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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Muad' Dib on February 6, 2006, at 0:13:11
Is there a risk of such one? How does serotonin syndrome manifest? High BP? High BPM?
Take care.
Posted by yxibow on February 6, 2006, at 3:29:29
In reply to Serotonin syndrome - Nardil + Stablon (tianeptine), posted by Muad' Dib on February 6, 2006, at 0:13:11
> Is there a risk of such one? How does serotonin syndrome manifest? High BP? High BPM?
>
> Take care.SS is very serious.
It is defined by:
At least 3 of the following symptoms and signs should be present: altered mental status (probably fairly common), agitation, tremor, shivering, diarrhea, hyperreflexia, myoclonus, ataxia, or hyperthermia.
Hyperthermia = (very) high fever (most common symptom)
myoclonus = jerkiness
ataxia = instability
Mild SS can be treated with propranolol which has some minor serotonin reducing properties.Major SS is usually treated with cyproheptadine or similar serotonin reducers. In a hospital. Along with Ativan and Klonopin.
And monitoring for up to 48 hours.
It is unpredictable to a degree. Measures are all supportive. Definately not something to be combining with a MAOI without an absolute ok from a doctor.
Posted by TJO on February 6, 2006, at 11:20:09
In reply to Serotonin syndrome - Nardil + Stablon (tianeptine), posted by Muad' Dib on February 6, 2006, at 0:13:11
> Is there a risk of such one?
I have not seen these two drugs used in combination. Nor can I think of an analagous situation to draw inferences from. The best that anyone could do right now is to guess. I imagine there are those who will say that since tianeptine "does the opposite" of SSRIs, it should be safe to combine with an MAOI. I wouldn't rely on such a limited level of reasoning to produce nothing more than a wild guess. *My* guess is that tianeptine *might* increase the turnover of 5-HT in certain regions of the brain via increased vesicular release. It can be argued that the increases seen in interstitial 5-HIAA is representative of this.
In other words, tianeptine might still act to increase 5-HT activity, a property that might lead to serotonin syndrome when mixed with an MAOI, especially Nardil.
- Scott
Posted by SLS on February 6, 2006, at 11:21:27
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianeptine), posted by TJO on February 6, 2006, at 11:20:09
Posted by ed_uk on February 6, 2006, at 13:16:44
In reply to Sorry. Above post is from SLS ^^^ (nm), posted by SLS on February 6, 2006, at 11:21:27
huh?
ed
Posted by Tom Twilight on February 6, 2006, at 15:20:05
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianeptine), posted by TJO on February 6, 2006, at 11:20:09
I've never heard of anyone combining Tianeptine and an MAOI, but then I don't think there is very much quality information on Tianeptine full stop, at least in English.
Hopefully a Start Low, Go Slow aproach would be reasonably safe.
I've generally had a fairly strong feeling when there is to much Serotonin in my system.Its your life at the end of the day, do what you think is best
Posted by blueberry on February 6, 2006, at 17:41:59
In reply to Serotonin syndrome - Nardil + Stablon (tianeptine), posted by Muad' Dib on February 6, 2006, at 0:13:11
I don't know what the risk of SS is if nardil and stablon are mixed. I think stablon will increase the flow of serotonin, but I don't know if it will increase serotonin levels.
Are the pills tabs or capsules? If tabs, cut them into quarters. If capsules, dump some of the contents out. Start real low. Stay at each new dose for a week before moving up.
Just be on the lookout for SS symptoms. Be aware that they might not appear all of a sudden, but may appear in gradual subtle fashion over days or even weeks. Just keep a sharp eye out.
I've done questionable or risky med trials before. It's sad some of us feel so bad that we feel we have to do that, but I guess that is reality. Go low and slow. That way any problems can be caught early before they get out of hand.
Posted by SLS on February 6, 2006, at 20:20:20
In reply to Re: Sorry. Above post is from SLS ^^^ » SLS, posted by ed_uk on February 6, 2006, at 13:16:44
> huh?
>
> ed
Sorry, Ed.:-)
TJO had been using my computer, and I forgot to change the posting name to SLS before submitting my post.
- Scott
Posted by SLS on February 6, 2006, at 20:30:21
In reply to Serotonin syndrome - Nardil + Stablon (tianeptine), posted by Muad' Dib on February 6, 2006, at 0:13:11
Hi.
If you have exhausted all of the alternatives you consider plausible, and feel that combining these two drugs represents your best chance of getting well, I guess it will be your responsibility to become more familiar with serotonin syndrome, its symptoms, and emergency treatments. I suggest you do several searches using Google on the Internet and create a list of both to discuss with your doctor.
