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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by schleprock on September 19, 2012, at 21:44:22
1. Has anyone here actually had it. What are the most common symptoms that one can know are unmistakebly SS related and not side-effects or an exacerbation of mental illness. And most importantly, what do you do when you know you have it? Go straight to the ER or merely self-unmedicate the offending medicine.
2. Does SS occur exclusively from the mixture of more than one serotonin-acting drug, or is it possible to experience it from a particular dose (or overdose) of a single drug? In regards to the former situation, is it possible that the combination of two drugs that have a weak effect on serotonin could result in SS.
Thank you, and stay well.
Posted by jono_in_adelaide on September 19, 2012, at 22:16:51
In reply to Two questions about Serotonin syndrome., posted by schleprock on September 19, 2012, at 21:44:22
It is most likely to occur when an MAOI and an SRI are combined, somewhat less likely when 2 SRI's are combined, and quite unlikely on a high dose of a single SRI
The illness covers a spectrum from mild to life threatening - in a mild case, stopping the offending meds would probably surfice (though i think it would be prudent to seek medical advice), in severe cases, high doses of periactin, chlorpromazine and other drugs and supportive measures are needed in a hospital setting.
I also suspect that because of publicity, people self diagniose seretonin syndrome in them selves on fairly shakey grounds.
Posted by phillipa on September 19, 2012, at 23:36:04
In reply to Re: Two questions about Serotonin syndrome., posted by jono_in_adelaide on September 19, 2012, at 22:16:51
Reminds me of my old pdoc who laughed at me when I asked if I could get serotonin syndrome from the 50mg of luvox and up to 5mg of lexapro. She said "call me" if you get it so I deduced that is was not something to worry about Phillipa
Posted by jono_in_adelaide on September 19, 2012, at 23:54:01
In reply to Re: Two questions about Serotonin syndrome. » jono_in_adelaide, posted by phillipa on September 19, 2012, at 23:36:04
One of my friends was prescrbed simvastatin for high cholesterol, and the pharmacist gave him one of those wonderful leaflets that lists every side effect ever reported..... he took the first pill with breakfast, and by lunch time he was convinced he was suffering from all of them.
With me its headlice - someone only has to mention them, and i start scratching at my head
Posted by SLS on September 20, 2012, at 1:09:40
In reply to Two questions about Serotonin syndrome., posted by schleprock on September 19, 2012, at 21:44:22
> 1. Has anyone here actually had it.
Yes.
> What are the most common symptoms that one can know are unmistakebly SS related and not side-effects or an exacerbation of mental illness.
Incoherence, muscle rigidity, hyperpyrexia.
> And most importantly, what do you do when you know you have it? Go straight to the ER or merely self-unmedicate the offending medicine.
That's a tough call. First of all, you would not be able to get yourself to the ER because of the effects of the syndrome. Your doctor can prescribe some cyproheptadine (Periactin) as an emergency treatment.
> 2. Does SS occur exclusively from the mixture of more than one serotonin-acting drug, or is it possible to experience it from a particular dose (or overdose) of a single drug?
Single drugs can precipitate SS, too.
Serotonin syndrome is inconsistent and unpredictable. Even Remeron has been reported to precipitate SS when added to an SRI.
- Scott
-------------------------------------Mental status changes
Confusion (51%)
Agitation (34%)
Hypomania (21%)
Anxiety (15%)
Coma (29%)Cardiovascular
Sinus tachycardia (36%)
Hypertension (35%)
Hypotension (15%)Gastrointestinal
Nausea (23%)
Diarrhea (8%)
Abdominal pain (4%)
Salivation (2%)Motor Abnormalities
Myoclonus (58%)
Hyperreflexia (52%)
Muscle rigidity (51%)
Restlessness (48%)
Tremor (43%)
Ataxia/incoordination (40%)
Shivering (26%)
Nystagmus (15%)
Seizures (12%)Other
Diaphoresis (45%)
Unreactive pupils (20%)
Tachypnea (26%)
Hyperpyrexia (45%)
-------------------------------------
Posted by jono_in_adelaide on September 20, 2012, at 1:29:28
In reply to Re: Two questions about Serotonin syndrome. » schleprock, posted by SLS on September 20, 2012, at 1:09:40
Scott, what precipitated your seretonin syndrome?
Posted by SLS on September 20, 2012, at 4:38:29
In reply to Re: Two questions about Serotonin syndrome., posted by jono_in_adelaide on September 20, 2012, at 1:29:28
> Scott, what precipitated your seretonin syndrome?
Out of desperation, I performed an experiment. I was taking Parnate at the time. I decided to take a small dose of a SRI to see if I really would get serotonin syndrome. I decided to use Effexor because it had the shortest half life of the things I had laying around. Effexor XR didn't exist at the time, so I bit off and swallowed a very small piece of an Effexor IR 75 mg tablet. It took about 15 minutes before I became incoherent and pinned to my bed with muscle rigidity. I think it took about 45 minutes for the symptoms to abate. I was lucky. I have to believe that if someone were to react the same way I did, but taking a full dose instead, they would not be capable of thinking clearly enough nor be able to move their muscles in order to bring themselves to a hospital. If, in this state, hyperpyrexia were to ensue, death or brain damage are likely outcomes.
- Scott
Posted by SLS on September 20, 2012, at 4:59:50
In reply to Re: Two questions about Serotonin syndrome. » schleprock, posted by SLS on September 20, 2012, at 1:09:40
> Even Remeron has been reported to precipitate SS when added to an SRI.
