anybody familiar with serentonin syndrome?
i went to the dr today because of my same complaint that i always have when i take an ssri. i wake up at night felling as if my heart stopped and my pupils are dilated this only happens when i take ssri's my doctor said i have serentonin syndrome and that i dont tolerate ssri's very well so she lowered my dose of zoloft to 12.5 mg my ? is is this even enough to help with anxiety and has anyone else experienced these side effects
Last edited by altj on Fri Jan 25, 2008 1:08 pm, edited 1 time in total.
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Guest
I do not have any personal experience with this, but found some info that may be helpful:
<A HREF="http://www.uspharmacist.com/oldformat.a ... cf2fa6.htm" TARGET=_blank>http://www.uspharmacist.com/oldformat.a ... fa6.htm</A>
Serotonin syndrome is described in the literature as a potentially serious drug-related condition characterized by a number of mental, autonomic and neuromuscular changes.1 Although serotonin syndrome can cause death, the condition is mild in most persons, and with supportive care alone they tend to recover completely. The syndrome, first described in animal models in the 1950s, was referred to as the "serotonin behavioral" or "hyperactivity syndrome."1 Reports of serotonin syndrome in humans followed, and have become increasingly frequent since the 1960s. The earliest reports involved persons who were taking monoamine oxidase inhibitors (MAOIs). Some of the early reports included patients who were also taking tryptophan, a serotonin precursor.1,2
Serotonin syndrome is most often reported in patients taking two or more medications that increase CNS serotonin levels by different mechanisms. The most common drug combinations associated with serotonin syndrome involve the MAOIs, selective serotonin reuptake inhibitors (SSRIs), and the tricyclic antidepressants.3 Because of the dramatic rise in the use of SSRIs, it is predicted that emergency room physicians are going to encounter the serotonin syndrome more frequently than in the past.1 Symptoms associated with the condition appear in TABLE 1.
TABLE 1.
Symptoms Associated with Serotonin Syndrome
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%)
References 2, 4
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%)
Several other medications can precipitate the serotonin syndrome (TABLE 2). Increased reporting of cases appears to be related to at least three things: recently published diagnostic criteria describing serotonin syndrome; greater use of antidepressant medications, such as the SSRIs; and an increased attempt by physicians to differentiate serotonin syndrome from neuroleptic malignant syndrome.4
TABLE 2.
Drugs that Affect Serotonin Levels
Effect Drug
Increase serotonin synthesis L-tryptophan
Decrease serotonin
metabolism isocarboxazid
phenelzine
selegiline
tranylcypromine
Increase serotonin release amphetamines
cocaine
reserpine
Inhibit serotonin uptake amitriptyline
clomipramine
desipramine
doxepin
imipramine
nortriptyline
protriptyline
fluvoxamine
fluoxetine
paroxetine
nefazadone
sertraline
trazodone
amphetamines
cocaine
dextromethorphan
meperidine
venlafaxine
Direct serotonin
receptor agonists buspirone
lysergic acid
diethylamide(LSD)
sumatriptan
Nonspecific increase in
serotonin activity lithium
Dopamine agonists amantadine
bromocriptine
bupropion
levodopa
pergolide
pramipexole
References 2, 4
Mild to moderately severe cases of serotonin syndrome usually resolve in 24 to 72 hours.1 Though most cases can be treated and resolve within a week, some patients become acutely ill and require hospitalization. In some instances patients have been admitted to the ICU and required mechanical ventilation. Mortality associated with this condition is estimated to be 11%.4
Serotonin Receptors
Serotonin (5-HT; 5-hydroxytryptamine) occurs naturally in the body. In the periphery, serotonin acts both as a gastrointestinal regulating agent and a modulator of blood vessel tone.5 Although only 2% of the body’s serotonin is found in the brain as a neurotransmitter, the chemical can have a profound effect on body functions. As a neurotransmitter, serotonin is involved in the modulation of motor function, pain perception, appetite, and outflow from the sympathetic nervous system.4
Serotonin acts at receptors generally classified into one of four categories, depending upon function and location. The four recognized serotonin receptors identified are 5-HT1, 5-HT2, 5-HT3 and 5-HT4. Receptor subtypes also have been identified. For example, the 5-HT1d subtype lies outside the CNS and is the receptor through which sumatriptan exerts its antimigraine effect. Researchers agree that the majority of signs and symptoms associated with serotonin syndrome involve excessive stimulation of the 5-HT1A receptor.1,6 Recent studies, however, show that the 5-HT2 receptor may be at least partially responsible for the serotonin syndrome.1,4 The 5-HT2 receptors are located in the brain and peripheral blood vessels.
