a brief and relatively mild episode and hope that you don't have to go through it again. Extreme cases can cause seizures, extremely high fever, delirium, and even death.
-elizabeth
Posted by k9lover on August 17, 2001, at 8:45:11
In reply to Re: How serious is serotonin syndrome » PaulB, posted by Elizabeth on August 17, 2001, at 3:48:17
> > I guess I had what you might call a serotonin syndrome when I first tried 5-HTP a few weeks ago. I was real sick, teeth non-stop chattering, hypomanic.
>
> The chattering teeth are a big telltale sign. I'm glad it was a brief and relatively mild episode and hope that you don't have to go through it again. Extreme cases can cause seizures, extremely high fever, delirium, and even death.
>
> -elizabethWhat a timely post - this happened to me again last night, and this time I knew what it was - here's a link that was helpful to me...
http://www.uspharmacist.com/NewLook/DisplayArticle.cfm?item_num=94
Posted by Teri on August 17, 2001, at 8:56:54
In reply to Re: How serious is serotonin syndrome » PaulB, posted by Elizabeth on August 17, 2001, at 3:48:17
hi. Back in the early 70's I took too many amphetemines and had all of the symptoms of serotonin syndrome. They just didn't call it that back then. I was trembling all over, teeth chattering, shivering, heart rate up. It was really scary. I think because of that experience I can't handle SSRI meds. I took Zoloft and Trazadone at night for sleep and the combination created the Serotonin Syndrome again. It came on while I was at work. Not fun! I had to take a month off to recover, go cold turkey from the antidepressants and take Xanax 3x day. I just recently tried Effexor XR and the reaction was similar to what had happend in the past. I'm weaning off of it and taking Klonopin to take the edge off the effects of Effexor plus the withdrawal. I'm taking 10mg of Celexa to help with the withdrawals also, but am scared to take more of it because of the serotonin thing. I think what I did in my past rewired my brain to where I'm just too sensitive to it. I looked up drug interactions on this site that is by Dr. Koops and sure enough, it said that the combo of Trazadone and Zoloft is severe for Serotonin Syndrome. Wish my doctor would have know that. Teri
Posted by PaulB on August 17, 2001, at 12:26:04
In reply to Re: How serious is serotonin syndrome, posted by Teri on August 17, 2001, at 8:56:54
I appreciate the feedback. This particular incident wasnt what I would call serious despite the extreme initial reaction, it just seemed to fade. Like I wrote by the time I got to the hospital I was fine and just went to the canteria and has some breakfast. Since then I have been using 5-HTP at 100mg a day, first thing on an empty stomach. Occasionaly my muscles seem to start twitching, wich is weird but thats all. When it works it really WORKS and I truly believe I am 5-Ht deficient, just trying to correct this problem, is so difficult.
PaulB
Posted by Daveman on August 17, 2001, at 23:22:36
In reply to Re: How serious is serotonin syndrome » PaulB, posted by Elizabeth on August 17, 2001, at 3:48:17
As I take Celexa 40 mg/day, my doc told me not to take 5-HTP unless I wanted to have an "interesting experience". I told him the depression/anxiety/insomnia I had earlier this year was quite "interesting" enough for one lifetime:)
Dave
Posted by Sunnely on August 17, 2001, at 23:57:11
In reply to How serious is serotonin syndrome, posted by PaulB on August 16, 2001, at 14:29:32
> I guess I had what you might call a serotonin syndrome when I first tried 5-HTP a few weeks ago. I was real sick, teeth non-stop chattering, hypomanic.
Serotonin syndrome usually occurs when a serotonergic drug is added to another serotonergic drug (can also occur with use of a serotonergic drug alone). It usually occurs within minutes to hours after a second agent is added. It is usually mild and resolves within hours after the offending drugs are discontinued. However serious complications such as severe hyperthermia, seizures, respiratory failure and even death have been reported.
The clinical picture of serotonin syndrome may present as mental status changes such as confusion, agitation, and hypomania. This is usually accompanied by other symptoms such as uncontrollable shivering or teeth-chattering, hyperreflexia, involuntary leg jerkiness or myoclonus, incoordination, restlessness, fever, sweating, diarrhea.
Some of the culprit combinations include:
MAOI + SRIs (serotonin-enhancing antidepressants)
MAOI + Meperidine (Demerol)
MAOI + Dextromethorphan (Robitussin DM)
Tryptophan + SSRI
Trazodone + SSRI
St. John's Wort + SSRIs
"Ecstasy" Intoxication (and deaths) resembles features of serotonin syndrome
Theoretically, 5HTP or SAMe + SSRIsTreatment:
1. Avoidance. If possible, avoid combination of serotonergic drugs. Use cautiously if clinically indicated. Observe washout period strictly from MAOI to SRIs and vice versa. Note: Prozac has very long half-life and therefore, requires much longer washout period than the others.
2. If suspected, stop the offending drugs immediately.
3. Symptomatic treatment if needed, such as: cooling blanket for hyperthermia, IM chlorpromazine for fever, anticonvulsants for seizures, clonazepam (Klonopin) for myoclonus, nifedipine (Procardia) for high blood pressure.
4. The use of a serotonin blocker such as cyproheptadine (Periactin) at 4 mg by mouth, may be repeated in 30 minutes also helps.
This is the end of the thread.
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