Serotonin syndrome can evolve gradually or occur paroxsysmally. I wouldn't know what to expect with tianeptine. From my personal experience combining imipramine with phenelzine, I found that SS occured gradually with these two drugs. However, when adding a small amount of venlafaxine to tranylcypromine, the onset of SS was rapid and severe.
Serotonin syndrome is unpredictable.
- Scott
Posted by Phillipa on February 6, 2006, at 22:03:44
In reply to Re: Sorry. Above post is from SLS ^^^, posted by SLS on February 6, 2006, at 20:20:20
Oh wondered about that myself as I recognized your posting style. Fondly, Phillipa The Great SLS!!!!!
Posted by ed_uk on February 7, 2006, at 13:47:13
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianeptine) » Muad' Dib, posted by SLS on February 6, 2006, at 20:30:21
Hi Scott
Who is TJO?
Regards
Ed
Posted by TJO on February 7, 2006, at 14:05:27
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianeptine) » SLS, posted by ed_uk on February 7, 2006, at 13:47:13
> Hi Scott
>
> Who is TJO?
>
> Regards
>
> EdHi Ed,
My name is Tammy and I attend the same day program as SLS. We frequently end up sharing a computer and forget to change the name on the post before posting....sorry for the confusion.Sincerely,
Tammy
Posted by ed_uk on February 7, 2006, at 14:22:47
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianeptine), posted by TJO on February 7, 2006, at 14:05:27
Hi Tammy
>My name is Tammy and I attend the same day program as SLS. We frequently end up sharing a computer and forget to change the name on the post before posting....sorry for the confusion.
No problem :) I've read several of your posts recently. I didn't know you knew SLS though!
Regards
Ed
Posted by TJO on February 7, 2006, at 16:57:48
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianeptine) » TJO, posted by ed_uk on February 7, 2006, at 14:22:47
> Hi Tammy
>
> >My name is Tammy and I attend the same day program as SLS. We frequently end up sharing a computer and forget to change the name on the post before posting....sorry for the confusion.
>
> No problem :) I've read several of your posts recently. I didn't know you knew SLS though!
>
> Regards
>
> EdYes, and he is a wonderful guy! :-)
Tam
Posted by Maxime on February 8, 2006, at 17:40:52
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianeptine), posted by TJO on February 7, 2006, at 16:57:48
Can serotonin really be fatal?
Maxime
Posted by Phillipa on February 8, 2006, at 18:54:45
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianept, posted by Maxime on February 8, 2006, at 17:40:52
Maxie why? You are worrying me. Love Jan
Posted by Maxime on February 8, 2006, at 20:20:17
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianept » Maxime, posted by Phillipa on February 8, 2006, at 18:54:45
> Maxie why? You are worrying me. Love Jan
I'm just curious. In some literature, Serotonin Syndrome is refered to as being a potentially fatal occurence. Yet there have been people on this board who have had it and lived to tell the tale.
Maxie
Posted by yxibow on February 9, 2006, at 0:24:35
In reply to Re: Serotonin syndrome - Nardil + Stablon (tianept, posted by Maxime on February 8, 2006, at 17:40:52
> Can serotonin really be fatal?
>
> MaximeSerotonin Syndrome, not Serotonin itself, can be fatal, yes. It is also unpredictable. It is why multiple drugs that boost serotonin in the synapses of the brain should be combined carefully. It mimics some of the characteristics of NMS (Neuroleptic Malignant Syndrome).
It is usually characterized by at least the following symptoms: a very high temperature, agitation and confusion, and a variety of tremors and jerkiness.
Most cases resolve without further sequelae within 1 to two days with hospitcal care. Sometimes it is necessary to use serotonin antagonists, specifically cyproheptadine. Mild cases can be resolved with propranolol (this is why propranolol can cause depression in some people.) Benzodiazepines are sometimes used to control seizures and jerky motions.
Data from 1998 shows that over 27,000 SSRI exposures occurred, over 2600 major cases occurred, and 21 deaths happened.
These are quotes from emedicine.
It is a serious condition and should be immediately be reported to a doctor if multiple medications that have been prescribed have a probable cause for SS.
I have survived subclinical SS several times, because some drugs were made before we knew the knowledge of the P450 system. Robaxin happens to clash with one of my medications, probably Cymbalta. I felt slightly odd and had a subclinical fever (basically none.) So we adjusted it.
Its something to be aware of when taking SSRIs and then combining them with other medications.
But I wrote this up to clarify, not to scare people. Serious SS is still a rarity.
Posted by Lamdage22 on August 28, 2012, at 3:10:20
In reply to Serotonin syndrome - Nardil + Stablon (tianeptine), posted by Muad' Dib on February 6, 2006, at 0:13:11
Did you do it? (Nardil+Stablon)?
Id be interested in your experience..
This is the end of the thread.
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