Most cerebral functions are the result of the convergence of many different neurotransmitters, including serotonin.7 This complex network of neurotransmitters makes it possible for serotonin to affect many functions and actions of the brain. For example, serotonin often serves as a cotransmitter along with gamma-aminobutyric acid (GABA) and norepinephrine. Serotonin antagonizes GABAB receptors, causing upregulation of this subtype. The activity of benzodiazepines in the treatment of serotonin syndrome is thought to occur because these compounds act as strong agonists at GABAB receptors. Certain dopaminergic neurons have serotonin receptors, resulting in serotonin-modulated release of dopamine in different areas of the brain.
<A HREF="http://www.uspharmacist.com/oldformat.a ... cf2fa6.htm" TARGET=_blank>http://www.uspharmacist.com/oldformat.a ... fa6.htm</A>
Serotonin syndrome is described in the literature as a potentially serious drug-related condition characterized by a number of mental, autonomic and neuromuscular changes.1 Although serotonin syndrome can cause death, the condition is mild in most persons, and with supportive care alone they tend to recover completely. The syndrome, first described in animal models in the 1950s, was referred to as the "serotonin behavioral" or "hyperactivity syndrome."1 Reports of serotonin syndrome in humans followed, and have become increasingly frequent since the 1960s. The earliest reports involved persons who were taking monoamine oxidase inhibitors (MAOIs). Some of the early reports included patients who were also taking tryptophan, a serotonin precursor.1,2
Serotonin syndrome is most often reported in patients taking two or more medications that increase CNS serotonin levels by different mechanisms. The most common drug combinations associated with serotonin syndrome involve the MAOIs, selective serotonin reuptake inhibitors (SSRIs), and the tricyclic antidepressants.3 Because of the dramatic rise in the use of SSRIs, it is predicted that emergency room physicians are going to encounter the serotonin syndrome more frequently than in the past.1 Symptoms associated with the condition appear in TABLE 1.
TABLE 1.
Symptoms Associated with Serotonin Syndrome
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%)
References 2, 4
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%)
Several other medications can precipitate the serotonin syndrome (TABLE 2). Increased reporting of cases appears to be related to at least three things: recently published diagnostic criteria describing serotonin syndrome; greater use of antidepressant medications, such as the SSRIs; and an increased attempt by physicians to differentiate serotonin syndrome from neuroleptic malignant syndrome.4
TABLE 2.
Drugs that Affect Serotonin Levels
Effect Drug
Increase serotonin synthesis L-tryptophan
Decrease serotonin
metabolism isocarboxazid
phenelzine
selegiline
tranylcypromine
Increase serotonin release amphetamines
cocaine
reserpine
Inhibit serotonin uptake amitriptyline
clomipramine
desipramine
doxepin
imipramine
nortriptyline
protriptyline
fluvoxamine
fluoxetine
paroxetine
nefazadone
sertraline
trazodone
amphetamines
cocaine
dextromethorphan
meperidine
venlafaxine
Direct serotonin
receptor agonists buspirone
lysergic acid
diethylamide(LSD)
sumatriptan
Nonspecific increase in
serotonin activity lithium
Dopamine agonists amantadine
bromocriptine
bupropion
levodopa
pergolide
pramipexole
References 2, 4
Mild to moderately severe cases of serotonin syndrome usually resolve in 24 to 72 hours.1 Though most cases can be treated and resolve within a week, some patients become acutely ill and require hospitalization. In some instances patients have been admitted to the ICU and required mechanical ventilation. Mortality associated with this condition is estimated to be 11%.4
Serotonin Receptors
Serotonin (5-HT; 5-hydroxytryptamine) occurs naturally in the body. In the periphery, serotonin acts both as a gastrointestinal regulating agent and a modulator of blood vessel tone.5 Although only 2% of the body’s serotonin is found in the brain as a neurotransmitter, the chemical can have a profound effect on body functions. As a neurotransmitter, serotonin is involved in the modulation of motor function, pain perception, appetite, and outflow from the sympathetic nervous system.4
Serotonin acts at receptors generally classified into one of four categories, depending upon function and location. The four recognized serotonin receptors identified are 5-HT1, 5-HT2, 5-HT3 and 5-HT4. Receptor subtypes also have been identified. For example, the 5-HT1d subtype lies outside the CNS and is the receptor through which sumatriptan exerts its antimigraine effect. Researchers agree that the majority of signs and symptoms associated with serotonin syndrome involve excessive stimulation of the 5-HT1A receptor.1,6 Recent studies, however, show that the 5-HT2 receptor may be at least partially responsible for the serotonin syndrome.1,4 The 5-HT2 receptors are located in the brain and peripheral blood vessels.
Most cerebral functions are the result of the convergence of many different neurotransmitters, including serotonin.7 This complex network of neurotransmitters makes it possible for serotonin to affect many functions and actions of the brain. For example, serotonin often serves as a cotransmitter along with gamma-aminobutyric acid (GABA) and norepinephrine. Serotonin antagonizes GABAB receptors, causing upregulation of this subtype. The activity of benzodiazepines in the treatment of serotonin syndrome is thought to occur because these compounds act as strong agonists at GABAB receptors. Certain dopaminergic neurons have serotonin receptors, resulting in serotonin-modulated release of dopamine in different areas of the brain.
