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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by Abaigeal on October 29, 2011, at 20:23:10
So I had been taking amitriptyline for about 2 years for chronic migraines, and recently went to a psych doctor for severe anxiety. She put me on zoloft, so I had been taking them together for about 4 or 5 months. During those months I didn't realize it but I had been getting black outs, confusion and severe depression/anxiety. A few weeks ago I for some reason thought it would be a good idea to cut my leg up with a knife, long story short. Got sent to a psych ward, stayed there for about 4 days because I wasn't actually suicidal. They decided it would be a good idea to up my dose of amitriptyline and zoloft. About 5 days after getting out on the higher doses, I was feeling like complete sh*t, couldn't get out of bed, couldn't do anything. I slept for 3 days straight. When I woke up I still was feeling very sick.. that night I started hallucinating, like really bad vivid hallucinations, I couldn't even walk straight, was falling into everything. The next day I didn't hallucinate, but was still very sick. Fever, chills, shaking, ataxia, headache, nausea. The next morning, however, I immediately started throwing up when I woke up, shaking, hallucinations, couldn't see or hear things right, couldn't walk. I started hyperventilating I guess. I had exhaled so much carbon dioxide that my arms and legs seized and turned rock hard. Everything tingling, my brain felt like it was literally going to explode. My jaw hurt, my chest hurt, my hands and feet were WHITE, nonstop vomiting, I couldn't move anything. My boyfriend somehow got me into the car and drove as fast as he could to the hospital. I didn't even have shoes. I walk in, they ask how they can help me, and the words stumble out of my mouth "I can't move" And the jack *ss nurse says, yeah I can see that. Sits me down, asks my boyfriend if I've done any drugs, of course assuming I did this to myself. He said I was taking amitriptyline, and the doctor goes, "Oh.." and gets me a bag to breath into. My heart rate was over 150 for 3 days. Nonstop hallucinations, I was basically sedated 90% of the time and was still hallucinating. There was a very good chance that I was going to die. Anyway.. now I'm on ativan, no more hallucinations, but when I miss a dose I get insanely sick, severe chest pains, nausea, my head hurts constantly, nothing relieves the pain. I can't talk as well as I used to, I stumble a lot. It's been almost a week since I was released, and I'm still feeling like complete sh*t. Am I always going to feel the effects of serotonin syndrome?
Posted by Phillipa on October 29, 2011, at 23:36:16
In reply to Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 29, 2011, at 20:23:10
Were you diagnosed with serotonin syndrome? Didn't see that mentioned in your post other than title? Hope you feel better soon. Phillipa
Posted by Abaigeal on October 29, 2011, at 23:37:37
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » Abaigeal, posted by Phillipa on October 29, 2011, at 23:36:16
> Were you diagnosed with serotonin syndrome? Didn't see that mentioned in your post other than title? Hope you feel better soon. Phillipa
yes I was lol, sorry. Very severe serotonin syndrome by multiple doctors
Posted by Phillipa on October 29, 2011, at 23:50:44
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 29, 2011, at 23:37:37
Abigail also welcome to babble see you are new. And they sent you right home after ER? Didn't keep you for a while? Sounds horrible. Others with more knowledge will respond also. I am going to read your first post again. Phillipa
Posted by Abaigeal on October 29, 2011, at 23:52:09
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » Abaigeal, posted by Phillipa on October 29, 2011, at 23:50:44
I was in the ER for 3 days haha, they sent me home right when the hallucinations and delusions went away
Posted by sleepygirl2 on October 30, 2011, at 0:31:16
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 29, 2011, at 23:52:09
Holy crap! This sounds awful :-(
I'm sorry this is happening with you.
Tell me some medical professional is monitoring your condition.
Posted by creepy on October 30, 2011, at 1:13:44
In reply to Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 29, 2011, at 20:23:10
Zoloft interacts with other TCAs too.. I had to take very small amounts of desipramine when I was on both.
the combo can raise desipramine levels something like 200-300%.
It could take a few weeks to get back to normal, sounds like you were pretty sick.
The doc that prescribed the zoloft should have known better, IMO. Did they even look to see what else you were on?
Posted by jono_in_adelaide on October 30, 2011, at 6:40:38
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by creepy on October 30, 2011, at 1:13:44
I dont think Zoloft does interact with the TCA's, seretonin syndrome with amitriptyline must be extremely rare, it is generaly felt that the only TCA with enough seratogenic activity to cause seretonin syndrome is clomipramine.
Posted by SLS on October 30, 2011, at 7:32:17
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 30, 2011, at 6:40:38
> I dont think Zoloft does interact with the TCA's, seretonin syndrome with amitriptyline must be extremely rare, it is generaly felt that the only TCA with enough seratogenic activity to cause seretonin syndrome is clomipramine.
Imipramine can also precipitate SS when combined with a MAOI. It did in me, although it was relatively mild. I experienced severe hypotension, hyperreflexia and muscle rigidity while I was taking imipramine and Nardil together. I had to crawl around my apartment to keep from fainting.
- Scott
Posted by Abaigeal on October 30, 2011, at 9:12:15
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » jono_in_adelaide, posted by SLS on October 30, 2011, at 7:32:17
Well I wasn't taking anything else. Oh and while I was sleeping for 3 days, I would occasionally wake up and take more amitriptyline, which I don't remember doing.
