I'm not sure how aware everyone is of this particular drug complication but considering many users browsing this forum take SSRI's I felt that maybe an informational post should be made so that people are a little bit more aware of this issue. I apologize if this is posted elsewhere, a brief search on both the free-board and VIP board had few results, if you do know of another post feel free to reply and link it. The more information the better!
Disclaimer: I am not a doctor, this was just some personal research I did on my own. Consult a professional and don't use this as your anti-serotonin syndrome guide.


What is it?
The issue I am going to discuss is Serotonin Syndrome or more accurately called serotonin toxicity. Basically it is when you have too much serotonin being released into your body. The serious part of this is that the symptoms can happen in minutes and they can be fatal. Common symptoms are but not limited to:
-Fever, increased heart rate, hallucinations, diarrhea
-Loss of consciousness, cognitive ability, coma
-Seizures, loss of feeling in limbs, uncontrollable twitching
Personally I take Paroxetine (Paxil) to manage anxiety so that is where I first started hearing about Serotonin Syndrome (SS). Many anti-depressants are classified as SSRI's which stands for Selective Serotonin Re-uptake Inhibitor. To understand what SSRI's do you have to understand a little bit about Neurotransmitter's (NT). Imagine an electrical wire cut in half that when you put them close to each other sparks arc across it, that's like a NT and the synaptic gap (the space between). When serotonin is released from one side of the "wire" some of it goes into the other side but some of it also gets reabsorbed back into the initial "wire". SSRI's inhibit that from happening so more gets absorbed into the other side of the "wire" and thus into your target zones in the brain and body. In the end your serotonin levels are increased and your depression/anxiety is relieved/leavened.

So what we have here is a lot more serotonin getting to different parts of your brain/body which is good for you if you have problems with depression, anxiety, or whatever you are prescribed the SSRI for.



So why does it matter to you?
What is bad is when you use another drug which may have effects on serotonin levels as well. First, and most obviously, overdosing on your SSRI will increase the serotonin levels and can possible cause SS. Next is mixing anti-depressants such as MAOI's, SNRI's, and SSRI's or other medications used to treat depression/anxiety. The combination can not only prevent reuptake of serotonin, but increase the amount of serotonin released so you have a compounding affect.

One of the other more common drugs known to interact badly with SSRI's (especially offered on websites referred to on this board) is Tramadol. Tramadol, marketed under the name Ultram, is an opiod analgesic, somewhat less potent than the usual suspects such as Vicodin, Percocet, and Oxycontin; thus it is much more easily procured using various websites found on this board. However risk of SS is not limited to Tramadol, other opiods such as Demerol and some pain relievers especially triptans (migraine medicines) can have the same amplifying effect. When combined the serotonin levels in the brain become too high and SS can result.
Finally there is another unexpected drug that can also trigger SS and prove fatal: cough syrup. Over the counter cough syrups containing dextromethorphan can affect serotonin levels and increase the likelihood of SS. Check the label for the contents and avoid cough syrups that have DM in the label such as Robitussin DM.
Herbal remedies such as St John's Wort and ginseng can also increase the amount of serotonin in your bloodstream.
Oh yeah, combination with illicit drugs like LSD and Ecstasy will increase your risk of SS. Plus shame on you for taking them in the first place!



How do I prevent accidentally taking the wrong combination?
First and foremost, read the labels! If it says "do not take with X medication unless directed by your doctor' don't do it! Or at least call your doctor and ask! Ask your doctor when prescribed a new drug or next visit about SS and how to avoid it! Research, research, research! I'm not a neuropsychologist I'm an EMT and I've never seen a case of Serotonin Syndrome. I've never known anyone who had it. But I take an interest in my own personal health and put in the time and effort to try to understand it!



OK, so where did you copy and paste it from and who the hell are you to tell me what to do?
VERY GOOD QUESTION! Don't take my word for it, do the research yourself. If you wikipedia I will slap you upside your head. Wikipedia is the devil. A good source of information is http://www.erowid.org for drug interactions. Check medical journals, talk to medical professionals, google it! Make sure that the website isn't a geocities site, but most .edu or .gov websites can be trusted! I didn't copy and paste this from anywhere, I did my research and found out as much as I could and decided to share it with you. There may be error's, I hope to God there isn't but this post is as accurate as the current research is. I am not a medical doctor, I'm just a college student who happens to like care about people. If you really have a problem with this post and want sources I can cite it for you but don't be a pain in my [censored] and don't be lazy, do your own research.



OK OK, where do I start looking?
Your best bet is your doctor. Talk to him about possible complications, your lifestyle, what you eat, and be honest about any other drugs you may take whether they be prescribed or not. Chances are if they aren't prescribed in the first place, telling him you bum a Ultram off your roomate every now and then isn't going to really change his mind about prescribing you Ultram, he wasn't going to in the first place! So be honest.

