Warning - Serotonin Syndrome

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    Warning - Serotonin Syndrome


    This is a heads-up to the one or two bros here that take anti-depressants. I take lexapro (20mg) and wellbutrin (150mg) ED. For better or for worse, I am also prone to experimentation with chems (well, I guess we all are or we wouldn't be on this board, right?) Yesterday afternoon I picked up a supp containing 5-htp and tyrosine. Thinking that "if a little serotonin is good, then more would be better" I popped two caps before lunch - the dosage was small and I wasn't the least bit concerned.

    Thirty minutes later, I was laying on the floor of a public building puking my guts out. I was intensely dizzy, my extremities were numb, and I was sweating like I had run a marathon. A passer-by thought I was having a MI and called an ambulance.

    Dudes, this sucked so bad that it is hard to put into words. If you're on prescription meds, PLEASE do your homework before you take anything that has the potential to effect neurotransmitter levels in a significant way.

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    sorry to hear that bro... that's a pretty extreme reaction.
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    Talking


    Dude, it sucked like a Hoover. If projectile vomiting were an olympic sport, I would have won the gold...AND the silver.

    I'm disappointed because I want to try phenibut, but now I'm afraid. Is anyone aware of a potential reaction b/t Phenibut / lexapro/ wellbutrin?

    Quote Originally Posted by prime
    sorry to hear that bro... that's a pretty extreme reaction.
    •   
       

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    Try going of the wellbutrin and lexapro and just trying St.johns wort. I have read of many people doing that. It will work just as well, but you may have to take some time off for the scripts to clear your system first. I read a lot about it on Kelly's St.johns wort page forum.
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    i use phenibut (great stuff) and i am on an ssri (zoloft) and it doesn't interfere at all. phenibut will increase gaba output (gaba mimetic) to cause rlaxation and better sleep.wellbutrin works on dopamine receptors i believe and should not react w/ phenibut. oh, and thanx for the heads up on the 5-htp.
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    i wouldnt **** with st. johns, I have heard that it works well with mild depression but can make moderate or severe depression worse.
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    Quote Originally Posted by UNDERTAKER
    i wouldnt **** with st. johns, I have heard that it works well with mild depression but can make moderate or severe depression worse.
    What?!??!?! Where did you hear that crap?. I have been taking it for years and so have a lot of people! Here, take a look at this link and in the forums...What you have heard is a bunk of BULL****!.

    http://www.sjwinfo.org/
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    Really?

    I have 'heard' that a recent study proved that ST. John's wort had no scientific benefit for clinically depressed patients compared to placebo. Don't have the study handy but surely someone who works in this area could chime in...
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    Quote Originally Posted by T-Bone
    Try going of the wellbutrin and lexapro and just trying St.johns wort. I have read of many people doing that. It will work just as well, but you may have to take some time off for the scripts to clear your system first. I read a lot about it on Kelly's St.johns wort page forum.
    Although SJW seems to have some merit, I don't think it would be a good idea for me to abandon the medication I take now. The function and interaction between the various neurotransmitters has not been fully elucidated, and the effects of being "off" for a time followed by introduction of SJW are unknown. For someone with moderate depression/anxiety, it would be difficult to determine the proper dose of SJW and how it might interact with other medications, so I think this is a risky proposition.

    The serotonin syndrome was a terrible experience and one that I do not wish to repeat. It appears that there is little room for error when dealing with neurotransmitters.
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    Saint John's didn't do too much for me, it would lift my mood for a day or so then it would come crashing back down even worse. It does not work for everyone so, can have annoying sides like insomnia, photosensitvity and negation of birth control pills in women.

    It's not a panacea for depression and I don't care if an herb site touts it as a miracle or not.

    I've had far better luck with ALCAR, folic acid, garlic and selenium. Go figure.
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    It all depends on the brand you get. It is prescibed in Germany for depression and has been for decades. You should not take it if you haven't been diagnosed with depression and/or anxiety disorder, or been prescibed and SSRI. Of course come off the SSRI and make sure its out of your system before you start the SJW. There is plenty of information on about it on the site I linked. It has been studied more than creatine, and is proven safe and effective. If you want to read over boring studies, go ahead and search for them. You have to take the correct dosage and some of the brands out there are just crap and don't work at all. Look over that site, it has plenty of info.
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    Quote Originally Posted by s.norman
    i use phenibut (great stuff) and i am on an ssri (zoloft) and it doesn't interfere at all. phenibut will increase gaba output (gaba mimetic) to cause rlaxation and better sleep.wellbutrin works on dopamine receptors i believe and should not react w/ phenibut. oh, and thanx for the heads up on the 5-htp.
    I agree, a GABA is a great addition to an SSRI.
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    Quote Originally Posted by DR.D
    I agree, a GABA is a great addition to an SSRI.
    Doc, could you expound on this a little bit? I would like to give phenibut or PA's Gabatropin a try (or maybe even kratom), but after my 5htp/tyrosine disaster I'm a little hesitant when it comes to neurotransmitters. I would love to find something that can help me relax and/or induce sleep - but the possibility of a negative interaction is something that I wish to avoid like the plague.

