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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by cactus on September 14, 2009, at 15:06:15
long story short, taken off 10mg Edronax (high dose) by pdoc, 24hr washout then onto Cymbalta. 2 doses later, very sick boy. Very smart GP picked it up instantly, next day pdoc took my lamictal from 125mg a day to 50mg the next then nothing.
The worst of it is over now but I had NO idea Lamictal causes withdrawal, which for me is very similar to SSRI/SNRI but not quite as intense and slower to come on. So for now I'm riding that one out. What a horrible, horrible 9 days, it has been.
The thing that bugs me most, is that I told my relatively new pdoc that anything with serotonin doesn't really agree with me but he really forced me to try cymbalta. I feel like a total idiot, I never should have taken it. Luckily I didn't have to go to hospital. The couch is my friend for now. I'll never touch Lamictal again either. I got some Atenolol (beta blocker) for my blood pressure which went up to 170/90. It's usually 110/70.
Does Atenolol have withdrawal? Now all I have to do is very, very slowly ditch my clonazepam. Then I'll be drug free again. Why don't pdocs listen? Then again why did I listen to him?
Posted by Phillipa on September 14, 2009, at 20:27:54
In reply to 1st bad case of serotonin syndrome, YUCK!!, posted by cactus on September 14, 2009, at 15:06:15
Cactus so sorry glad your're okay now. Why do we do what they say I used to don't anymore. I kind of listen to my body. Phillipa
Posted by yxibow on September 14, 2009, at 23:49:26
In reply to 1st bad case of serotonin syndrome, YUCK!!, posted by cactus on September 14, 2009, at 15:06:15
> long story short, taken off 10mg Edronax (high dose) by pdoc, 24hr washout then onto Cymbalta. 2 doses later, very sick boy. Very smart GP picked it up instantly, next day pdoc took my lamictal from 125mg a day to 50mg the next then nothing.
What does the Lamictal have to do with serotonin ? Its a sodium-gate anti-epileptic drug. It has no action directly related to serotonin.
Its also a very good antidepressant in its own right and also in combination with other antidepressants among other things to improve mood and lessen suicidal thoughts.
> The worst of it is over now but I had NO idea Lamictal causes withdrawal, which for me is very similar to SSRI/SNRI but not quite as intense and slower to come on. So for now I'm riding that one out. What a horrible, horrible 9 days, it has been.
I'm sorry to hear you had withdrawal from it. As far as I can see its not supposed to be dropped like a lead brick unless you experience severe rash that could be SJS.In fact if you've been off of Lamictal for parts of a week or so because you've forgotten doses, you have to start the taper all over again for safety's sake.
>
> The thing that bugs me most, is that I told my relatively new pdoc that anything with serotonin doesn't really agree with me but he really forced me to try cymbalta.
I'm not sure about "serotonin not agreeing with you". Most all non-MAOI/etc antidepressants incorporate 5HT manipulation for a reason. But I know that not everyone responds to everything. I tend these days to be a bit off put by noradrenergic agents, opposite to what you seem to be responsive to. And our transmitters aren't set in stone, they change over time with neuroplasticity. So its possible some day that you may respond better to 5HT.
So you're lucky to be in a place that still has reboxetine and as you probably know is an NRI.
But in the US at least, we now have Strattera (atomoxetine).You can read up on NRIs if you want at
http://www.crazymeds.us/nri.html
I feel like a total idiot, I never should have taken it. Luckily I didn't have to go to hospital. The couch is my friend for now. I'll never touch Lamictal again either. I got some Atenolol (beta blocker) for my blood pressure which went up to 170/90. It's usually 110/70.
How much Cymbalta were you given ? Dumping an SNRI will cause a ton of problems. Not 2 days worth though, probably.
It sounds like a lot of medication was dumped and added way too quickly. The actions of all of that plus the anxiety surrounding it is not surprising that you had hypertension.
However the diastolic is more important. 90 is not a high diastolic. The systolic of that rate means you had a temporary disturbance. Excercise alone can raise things temporarily to 200.... but that's actually the point, because it changes resting blood pressure over time.
> Does Atenolol have withdrawal? Now all I have to do is very, very slowly ditch my clonazepam. Then I'll be drug free again. Why don't pdocs listen? Then again why did I listen to him?
