Serotonin Syndrome
Poly-pharmacy or the use of multiple drugs to treat a condition has always been a situation that bears watching. In some conditions drugs are purposely prescribed in combination in order to create a synergistic affect - leading to a more effective outcome in symptom management or resolution.
There are times however, when a combination of drugs can be lethal if not watched carefully. In these situations, it is important for doctors to have a heightened awareness of these potential complications and avoid prescribing such combinations for their patients.
One condition that seems to be on the rise again is serotonin syndrome and it is seen most often in patients being treated for migraine headaches because of the combination of drugs involved. This syndrome is a result of too much serotonin in the body and it presents with a variety of symptoms that resemble neuroleptic malignant syndrome--a serious condition seen in patients taking neuroleptic drugs.
This article is very good as well. It has a bit more clinical information related recognition and management. It contains lists of specific drugs to be aware of. It also includes some case studies and differential diagnosis information I think might be interesting and helpful.
If you find you are taking any medications or have any concerns about your medication regimen, I encourage you to talk to your physician promptly and discuss appropriate alternatives.
Related Topics: Study: SSRI Antidepressants Save Lives, Preventing Migraine Pain
Technorati Tags: migraine, SSRI, serotonin syndrome
There are times however, when a combination of drugs can be lethal if not watched carefully. In these situations, it is important for doctors to have a heightened awareness of these potential complications and avoid prescribing such combinations for their patients.
One condition that seems to be on the rise again is serotonin syndrome and it is seen most often in patients being treated for migraine headaches because of the combination of drugs involved. This syndrome is a result of too much serotonin in the body and it presents with a variety of symptoms that resemble neuroleptic malignant syndrome--a serious condition seen in patients taking neuroleptic drugs.
This article is very good as well. It has a bit more clinical information related recognition and management. It contains lists of specific drugs to be aware of. It also includes some case studies and differential diagnosis information I think might be interesting and helpful.
If you find you are taking any medications or have any concerns about your medication regimen, I encourage you to talk to your physician promptly and discuss appropriate alternatives.
Related Topics: Study: SSRI Antidepressants Save Lives, Preventing Migraine Pain
Technorati Tags: migraine, SSRI, serotonin syndrome
21 Comments:
thank you for this valuble information and please let us know more to it
I was told that I had serotonin syndrome after trying to quit taking Effexor "cold turkey".
My doctor wanted to prescrive effexor, I will let him know
I have migrane headaches! whew
I was just on the site after looking over some side effects from different medications that I'm on. I take Wellbutrin XL & Lexapro along with some meds for migraine headaches. This article concerns me greatly. Would this be something to bring up to the doctor or would they catch this on their own?
smiley31
I have been on Paxil for approx. 6 years and was taken to the ER once with confusion, rapid heartbeat, severe mood changes. The ER let me go with no diagnosis of serotonin syndrome. Also had similar difficulties when first going on the drug. Recently have been having similar problems when a doctor prescribed Trazadone for insomnia and increased my dosage of Paxil. She (most recent doctor) told me on the phone recently about serotonin syndrome. Can't believe this wasn't accurately diagnosed sooner.
to "smiley31"'s comment. DON'T wait for the doctors to "catch" it. I have been treated for fibromyalgia for about 2 years,with depression and aniety.My PCP Dr has prescribed Ultracett and have been taking for 2 yrs. My Physic Dr has prescribed effexor. over a short period of time My BP has increased enough to send me to the ER room a few times now. Headaches are occuring daily now and lethargy,confusion are just a few that have since increased. Recently prior to my Dr going on his vacation,refilled a prescription of the Ultracett(remeber,taking this for 2 yrs) was wriiten with the wrong miligram. Long story short, today they have diagnosised me with serotonin syndrom merley due to both my Dr's prescribing me medication that do not intereact and cause the addtional problems I have been having(ei,High BP,depression,sweats,confusion,aniexty,headaches) not only did NEITHER Dr "catch" this, niether has my pharmasist. Needleass to say, and greatly sad to say I have been negleted by ALL my medical providers inwhich I have to put my faith in treating me correctly. Now I am up against having to change over ALL my medications. and we all know how difficult of a transition that can be. PLEASE EVERYONE, research your own medications,research the adverse effects, combination drugs, ect. We can no longer just "trust" it will all be right.I have lost two jobs in the past 9 months,due to all my complication.
i am comong off lexipro down to 5 mg from 20...also i have been on meds for adult adhd....54 mg of concerta another 18 mg of concerta in late morning and 5 to 10 mg of ritalin in am and late afternoon....also i am on zomig when i get a migraine every two weeks or so...and i am on prometrium and vitelle dot as hormone meds for menopause. could this all add up to seratonan syndrome....please advise if you have any knowledge...thanks. sb
Last year it started around Thanksgiving. I was on two SSRI medications. I am bipolar as well as having fibromylagia and migraines. I didn't know about serotonin syndrome. I was in the hospital voluntarily because life had gotten very hard to deal with. I started having trouble walking. One day I had a seizure like event while there. The doctor did not stop my medication. Finally I was discharged on still on SSRI's. By Christmas I started having more seizure type events. I had to walk with a cane. My legs kept giving out. I was seen as "hysterical" when takne to the ER. Finally my regular psychiatrist realized what was going on. Took me off the SSRI's. I was so disturbed by the lack of support from the medical community that I almost did what the drugs were supposed to keep me from doing. Only knowing that I loved my family kept me safe. Now I am on the least medication I have been on in years and doing the best I have been in years. Serotonin syndrome for me was a nightmare. Recently I had a bad time when I lost a family member. I tried Wellbutrin again. Within a day I started having symptoms again. I called my doctor. He allowed me to stop it. I instead increased my therapy sessions. The important thing is to have a doctor you can trust and listens to you. I am fortunate. The doctor in the hospital did not. I know this is long but this was my experience. Good luck to those who have been there. You do recover but it is scary when you are there.