Another great source is Google Scholar. For those of you who don't know Google has a great special search site at http://scholar.google.com where you can do a search for Serotonin Syndrome and find many many scholarly journal articles from medical publications about it. If you can't get through the medical jargon, just use regular Google but be wary of the content.



Good luck with your medical issues and be safe!

http://www.drugdigest.org/DD/Interaction/ChooseDrugs/1,4109,,00.html

Above is a link to a site that is comprehensive when it comes to interactions.

Our resident ER doc, Chemsynth, is an expert on this condition; in fact he wrote the article which appears on Erowid.

He'd probably disagree that the best place to look is your doctor, because a lot of them don't know anything about it!

Wikipedia is OK as long as each claim is referenced, and the references check out. Same with Erowid, but I wouldn't give much credit to the reports from those people who take multiple drugs on a regular basis purely to get high.

I generally trust Erowid's negative experiences. When people report that they woke up naked on the roof of Wendy's bleeding from their ears I pay attention to what the hell just happened. Thanks for the heads up on chemsynth's article, I just read through it and it was a great read... direct link below... as soon as i figure out why i can't edit my topics i'll add it to the above post:

http://www.erowid.org/references/refs_view.php?A=ShowDoc1&ID=6464

Serotonin syndrome is no fun. and nephro is right--i wouldn't waste time talking to a doc about it; you probably know more than they do at this point.

chemsynth

Negative experiences due to the interaction of 2 drugs or the overdose of 1 drug are fine - and indeed could be worth their weight in gold to medical science; it's the reports of people who say they took their usual cocktail of mushrooms, pot, alcohol, pregabalin, Xanax, LSD and OxyContin, but had an adverse experience because they added clonidine, methamphetamine, Ritalin and GHB this time. There are too many variables to draw any conclusions.

This is an all-time favourite of mine:

http://www.erowid.org/experiences/exp.php?ID=50637

I really cannot find any useful conclusion from this report, except that the person who wrote it is a complete tosser.

Nephro....The Link....OMG.....Damn Kids these days

Appreciate your contribution, Oxy80, but FYI, I checked this site out when I was in nursing school, just to compare it with the books we used. I found it lacking even at that time. Here is just an example of the drug "interactions" when I plugged in OxycontinCR, Hydro and Xanax:

"Check Interactions
No interactions were found for the drugs you selected.

You searched for interactions between the following drugs:

* Hydrocodone and Acetaminophen Tablets
* OxyContin Extended-Release Tablets
* Xanax"

No interactions at all? Not even increased grogginess? The above combo could be extremely hazardous to one's health.This site is not suitable for especially the average person looking for interactions. The best way is to contact a pharmacist. If you don't want your name to show up, dial *67 first. I do not recommend this site. Computers will never take the place of common sense.

Did you know DIALING *67 will not block your phone # from any toll free number?

It still amazes me to this day that people don't use their heads when it comes to meds.

I am no expert pharmacist, but I would know that those meds would have some effects on my body.

Those little stickers and warnings about 'not mixing with other meds without physician advice' or 'do not operate heavy machinery' aren't there just to keep the pharmacist busy.

I was referring to calling a local pharmacy if one did not want their name recognized. Thank you for that information, though.

I just tested it and at least where I am, *67 did block the phone number. Sorry for being off-topic, but just wanted to clarify that this may not be true for all instances.

I just checked for interactions between:

# Aspirin and carisoprodol
# Aspirin, Butalbital, and Caffeine Capsules

and all it did was tell me not to consume alcohol with them - nothing about not taking 2 aspirin products together or any interaction between carisoprodol and butalbital.

there's nothing between those meds--no cytochrome interactions, no nothing.

chemsynth

Surely double doses of aspirin can irritate your stomach? And isn't carisoprodol going to increase drowsiness with butalbital? Carispoprodol knocks some people out on its own.

They may not be interactions in the sense you refer to but how many aspirin products can one take together?

good question. here in the US, the focus has been on the number of products with acetaminophen in them--combinations of which can lead to hepatic failure. most ASA is enteric coated now, so the risk to the gastric mucosa is less. regarding butalbital, the dose in things like fioricet is pretty low (my pharmacology professor said fioricet has the analgesic efficacy of a cup of hot chocolate), so i suppose it would depend more on underlying pain issues as well as tolerance. Soma would snocker many people, but that may be/?is? a goal of therapy when used as a so-called "muscle relaxant".

chemsynth

Yes I completely believe you regarding butalbital preparations; they make little sense to me. The closest we had was Equagesic (meprobamate and aspirin) but it was axed ages ago.

Also, we have the same problem with APAP due to the many multi-ingredient proprietary OTC cold and flu pills and potions on the market, many if not most containing APAP. So now there is a large warning on such products to the tune of, "DO NOT TAKE ANY OTHER PARACETAMOL-CONTAINING PRODUCTS" or similar, and the APAP pills have a warning about the maximum single dose and the maximum 24-hour dose.