Posted by Peter Heuer on October 30, 2011, at 15:39:34
In reply to Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 29, 2011, at 20:23:10
Amitriptyline plus SSRI-drugs is a bad combination of medicines.
I was on Elavil and Prozac for a while, and that was the worst time of my life.
The psychiatrist that prescribed these two drugs for me was incompetent.
I have fired him long time ago. Now I'm my own doctor.
Peter Heuer
Posted by jono_in_adelaide on October 30, 2011, at 18:21:23
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 30, 2011, at 9:12:15
You were in a hospital,and they were letting you self administer meds? What sort of a hospital was this?
Posted by jono_in_adelaide on October 30, 2011, at 18:25:44
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Peter Heuer on October 30, 2011, at 15:39:34
The danger with prozac/paxil and a tricyclic is because paxil/prozac inhibit the metabolism of tricyclics, so your blood levels go sky high. A tricyclic plus either Zoloft or Celexa is very safe and cmmonly used (Usualy nortriptyline is used because it has less side effects like sedation than amitriptyline)
Posted by jono_in_adelaide on October 30, 2011, at 18:27:32
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Peter Heuer on October 30, 2011, at 15:39:34
Scott, thats interesting..... maybe it would be wise for people taking these combination approaches to have a few tables of Periactin on hand incase SS does develop - 2 Periactin will stop the syndrome in its tracks (along with stopping the offending drug of course)
Posted by Phillipa on October 30, 2011, at 18:44:06
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 29, 2011, at 23:52:09
Could you reply to the questions of the hospital letting you self administer meds when in the ER? Phillipa
Posted by Abaigeal on October 30, 2011, at 19:25:50
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » Abaigeal, posted by Phillipa on October 30, 2011, at 18:44:06
They did not, they dosed me up every 2 hours or so. But I am now self administering since I've been out of the hospital
Posted by Phillipa on October 30, 2011, at 20:54:05
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 30, 2011, at 19:25:50
Thanks for answering. We get concerned when someone doesn't repost after being so ill. Things any better now? What is your docs plan for meds for you? Phillipa
Posted by creepy on October 30, 2011, at 22:09:00
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 30, 2011, at 6:40:38
Lots of interactions with these two classes of medication. Its important to know since it gets missed. Especially nowadays with docs squeezing patients with multiple meds into 10minute windows. Its no wonder theres so much concern over liability =(
Heres the study on sertraline + desipramine if anyones interested
http://www.ncbi.nlm.nih.gov/pubmed/9241008
Posted by creepy on October 30, 2011, at 22:10:53
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » jono_in_adelaide, posted by SLS on October 30, 2011, at 7:32:17
I could see desipramine with an MAOI.. but not a serotinergic one like imipramine. Im guessing you were experimenting since other options didnt work out?
Posted by Abaigeal on October 31, 2011, at 6:14:55
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft » Abaigeal, posted by Phillipa on October 30, 2011, at 20:54:05
things are...okay right now. I get extremely sick at least once a day where I can't do anything, just lay on the couch, chest pains, nausea, angry all the time, I've had a headache for at least a month... I have no idea what to do! The doctors don't know sh*t yet.
Posted by jono_in_adelaide on October 31, 2011, at 6:47:35
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 6:14:55
"Thus, when coadministered with 50 mg/day desipramine, sertraline had significantly less pharmacokinetic interaction than paroxetine with desipramine at the recommended starting dosages of 50 mg/day and 20 mg/day, respectively."
I dont think that suggests there are significant interactions between sertraline and desipramine.
Posted by Abaigeal on October 31, 2011, at 10:36:11
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 31, 2011, at 6:47:35
amitriptyline is a totally different drug, it's old as f*ck. I'm getting extremely agitated, and I don't know what to do. I can't sleep for more than 2 hours.. ugh
Posted by jono_in_adelaide on October 31, 2011, at 17:35:00
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 10:36:11
OK, have you tried a mild sleeping pill, such as ambien?
Have you considered that the symptoms you are getting are because of the condition that led you to a psychiatrist, rather than your misadventure with meds?
Try and not get into the victim trap of blaming everything wrong in your life on that one misadventure.
I'd ask your doc for a mild sleeping pill, take a simple analgesic for the headaches (for example Exedrin) and perhaps go back on another antidepressant, such as mirtazapine (Remeron)
Posted by dove on October 31, 2011, at 17:39:08
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by Abaigeal on October 31, 2011, at 10:36:11
Do sleep meds like Ambien or Lunesta trigger serotonin effects? Could she take something like that to help with sleep, or something along the lines of Gabapentin or Lyrica?
Posted by Abaigeal on October 31, 2011, at 18:19:07
In reply to Re: Serotonin syndrome. Amitriptyline+zoloft, posted by jono_in_adelaide on October 31, 2011, at 17:35:00
Okay, right now, I have no idea what is going on with my brain. I'm trying to get some ideas of what to tell the psychiatrist tomorrow. I keep going from being happy to angry, to anxious, panic attacks, sad, hopeless. And not sleeping well, with a headache all the time, does not help. I've never been like this before. Is it possible amitriptyline has been covering up the onset symptoms of maybe bipolar disorder?
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