Atenolol doesn't have "withdrawal" per se -- if you have been using it for more than a week or so, you should cut down on it slower. Its a heart medication and cardioselective, so don't drop it cold if you're taking it long term. You could have high blood pressure spikes or pulse problems if you do.
Doctors do listen -- unfortunately some aren't the best, and some are rather cursory. I'm sorry you had a bad relationship. You go to a doctor for advice, and if the relationship doesn't agree, you try something else.
At any rate, what you had was not serotonin syndrome. Not that I can tell. Its more likely that you had a bad reaction to Cymbalta, especially if you were given a high dose to start with (e.g. 60mg).
Serotonin syndrome manifests itself in a completely different manner -- in fact, you might not even be aware of it which admittedly is an alarming thought, it causes much more things than a temporary blood pressure (or pulse) spike -- including hallucinations, psychosis, and most notably very high temperature.
Since there is no serotonergic profile in Reboxetine, as noted before, something else happened.
Nonetheless I do share your sympathy. I wouldn't give up on medications -- it sounds like you had a fair scare.I've had nasty situations, Trazodone once caused a pulse rate over 150, which is a possible and known idiosyncratic effect.
There are always side effects. It depends whether the benefits outweigh the risks and whether you can be functional in life without medication, which would be a wonderful place to be, I completely agree.- tidings
Jay
Posted by cactus on September 15, 2009, at 1:14:19
In reply to Re: 1st bad case of serotonin syndrome, YUCK!! » cactus, posted by yxibow on September 14, 2009, at 23:49:26
thanks Jay and P, I didn't think it was serotonin syndrome either, I did have a high temp, which is still there but lower now. I know Edronax is a NRI and it was working miracles for me but it really pooped out very quickly, that's why lamictal was added. I didn't get the rash. My pdoc was too busy thinking about how to keep the Edronax working and then his trip to Spain popped up. I was having hallucination, mild ones out of the corner of my eyes. Jumping at spiders that weren't there, etc...
It must have been a bad reaction to the cymbalta, 2 hours after my 1st dose it started in my legs and I have RLS and there is no way that could push through 6mg of clonazepam, then the fever started. I was sweating so bad but shivering, freezing cold and sleepy. No flu or infection manifested. The GP who picked it up used to work as the intake GP at a psych facility here for years. He said he had never seen anything like it happen so quickly. Who knows?
Anyway we have Strattera here too, but it's off label for depression. If I decide to give anything a go I think it will be Zyban next if I start crashing again. That's off label for depression but I can get it cheap for smoking for about 3 months. I need to give up anyway. What do you think? The 3 best meds I've ever responded to over the last 17+ years have been Edronax, modafinil and ropinirole. The other AD's have been a nightmare and I'm very wary of them.
Yes I've had my thyroid checked about 4 times, perfect every time. I seem to respond better to NE and DA action. Any suggestions would be greatly appreciated. Peace! confused, brain zapping C.
Posted by Phillipa on September 15, 2009, at 19:48:03
In reply to Re: 1st bad case of serotonin syndrome, YUCK!! » yxibow, posted by cactus on September 15, 2009, at 1:14:19
Cactus brain zapping withdrew too fast add some back in of the meds? And taper from there? What was the starting dose of cymbalta? So sorry your're suffering so. Phillipa
Posted by cactus on September 15, 2009, at 22:20:03
In reply to Re: 1st bad case of serotonin syndrome, YUCK!! » cactus, posted by Phillipa on September 15, 2009, at 19:48:03
Brain zaps are gone and so are my meds. I threw them out. I actually feel much better today. I had a session with my myotherapist yesterday, most likely a coincidence but I don't care, I still have problems moving my head too quickly or sitting, standing or lying down too quickly but all in all, I feel so much better today. I only took 2 caps, 30mg cymbalta last week, low dose I know.
