Talk:Serotonin syndrome
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This is a very, very serious condition. Without making any modifications in my ssri dosage (Wellbutrin & Paxil combo), I have experienced 8 episodes of this syndrome in the past 3 years. Each episode lasted 2 to 3 weeks and began with intense nausea, complete inability to eat or keep food down. Keeping fluids down was a trial. The desire to vomit is overwhelming for the first week and abates in the second week. Sleep disruption but still needed to sleep 12-16 hours a day. My mind was useless the rest of the day. Drenching night sweats common. In 3 of the 8 episodes I had to go to the hospital for IV rehydration and anti-nausea drugs. Must keep up drug intake and ssri dosage during syndrome unless one plans on changing or going off drugs. Gradual ability to tolerate more and more liquid, broth, desire for jello. Once back on regular food I'm ravenous. I am going off of my ssri's because of the intense disruption this syndrome has caused in my life. Doctors know literally nothing about this and only prescribe anti-nausea suppositories while suggesting other causes.
--common sense should tell you that if you are taking a drug that causes side effects worse then the original symptoms it's treating it would be a good idea to stop taking it. --Arm
Doctors generally do not know very much about serotonergic neurotransmission at all. The equilibrium is reestablished nearly instantly, so it's generally a mystery how SSRIs have any effect at all, and they are only used because they are relatively safe. Review the literature from the Food and Drug Administration if you like. Long-term remission rates for SSRIs are comparable to placebo. For anyone looking for effective treatment, I would seriously recommend trying moclobemide monotherapy (450mg-1200mg/day), and switching to a classic MAO if that doesn't work. At least these have good, well-documented results with a good side-effect profile. --Unregistered
I can sympathize with your experiences with this. My doctors upped my dosage of antidepressants too quickly, which eventually gave me serious sleeping problems (I also felt the need to sleep 12+ hours a day, but always felt sleepy nonetheless). They figured my sleeping problems were from more anxiety problems, so prescribed even more antidepressants! But eventually I figured out I was actually on too much, reduced my dosage, and then all was well. I definitely got the impression that the prescribers weren't nearly as familiar with the side effects of overdose as they were with just the regular side effects. --anonymous
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[edit] New info
I'm adding a bit based on a long string of personal experience. I can't even take Prozac, Luvoc, Paxil, and the like without flipping out. Coolgamer 21:49, 26 September 2005 (UTC)
I am on a Wellbrutrin and Paxil combination. It took quite over two years to figure out what combination and what kind of medication worked best for myself. I have been working with depression for all of my adult life and I believe my childhood. Currently, I'm 39. The medication has made a significant difference in my perception of myself and my world. My comments are three fold, one, everyone one's body and brain are unique and you can only listen to your own reactions to the medications, two, nutriants and herbals can affect how your medication is processed, three, I just found out that cough rememdies can bring on this syndrome! (DM)? I just stopped taking the cough syrup and my body stopped shaking and I could sleep after not for 4 nights. PS
[edit] Changes made
I made several changes and added a footnotes section. Note I forgot to log in and made them as 70.157.54.56, but it was me. Joema 20:14, 31 March 2006 (UTC)
[edit] Diphenhydramine?
I'm not a biochemist but the article on diphenhydramine (Benadryl, Unisom, Tylenol PM, etc.) says that it inhibits serotonin reuptake similar to an SSRI. Should it be on the list of medications that can cause serotonin syndrome? I take an SSRI so now that I know about serotonin syndrome I might stop taking my Tylenol PM at night, although I haven't had any problems so far. CBRQ 18:06, 8 June 2006 (UTC)
- Don't change any medication you take without first discussing with your doctor. You're right the article on diphenhydramine says that, however I don't see any medical literature indicating serotonin syndrome resulting from diphenhydramine and SSRIs. Drugs affecting serotonin reuptake vary widely in their strength. It's possible diphenhydramine is a very weak reuptake inhibitor or somehow affects only specific serotonin receptors (there are many). The point you raise is logical based on the article wording, but I'd suggest discussing with your doctor. Joema 02:21, 9 June 2006 (UTC)
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- Okay, great. Thanks a lot for the answer, I appreciate it. I should be seeing a psychiatrist again in a month or so; when I do I'll try to get an answer about that. CBRQ 01:47, 13 June 2006 (UTC)
- It's not biochemist, it's pharmacist, I believe. Either way :P, most over the counter medications will not raise serotonin levels in the brain to levels at which serotonin syndrome is even moderately acquireable. The syndrome simply means youve in a way 'overdosed' on serotonin. Your brain will typically be able to work with these things if you have the help of a psychiatrist, but OTC meds will rarely cause the syndrome if taken at the recommended dosages.--Neur0X .talk 19:52, 5 October 2006 (UTC)
[edit] Symptoms and mechanisms
I like this article, but I suspect it would be difficult for a layman to distinguish between Serotonin syndrome and simple medication side effects. Maybe one should set out that section more clearly. The reasons why the diffeent drug combinations affect 5-HT should be interesting, I have such a list somewhere and will post when I've found it. That would be a mechanism-based table as opposed to a drug-class table. The mechanism lay-out was easier for me to understand when I first came across this entity. --Seejyb 00:07, 14 August 2006 (UTC)
You are spot on there. Much of the discussion is confusing side effects with serotonin syndrome. The term serotonin syndrome is being used rather loosely in many medical reports, which are often by doctors who are not very familiar with this complex topic. This is why Professor Ian M Whyte (who has done the lions share of original research in this field), and I, advocate the term toxicity. This is meant to emphasise severity: i.e. toxicity = poisoning. That is essentially different to side effects, no matter how distressing those may be to individuals. The term toxidrome is being used increasingly (search the NLM data base) because it describes the picture of intoxication. For some drugs that effect the central nervous system (CNS) the picture is so unique that it is useful to describe it as precisely as possible to aid recognition when it presents. Serotonin toxicity is such a condition and only results from drug over-dose of single drugs, e.g. monoamine oxidase inhibitors like tranylcypromine, or combinations of monoamine oxidase inhibitors with serotonin reuptake inhibitors. I have written a series of explanatory pieces about this that may be seen on my website www.psychotropical.com under the section serotonin syndrome. Signature for aboveKen Gillman 00:11, 21 September 2006 (UTC)
[edit] Removed from page
The following paragraph was in the actual page, I have removed it here in case anyone would like this information, it was added by 58.87.7.43 which appears to be an IP used by Dr P Ken Gillman.
- This table would benefit from being updated, and made more relevant to primary verifiable references, but I cannot see who produced the original table. However, I would comment that almost all the references are secondary or tertiary, rather than primary, this is not ideal for a verifiable account. Perhaps if they would like to contact me I could assist with sources that would increase its direct science base and topicality. by user 58.87.7.43 08:22, 22 September 2006 (UTC)
Mr Bungle 07:37, 17 November 2006 (UTC)
Above is correct assumption, it was I. Ken Gillman 08:35, 26 November 2006 (UTC)
Much of the above is personal experience and has no direct relevance to improving the article. I suggest it would be helpful if such items were removed to avoid clutter and confusion. Can that be done? If so, who might do it? Ken Gillman 08:44, 26 November 2006 (UTC)
