Anyone heard of serotonin syndrome? Anyone experienced it??

[passing thru]

I was reading in a drug book about the drug Tramadol. It said not to give it with an SSRI. I forgot to see if it is a SSRI> It said if you gave tramadol with an SSRI . you could bring on the

serotonin syndrome."

So many drugs to remember !!

[lsyorke, RN]

It's an extremely dangerous side effect of taking more that one drug that alters serotonin metabolism.

""The serotonin syndrome is a hypersotonergic state which is a very dangerous and a potentially fatal side effect of serotonergic enhancing drugs which can have multiple psychiatric and non-psychiatric symptoms. It is a condition which has been on the rise since the 1960's when we began using more and more drugs which directly affect serotonin. This is a toxic condition which requires heightened clinical awareness in order to prevent, recognize, and treat the condition promptly. Promptness is vital because, as we just mentioned, the serotonin syndrome can be fatal and death from this side effect can come very rapidly. This syndrome is a toxic hyperserotonergic state whose rate of incidence is unknown, but is on the rise. The suspected cause of that increase is the introduction of the new selective serotonergic enhancing agents in clinical practice - the SSRIs. This disorder, brought on by excessive levels of serotonin, is difficult to distinguish from the neuroleptic malignant syndrome because the symptoms are so similar. The neuroleptic malignant syndrome is a serious condition brought on by the use of the neuroleptic drugs.

"The symptoms of the serotonin syndrome are: euphoria, drowsiness, sustained rapid eye movement, overreaction of the reflexes, rapid muscle contraction and relaxation in the ankle causing abnormal movements of the foot, clumsiness, restlessness, feeling drunk and dizzy, muscle contraction and relaxation in the jaw, sweating, intoxication, muscle twitching, rigidity, high body temperature, mental status changes were frequent (including confusion and hypomania - a "happy drunk" state), shivering, diarrhea, loss of consciousness and death. (The Serotonin Syndrome, AM J PSYCHIATRY, June 1991)

"The serotonin syndrome is generally caused by a combination of two or more drugs, one of which is often a selective sertonergic medication. The drugs which we know most frequently contribute to this condition are the combining of MAOIs with Prozac (this should also include the other SSRIs) or other drugs that have a powerful effect upon serotonin, ie, clomipramine (Anafranil), trazadone (Deseryl), etc. The combination of lithium with these selective serotonergic agents has been implicated in enhancing the serotonin syndrome. The tricyclic antidepressants, lithium, MAOIs, SSRIs, ECT (electric shock treatment), tryptophan, and the serotonin agonists (fenfluramine) all enhance serotonin neurotransmission and can contribute to this syndrome. Anything which will raise the level of serotonin can bring on this hyperserotonergic condition. The optimal treatment for the serotonin syndrome is discontinuation of the offending medication or medications, offer supportive measures, and wait for the symptoms to resolve. If the offending medication is discontinued, the condition will often resolve on its own within a 24 hour period. If the medication is not discontinued the condition can progress rapidly to a more serious state and become fatal. It should be apparent that the greater the enhancement of serotonin levels, the greater the chances of producing the serotonin syndrome. Therefore it is recommended that Zoloft, Prozac, Paxil, Luvox, Serzone, etc. not be used concurrently with each other or any other serotonergic drugs and that these serious adverse reactions should be expected with these combinations (Callahan, 1993). (PROZAC: PANACEA OR PANDORA?, p. 88)"

[fab4fan]

Oh, yes. I was on an SSRI to treat migraines. The first time I had serotonin syndrome, I was in ICU for three days, then m/s for another two. The second time I was in the hosp. for seven days. Never again will I let someone try to talk me into using SSRIs for migraines.

SSRIs are not the nice little pills the manufacturers of Zoloft, Paxil, and Wellbutrin would have you believe. They do help quite a few people, but they can have potentially lethal side-effects.

[SusanJean]

I was reading in a drug book about the drug Tramadol. It said not to give it with an SSRI. I forgot to see if it is a SSRI> It said if you gave tramadol with an SSRI . you could bring on the

serotonin syndrome."

So many drugs to remember !!

My info has this combo under "caution advised" - for tramadol there are dozens of drugs.

I believe this is where the doctor has to make the risk/benefit of the combination.

More serious combinations w/ tramadol are: carbamazepine, MAOinhib., phenytoins, rifampins and sodium oxybate. The following are listed as "avoid/use alternative."

I am not sure what the official PDR recommends, tho.

[stevierae]

Oh, yes. I was on an SSRI to treat migraines. The first time I had serotonin syndrome, I was in ICU for three days, then m/s for another two. The second time I was in the hosp. for seven days. Never again will I let someone try to talk me into using SSRIs for migraines.

SSRIs are not the nice little pills the manufacturers of Zoloft, Paxil, and Wellbutrin would have you believe. They do help quite a few people, but they can have potentially lethal side-effects.

So, does this mean that, theoretically, Paxil and Buproprion should NOT be used together? I have seen them used in combination, many times---usually, decreased dose of Paxil with increased dose of Buproprion, in an effort to find a combination that results in less sexual side effects.

[live4today, RN]

I take Celexa, and it is classed as a "SSRI" (Selective Seratonin Reuptake Inhibitor). Is it dangerous to take, too?

[lsyorke, RN]

Whenever you take a drug that alters serotonin metabolism you are at risk of serotonin syndrome. It is heightened dramatically when you take more that one ssri/snri, or another drug that effects serotonin ie accutane. You truly don't know how you will react until you take the drug. Serotonin sensitivity is very different person to person.

[Wise Woman RN]

5HTP, which you can get in the health food stores, is also a drug that can cause or contribute to serotonin syndrome.

[1Tulip]

5HTP, which you can get in the health food stores, is also a drug that can cause or contribute to serotonin syndrome.

I'm not certain about what 5-HTP is... but the chemical name for serotonin is 5-hydroxytryptamine. The metabolic pre-cursor to 5-HT is 5-HydroxytyptoPHAN. Could this be what the "Health" food stores are selling???? If so, I think this is irresponsibly dangerous.

If the product was well absorbed and had good bioavailability, I would expect that it could really kill some people. Herbals and other "natural" products are "safer" than real drugs, because they are usually destroyed in the stomach or liver before they can reach their receptor targets... that is to say they are largely biologically inert. BUT taken in large enough doses, I would expect 5-HTP could push up the levels of active serotonin throughout the body.

[stevierae]

Well, it makes sense, then, to be careful with the over the counter herbal St. John's Wort, as well. It's often called "The Poor Man's Prozac" and I guess has similar effects on depression and mood swings--therefore on serotonin.

[Miss Ludie]

Bupropion isn't an SSRI...is it? Gosh I hope it isn't 'cause I take it and Lexapro which IS an SSRI...going to have to do some reading I guess. I have felt those symptoms before though. Ewwww.

[ZZTopRN, BSN, RN]

Bupropion isn't an SSRI...is it? Gosh I hope it isn't 'cause I take it and Lexapro which IS an SSRI...going to have to do some reading I guess. I have felt those symptoms before though. Ewwww.

What does Zyprexa, Lexapro, Bupropion sound like to you?