I agree I was taken off these meds too quickly but I'm never putting any of them in my body again. C
Posted by Jeroen on September 16, 2009, at 8:19:39
In reply to 1st bad case of serotonin syndrome, YUCK!!, posted by cactus on September 14, 2009, at 15:06:15
mine listened today, i asked for seroquel XR low dose
you have a bad doctor TRY finding one who listen to you
Posted by cactus on September 16, 2009, at 14:14:12
In reply to Re: 1st bad case of serotonin syndrome, YUCK!!, posted by Jeroen on September 16, 2009, at 8:19:39
Posted by Phillipa on September 16, 2009, at 19:11:12
In reply to Re: 1st bad case of serotonin syndrome, YUCK!! » Phillipa, posted by cactus on September 15, 2009, at 22:20:03
Cactus zaps will leave. Hope you seriously never need meds again. Love Phillipa
Posted by cactus on September 17, 2009, at 22:34:33
In reply to Re: 1st bad case of serotonin syndrome, YUCK!! » cactus, posted by yxibow on September 14, 2009, at 23:49:26
From what I can gather, your FDA is very similar to out TGA. Now that I feel much better and can see properly again I just came across this.
http://www.tga.gov.au/adr/aadrb/aadr0908.htm
2 doses is what I took.
Posted by Phillipa on September 18, 2009, at 19:38:19
In reply to look what I just stumbled across. Interesting? » yxibow, posted by cactus on September 17, 2009, at 22:34:33
Cautus that's pretty scarey!!!!! Thanks Phillipa
Posted by yxibow on September 18, 2009, at 22:47:16
In reply to look what I just stumbled across. Interesting? » yxibow, posted by cactus on September 17, 2009, at 22:34:33
> From what I can gather, your FDA is very similar to out TGA. Now that I feel much better and can see properly again I just came across this.
>
> http://www.tga.gov.au/adr/aadrb/aadr0908.htm
>
> 2 doses is what I took.It's curious and interesting, but 7 out of 200,000, or 0.0035%, is in the margin of error. And then you have to consider the population of Australia vs the US, whether more or less is reported in either country, and you're in an astronomically low range.
These are barely at what would be considered "case reports" in a scientific magazine, granted not a pleasant thing for those who experienced it.
I'm not saying you couldn't have had an adverse effect, but as described it wouldn't have been clinical serotonin syndrome, possibly subclinical, because you were a) aware of it b) not in such a deep psychosis or one of a set of typical effects that you wouldn't even want to know about.
Still, however it is, I know it did cause you extreme discomfort, don't get me wrong that I'm not being empathetic.-- tidings
Posted by cactus on September 19, 2009, at 1:45:00
In reply to Re: look what I just stumbled across. Interesting? » cactus, posted by yxibow on September 18, 2009, at 22:47:16
Thanks Jay, I really appreciate that but the thing that floored me the most was that the government actually put it on the web.
Peace C
Posted by Phillipa on September 19, 2009, at 20:12:51
In reply to Re: look what I just stumbled across. Interesting? » yxibow, posted by cactus on September 19, 2009, at 1:45:00
Cactus what do you mean they put it on the web? Didn't use names did they? Phillipa
Posted by yxibow on September 20, 2009, at 1:24:41
In reply to Re: look what I just stumbled across. Interesting? » cactus, posted by Phillipa on September 19, 2009, at 20:12:51
> Cactus what do you mean they put it on the web? Didn't use names did they? Phillipa
No, Jan... its in the .au link that he provided -- the US also has an drug adversity reporting system, its tabulated, just anonymous case reports. If these are published in a journal, it just says like it said there, a X year old woman...
Posted by cactus on September 20, 2009, at 13:03:14
In reply to Re: look what I just stumbled across. Interesting? » cactus, posted by Phillipa on September 19, 2009, at 20:12:51
Thanks Jay and Jan, what Jay said is right. That link is to a public Australian Government medical advisory site on drug warnings and bad reactions to meds, and loads of other information. I was just pointing out to Jay that the Aussie Government had updated their stance on Cymbalta and changed the PI sheets accordingly.
It's not often you see a government do this so publicly over such a small reaction ratio. Jay you're right, it is a small ratio and I just had a very bad reaction. It's also interesting to note that as a new drug is released onto our market it's usually put up there for a period of time to see how people are reacting to it.
One thing I did notice was that Pristiq never made that list when it was released, which, for an AD is just unheard of in this country. Any NEW AD that hits our shelves is always on that list. Hmm, I suppose there is always a first time for everything.
Peace C
Posted by Jeroen on September 20, 2009, at 13:52:47
In reply to Re: look what I just stumbled across. Interesting? » Phillipa, posted by cactus on September 20, 2009, at 13:03:14
that's just sick, how people are going to react to it,
il'l take it from here......