My doctor prescribed 80 mgs. of lexapro. I also take wellbutrin 300XL and ativan. Is 80 safe and does anybody know what the harmful effects are of taking such a high dose?
To anonymous above:
To post questions about your specific situation, please visit Indie's Pain Management message board. Thank you!
Is it safe to take effexor and phentermine at the same time?
My friend is taking lexapro for anxiey and was feeling depressed so she tooks some St. John's Wort. Results were nausea, vomiting, rapid heart rate. She only took one dose of St. John's wort and that was four days ago. The nausea is better but depression has worsened. How long before the interaction between the drug and supplement should end?
I have been having GI problems for the past three months and have been on Cymbalta for about 6 months or so and I have migraines really bad, and I had a spinal tap done showing pseudotumor cerebri. I wonder if the medication had anything to do with it. The article was very helpful.
I was switching from 75g effexor xr to 20mg fluoxetine three days agoand have had almost zero sleep due to Vivid Nightmares.
The switch was for cost of Rx but now I'm going to stop both and call to find out what to do. From what I read on this site the two meds should not cross paths and this seems what one effect of this Serotonin Syndrome is, the vivid disturbing nightmares,
I must agree that if you or someone you know suspects you may have serotonin syndrome, DON'T wait for a dr. to catch it!!!
My dear husband/pharmacist was the one who noticed I was "not right". I am a nurse -- and my co-workers actually let me drive home (shame on them!!!) after seeing my BP spike up to 200/120! When I got home, I was sweating profusely, shaking uncontrollably, confused, eyes twitching, etc. etc. I had been taking 150 mg Zoloft for Post Partum Depression -- and my OB/GYN did not catch it. It's just an illness that isn't seen as much -- but is now on the rise.
My husband spoke with my OB on my behalf -- explaining what all was happening. My doctor agreed that I was likely in serotonin crisis. I'm being weaned off the Zoloft and started on Wellbutrin instead.
I am very lucky to have someone who noticed I needed help and took matters into his own hands (my husband sought out a pharmacotherapist who specializes in psychotropic drugs -- and told him I was in trouble).
Serotonin syndrome is life-threatening -- DON'T WAIT to be diagnosed!!! Get help if you have the symptoms!
i am on 40 mg. of cymbalta have been on it for 3 months now, i have been having pain in the left side of my head and high blood pressure slso very dizzy and shakiness, just a overall feeling of not feeling good , and even the depression is still there, what should i do?
I have been on wellbutrin in a.m. and zoloft at night. I questioned my physician if people get "use" or "tolerant" of their anti depressant. She said they call it the SSRI slump and prescribed ritalin with the other two. I have had depression through out my life, but worsened with menopause.
Anyone hear of this and how did it work? I am also on HRT.
I am on 90 mg. of Cymbalta and it has kept me pretty stable except I still feel depressed. I am getting more headaches which I take verapamil XL 180 mg. 2 x a day, 2 mg. klonopin. I see my therapist every week and I feel like I am treading water. I helps me to talk but I need to have a plan when I feel depressed. The headaches are coming more often and I take butubital for them. Maybe it is time for a change in therapists. I don't know what action to take, but I do know I HATE feeling depressed when I am on an anti-depressant.
I read one comment on taking 40 mgs. of Cymbalta, and still having depression problems and more.. I am now on 30 mgs. and i have taken cyclobenzaprine for years and still do.., but i have trouble with mood swings, and tierd all the time especially when driving. This never used to be.... I wonder if other people are tierd all the time from cymbalta..
A combination of drugs - 4800 mg of neurontin a day, klonopin, zoloft, seroquel, ativan, zanaflex, ms contin, oxyir, roxicodone,) put me on the respirator. My family was called in to say their good-byes. My husband had to make the heart wrenching decision to turn off life support even though I had a living will. Thank God (and I mean that quite literally) I woke up that morning. I had been taking these drugs a long time. My husband felt something was not right but trusted my doctors as I was seen once a month. If your family thinks something is wrong. IT PROBABLY IS!!! Please, it is always better to be safe than sorry. Thank you for this opportunity to tell my story.
I am lucky to be alive. I went by rescue to the er on December 21st 2007 I went into respritory arrest almost as soon as I arrived was agaited confused and put in 4 point restraints I was intubated in the er and brought to the ICU I was on Zolfot and Vicodin and methodone for years of back pain from an auto accident I am bipolar. I was sent home December 24th for christmas eve ( I am jewish) I had been in a hospital room and out of the ICU for one day. I was let go with possibe serotonin syndrome. On Janury 4th 2008 I once again went by rescue to the er This time I was hypothurmic as well as confused etc.. also was pulling out my own lines Once again in the ICU intubated for 3 days and kept in the hospital for 3 weeks they felt the need to make sure of what it was well it was serotonin syndrome Please be ware of all meds you take and any symptoms of the seortonin syndrome do this for yourself and the hell this could put your family through
Post a Comment