This is the most recent report appearing on Medline/PubMed:
http://www.ncbi.nlm.nih.gov/pubmed/22752315
- Scott
Posted by jono_in_adelaide on September 20, 2012, at 6:03:43
In reply to Re: Two questions about Serotonin syndrome., posted by SLS on September 20, 2012, at 4:59:50
Given the frequency with which mirtazepine and SRI's are coprescribed, it must be an incredibly unlikely event, and given that treatment resistant depression is a life threatening condition, I'd say that small risks are worth taking in its treatment
Posted by SLS on September 20, 2012, at 7:39:53
In reply to Re: Two questions about Serotonin syndrome., posted by jono_in_adelaide on September 20, 2012, at 6:03:43
> Given the frequency with which mirtazepine and SRI's are coprescribed, it must be an incredibly unlikely event, and given that treatment resistant depression is a life threatening condition, I'd say that small risks are worth taking in its treatment
Me, too.
There are only a handful of reports regarding this combination on Medline, so I would consider it unlikely that it will occur. I wouldn't think twice about combining mirtazepine with venlafaxine or any other SRI.
I guess my point is that serotonin syndrome is an enigmatic reaction that is unpredictable in its occurrence. I think people should be aware of its existence and how it manifests when combining serotonergic drugs.
- Scott
Posted by rjlockhart37 on September 20, 2012, at 13:29:59
In reply to Re: Two questions about Serotonin syndrome., posted by jono_in_adelaide on September 20, 2012, at 6:03:43
i don't know if this is the direct topic but I've expeirnced serotonin syndrome a couple years with mixing 5HTP at about 600mg with Prozac and it was awful...sweating...almost felt like I was a siezure...shaking...disorintation...and tremendous anxiety that is diffrent than traditional anxiety. I tried to ride it out without going to the hospital because if I told my parents what I did....well who gives a danm what they do...but yea...it lasted a couple hours and slowly left....my body started breaking down the excess serotonin. It usally can be treated with serotonin agntagist...and benzos usally in the hospital.
rj
Posted by ChicagoKat on September 20, 2012, at 15:22:20
In reply to Two questions about Serotonin syndrome., posted by schleprock on September 19, 2012, at 21:44:22
> 1. Has anyone here actually had it. What are the most common symptoms that one can know are unmistakebly SS related and not side-effects or an exacerbation of mental illness. And most importantly, what do you do when you know you have it? Go straight to the ER or merely self-unmedicate the offending medicine.
>
> 2. Does SS occur exclusively from the mixture of more than one serotonin-acting drug, or is it possible to experience it from a particular dose (or overdose) of a single drug? In regards to the former situation, is it possible that the combination of two drugs that have a weak effect on serotonin could result in SS.
>
> Thank you, and stay well.1. I've had SS...dumb me, I was on Prozac and had a cold and downed cough medicine with Dextromethorphan in it like it was no big deal. Boy did I pay...several hours later, I just could not sit still, had twitching, and then, worst of all had an unbelievably bad headache that was so bad it made me vomit over and over. had a high fever. Checked my BP and it was high, but labile. Went to the ER and they were clueless...if you can believe this, they gave me Zofran for my nausea and Demerol for my headache. The worst possible things they could have given me. Fortunately, my symptoms had subsided enough by then that I was OK. Didn't figure it out til later that it was SS, dumb pharmacist that I was. :(
2. SS can be caused by just one agent, though more commonly with two serotonergic agents. It's unpredictable in a way, except for obvious things like MAOIs and an SSRI. It all varies according to the drugs, the dosages, and the interidividual biochemistries of the patients.
I'm lucky; I once had a pdoc who prescribed chorpromazine for me (for my depression lol) but I hang onto it in case I ever have SS again, as it is an antidote.
I wish you the best,
Kat
Posted by phidippus on September 22, 2012, at 1:57:37
In reply to Two questions about Serotonin syndrome., posted by schleprock on September 19, 2012, at 21:44:22
>Has anyone here actually had it
Yes, I have.
>What are the most common symptoms that one can know are unmistakebly SS related?
Mild symptoms may only consist of increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent tremor or twitching), as well as overresponsive reflexes
Moderate intoxication includes additional abnormalities such as hyperactive bowel sounds, high blood pressure and hyperthermia; a temperature as high as 40 °C (104 °F) is common
Severe symptoms include severe increases in heart rate and blood pressure that may lead to shock. Temperature may rise to above 41.1 °C (106.0 °F) in life-threatening cases. Other abnormalities include metabolic acidosis, rhabdomyolysis, seizures, renal failure, and disseminated intravascular coagulation; these effects usually arise as a consequence of hyperthermia.
The symptoms are often described as a clinical triad of abnormalities:
Cognitive effects: headache, agitation,hypomania, mental confusion, hallucinations, coma
Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea.
Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.>what do you do when you know you have it?
Stop any serotogenic medications. If you start to get a fever, go to the ER.
>is it possible to experience it from a particular dose (or overdose) of a single drug?
Yes.
>is it possible that the combination of two drugs that have a weak effect on serotonin could result in SS?
It is unlikely.
Eric
Posted by iforgotmypassword on September 22, 2012, at 11:43:18
In reply to Re: Two questions about Serotonin syndrome., posted by jono_in_adelaide on September 19, 2012, at 23:54:01
to get people accusing each other of it.
it's an epidemic.
Posted by jane d on September 28, 2012, at 3:05:17
In reply to Re: Two questions about Serotonin syndrome., posted by jono_in_adelaide on September 19, 2012, at 23:54:01
> One of my friends was prescrbed simvastatin for high cholesterol, and the pharmacist gave him one of those wonderful leaflets that lists every side effect ever reported..... he took the first pill with breakfast, and by lunch time he was convinced he was suffering from all of them.
>
> With me its headlice - someone only has to mention them, and i start scratching at my headGee! Thanks a lot Jono! Perhaps by reviving this thread I can return the favor. And how are you with spiders? :)
This is the end of the thread.
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