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Guest
I have been there. My first experience was with self-medicating herbs. Not good.
Once I went back to meds (100mg Zoloft), it got to a point where I thought I need a stronger dosage, so I was perscribed 150 mg. Bad idea. I went back down to 100 mg.
My challenge then was to determine if the feelings were due to too much or not enough medication, since many of the symptoms of depression/anxiety are common with those of serotonin syndrome.
I used a pill cutter to lower the dosage to see what happened.
I took off about 10% and felt better, so I kept up about a week, and gradually took off less.
I now take the 100 plus a piece from before.
As the professionals will tell you, head meds are a trial-and-error situation, since there are no lab tests to determine the optimal level. A dosage of Zoloft of 12.5 mg is extremely low, but we all are different.
Hang in there.
Dave
Once I went back to meds (100mg Zoloft), it got to a point where I thought I need a stronger dosage, so I was perscribed 150 mg. Bad idea. I went back down to 100 mg.
My challenge then was to determine if the feelings were due to too much or not enough medication, since many of the symptoms of depression/anxiety are common with those of serotonin syndrome.
I used a pill cutter to lower the dosage to see what happened.
I took off about 10% and felt better, so I kept up about a week, and gradually took off less.
I now take the 100 plus a piece from before.
As the professionals will tell you, head meds are a trial-and-error situation, since there are no lab tests to determine the optimal level. A dosage of Zoloft of 12.5 mg is extremely low, but we all are different.
Hang in there.
Dave
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Guest
Hi,
I just wanted to comment on my personal experiance wiht Zoloft. It works for several people in my family--they are high doses. I have depression and anxiety. My primary care doctor put me on Zoloft on 25 mg. I have tried Wellburean, Paxil, Lexapro...curring on Xanax and Prozac (working so far). When taking Zoloft after a few weeks I started getting like a gas bubble in my chest. I would drink pop to make it "come out". Nothing. My chest and back muscles started to hurt. It was really uncomfortable and ANNOYING! My poor husband. I was finding it hard to read a book to my child or walk up the stairs. I thought maybe it was ashmtha. What do I know...I am not a doctor. I went back to my primary care doctor and he told me it was my anxiety that was taking over. I didn't think so but i am not a doc. So he upped the Zoloft to 50 mg. After a few days I couldnt even get off the couch or the bed. I layed there and cried with a heating pad on my back for an hour then my chest. I know that you shouldn't stop taking meds without permission but i thought I would try one time and I will see if its the Zoloft. I felt better the next day....I even rolled over in the morning and buroed! I was in tears of joy!!! I am only sharing this with you because I since have seen a psychiatric to sit down wiht me and have more time to get to know me. I am not pushing drugs. Its not for everyone. I have just found myself that i need to take them and finding the right one/ones takes a lot of time and frustration. Keep in touch with the doctor and try to stay aware of how you are feeling on them. Try to keep a daily journal, preahps. As Dave said everyone is different meaning different doses for different people. As, whenever i try something new I ask to take a small dose then work up so that my body doesn't react to it too much. I feel for you.
I just wanted to comment on my personal experiance wiht Zoloft. It works for several people in my family--they are high doses. I have depression and anxiety. My primary care doctor put me on Zoloft on 25 mg. I have tried Wellburean, Paxil, Lexapro...curring on Xanax and Prozac (working so far). When taking Zoloft after a few weeks I started getting like a gas bubble in my chest. I would drink pop to make it "come out". Nothing. My chest and back muscles started to hurt. It was really uncomfortable and ANNOYING! My poor husband. I was finding it hard to read a book to my child or walk up the stairs. I thought maybe it was ashmtha. What do I know...I am not a doctor. I went back to my primary care doctor and he told me it was my anxiety that was taking over. I didn't think so but i am not a doc. So he upped the Zoloft to 50 mg. After a few days I couldnt even get off the couch or the bed. I layed there and cried with a heating pad on my back for an hour then my chest. I know that you shouldn't stop taking meds without permission but i thought I would try one time and I will see if its the Zoloft. I felt better the next day....I even rolled over in the morning and buroed! I was in tears of joy!!! I am only sharing this with you because I since have seen a psychiatric to sit down wiht me and have more time to get to know me. I am not pushing drugs. Its not for everyone. I have just found myself that i need to take them and finding the right one/ones takes a lot of time and frustration. Keep in touch with the doctor and try to stay aware of how you are feeling on them. Try to keep a daily journal, preahps. As Dave said everyone is different meaning different doses for different people. As, whenever i try something new I ask to take a small dose then work up so that my body doesn't react to it too much. I feel for you.