The maximum pack size was reduced from 100 to 32, though some pharmacists consider it a joke, since you can walk down a typical street and buy a dozen packs from various shops.

The UK has very few aspirin products now; I think the only ones are aspirin 300mg pills and 75mg enteric-coated or soluble pills. Ibuprofen seems to have taken over OTC products in this regard.

Nephro that tool sounds like my 18 yr old step-brother, except for the being in school part. I did a wake and bake 1 or 2 times in high school but kids now will eat bottles of melatonin, drink Ambesol, down 36 Dramamine and for what? A good time? I have to agree with Mr. Huxley, once again on this matter.

"God deliver us from such criminal imbecility."

It's a good job he didn't go to school. Someone has to teach them, or try to, when they do turn up intoxicated. And since they tend to do this sort of thing in groups, some poor teacher can have half the class paralytic.

As one class replied when they were asked why they would never bring their PE kit, "We'd rather take drugs, Sir."

I just don't understand it. I was mad for PE when I was a kid; in fact I'd skip other lessons to join PE classes I wasn't supposed to be in. Of course, there was always the odd kid who'd always bring a sicknote, but the amount of malingerers these days can amount to most of the class. Forged notes are always amusing, but when the parents write notes such as, "Dear Sir, my daughter cannot do PE for the next 6 weeks as she has recently had her belly-button pierced", there's little the teacher can do.

Not all 800 number owners know how to use all the services that come with owning the 800 #.

http://www.fcc.gov/cgb/consumerfacts/callerid.html

I want to thank all of you for discussing this topic. I do have some of the symptoms related to SS. I'm going to discuss this topic with my neurologist at my monthly appointment.

thanks for the links..

Fubu

Bring some written drug interactions with you at your Drs visit. My Dr put me on an SSRI & Tramadol. I had to tell her that there it was contraindicated. She's an Interanl Medicine Doc but didnt know this...DUH. So be your own advocate & go equipped with written information.
Good luck.

Or perhaps bring in something from the pharmacy that would show the meds shouldn't be taken together. I've had to have the pharmacist call the ER doc to get a different med for me once because he gave me ultracet and I have seizures.

Please don't mess around if you think it's SS. I've had it and almost lost my job and fell asleep all the time, once while driving. PM me if you want to discuss more.

My doc gave me multiple meds that were just too much. When I finally went back, I saw her partner and she knew within 5 minutes what the problem was.

serotonin syndrome is scary but doesn't last long. a VA quack rx'd me citalopram (celexa) with not even a glance at my chart, which was in front of his nose. had he looked he would have seen that i have been taking Tramadol which is also a serotonergic drug.
the combination did me in after just a few days. i took a header through the shower curtain, i couldn't form coherent thoughts and in general felt that aside from a smashed up face, was in dire straights.
as i live in a remote, rural location and this rodeo was in the evening, i made the poor decision to call poison center. it was difficult because i was delirious and i thought the outfit would give me some sort of informed answer to what was ailing me. but noooo, that isn't what happened. the woman on the 'phone demanded that i call fire rescue and be transported. if i didn't she would!
i folded and got my friend and neighbor to cart me to the ER after poison control called him and confirmed. first time in an ER in 40 odd years! a sharp doc took a look at my meds and consulted the PDR for drug/drug reactions in the morning. she dx'd it as serotonin syndrome and after 8 or 10 hours i was back in my mind.
moral 1 is that now i never take a prescribed drug without researching it and possible reaction to others that i take. more docs have been good in treating me but there have been a couple of asshats.
PDR online provides good info about rx meds and has an active drug/drug interaction section.
moral 2 is only call poison center after one is dead.

serotonin syndrome is schizophrenia....

No it isn't.

I can't wait to read what other pearls of wisdom you have.

Another expert in psychotropic pharmacology checks in.
I'm waiting expectantly to hear an explanation of this opinion. Please don't be shy about sharing the information that led you to reach this remarkable conclusion.
It's a doozy.

When doctors are writing prescriptions they rarely think of Serotonin Syndrome. The level of awareness is pretty low. I think it has a lot to do with doctors rushing to see to many patients a day and they are not able to really research their patients history and get a good read on their charts. I am a nurse and I think I know more about the patient than the doctor because they have to take care of so many people it's crazy.

Serotonin syndrome occurs when you take medications that cause high levels of the chemical serotonin to accumulate in your body. Serotonin is a chemical produced by your body and is needed for your nerve cells and brain to function. But too much serotonin causes problems. So it can happen to people with schizophrenia people they are taking quite a few medications that have a higher risk of serotonin syndrome. The thing is that it can happen to many others taking certain combination of meds. So serontonin syndrome is definitely not schizophrenia.