Posted by yxibow on September 20, 2009, at 22:44:49
In reply to sick, posted by Jeroen on September 20, 2009, at 13:52:47
> that's just sick, how people are going to react to it,
>
>
> il'l take it from here......Its just natural, Jeroen. Here in the US, medications that enter the marketing point (after Phase III) have to have had a multi-thousand (usually around 4 thousand patients) patient trial.
But 4,000 patients on a drug is not 1,000,000 patients on the same one.Someone in the population is going to have a polypharmacy (multiple medication regime) or a rare heart disorder or something that can't be seen on a smaller patient trial and that is why Phase IV (post-marketing is necessary.
It is observation in the "real world" scenario that could never predict that out of so many million patient-years (that is a standard practice of statistics, multiply the estimated number of patients by the number of years that the drug has been out or has been estimated to be in use), out of that large amount, say 60 people suffer some liver disease because they all have some enzyme deficiency.
Then black box warnings descend upon medications, lawsuits start, etc. Some of this is plenty warranted, some of it knocks a drug off the market that is beneficial to most all people with regular checkups.
-- Jay
Posted by cactus on September 21, 2009, at 23:38:44
In reply to Re: Phase IV » Jeroen, posted by yxibow on September 20, 2009, at 22:44:49
Hey jay, I saw my emergency GP again from the recent crisis I went through. He told me to get another pdoc asap and knows my current one and doesn't think we're suited, he worked with him in the past, but did not put him down or say anything bad about him.
He and my current GP are still 100% sure it was serotonin syndrome. As he worked as an intake GP in one of the best psych facilities in my town, he told me it happens all the time and it's rarely reported, he hinted at things about certain meds but didn't fully elaborate on it.
He comes across as a very humble, older and wiser type. He's reffering me for a second opinion, which I didn't even ask for but appreciated. He said after reading all the meds I've tried he thinks he knows just the right person, considering my history, which shocked him actually.
He told me to stand firm on meds I didn't want to take and never, ever let a pdoc pressure or force you to take something that you know you can't tolerate.
*****(Massive exception there for bipolar or schizophrenia, see your pdoc if you're feeling sick from your meds or go to emergency)*****
I'm talking about the start up side effects, that make you extremely sick.
I had let this go but after sitting with him for 30mins today, with all the meds I've taken over the last 17+ years I'm going to look into it further.
Now that it's over, I have the dreaded invasive/intrusive thoughts starting to pop up again and no CBT/yoga/meditation/fish oil/supplements or exercise is getting rid of them.
One thing I did learn today is that serotonin syndrome is a lot more common than most people know.
It goes unreported because people stop their meds when they get sick and throw them away and don't go back to the same doc or pdoc ever again, if they're not hospitalised.
Everyone is different and what might cause rapid onset on one person might not on another, but they never say anything because they are ashamed they have depression and prefer to suffer in silence.
Cymbalta was my poison, but it might be something else for someone else.
An enlightened Cactus, Peace
Posted by yxibow on September 22, 2009, at 0:22:06
In reply to Re: Can't let it go now, saw doc again! » yxibow, posted by cactus on September 21, 2009, at 23:38:44
Not a problem... it didn't sound like it fit the profile to me, but again, we can't all sit here and practice medicine without a license so to speak.
If they re-evaluated it as that, well yes, I know serotonin syndrome goes unreported, I think especially cases where (fortunately) the patient is coherent and feels fewer of the most serious effects, not to be morose, but... well... comas, or on the other end of the spectrum, probably even more common, where little is felt and it can stretch on for time before it enters a stage that should be taken care of.
This is why that (and my doctor is aware and it is taken for a specific reason, hopefully for better sleep) people should tell their doctor what "dietary supplements" they are taking. For example I take a modest amount of 5-HTP and L-tryptophan.
Well that pretty much is a rule-out for a lot of people on MAOIs, and for people who are taking multiple serotonin affecting agents, it may or may not be the best idea, depending on the amount of supplement(s) on takes.-- tidings
Posted by Phillipa on September 22, 2009, at 20:07:14
In reply to Re: Can't let it go now, saw doc again! » yxibow, posted by cactus on September 21, 2009, at 23:38:44
Cactus wow you're a lucky person. Hope your're feeling a bit better now. Love Phillipa
This is the end of the thread.
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