    Right now I take 150/day of wellbutrin and 20mg per day of lexapro. My knowledge of the actions and interactions of these compounds is poor, but it's my understanding that bupropion increases norepinephrine and, to a smaller extent, dopamine. In contrast, lexapro is an SSRI with fewer side effects than the older tri-cyclics.

    Can you shed any light on how phenibut would intereact with the other two?
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    Quote Originally Posted by utk1976
    Doc, could you expound on this a little bit? I would like to give phenibut or PA's Gabatropin a try (or maybe even kratom), but after my 5htp/tyrosine disaster I'm a little hesitant when it comes to neurotransmitters. I would love to find something that can help me relax and/or induce sleep - but the possibility of a negative interaction is something that I wish to avoid like the plague.

    Right now I take 150/day of wellbutrin and 20mg per day of lexapro. My knowledge of the actions and interactions of these compounds is poor, but it's my understanding that bupropion increases norepinephrine and, to a smaller extent, dopamine. In contrast, lexapro is an SSRI with fewer side effects than the older tri-cyclics.

    Can you shed any light on how phenibut would intereact with the other two?
    Phen is a GABA modulator, which will reduce the effectiveness of the Bu and Lex. Lex is an atypical SSRI, it activates rather than sedates. And while Bu has some relaxing effects uncharacteristic of most adrenergics, it's a strong cardioaccelerant to me, so it hypes me too. If your trying to relax, I recommend a combo more like Bu/zoloft or Bu/pamelor or Bu/Xanax or even just Serzone or Cylert solo. That's why I say the Phen may help to take the edge off. Lex is strong stuff, maybe you could even reduce the dose and still retain the benefits. I have taken every combo you can think of with this kind of stuff, so trust me that a benzo or the Phen would be great to add to the combo. Of course, Phen does little for me so I suggest a real benzo. Ativan is my fav. for it's versitility. Maybe you can talk to you doc. Tell me exactly what you want from this, and I'll tell you what to tell him to get what you need.
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    Hey doc D. what do you think about Tianeptine (stablon)? Im researching near and far, Ive got what seems to be stress induced anxiety/depression together with HPA burnout and this looks real promising...
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    Quote Originally Posted by DR.D
    Phen is a GABA modulator, which will reduce the effectiveness of the Bu and Lex. Lex is an atypical SSRI, it activates rather than sedates. And while Bu has some relaxing effects uncharacteristic of most adrenergics, it's a strong cardioaccelerant to me, so it hypes me too. If your trying to relax, I recommend a combo more like Bu/zoloft or Bu/pamelor or Bu/Xanax or even just Serzone or Cylert solo. That's why I say the Phen may help to take the edge off. Lex is strong stuff, maybe you could even reduce the dose and still retain the benefits. I have taken every combo you can think of with this kind of stuff, so trust me that a benzo or the Phen would be great to add to the combo. Of course, Phen does little for me so I suggest a real benzo. Ativan is my fav. for it's versitility. Maybe you can talk to you doc. Tell me exactly what you want from this, and I'll tell you what to tell him to get what you need.
    Thanks for the info Doc. I'll add the Phen in later this month. I am fairly happy with the Bu/lex combo, but at the same time, I'm always looking to teak things to get the most benefit with the fewest side effects. The Bu picks me up a little, so I take it first thing in the morning and save the Lexapro for late afternoon/evening. I was on Lexapro 20mg for a full year before I asked my doc about Wellbutrin. For me, Bu has been a miracle drug. It doesn't make me high (ala amphetamine) or give some wonderful buzz, but it does help reduce the intensity and frequency of depressive episodes - and that's great by me.

    I've been reading about people's experiences with Phen for quite a while now, so I'm thinking of adding it into the mix...perhaps around 8 or 9 pm. It's my understanding that Phen is used in Europe to treat some cases of insomnia, so it sounds like a good fit for me. Right now I sometimes take Amitryptilene (sp?) in the evening just for the sleep inducing effects, but it tends to leave me a little groggy. I have taken both Xanax and Valium before (experimentation) and agree that they would be a good addition. As you might have guessed, however, my Doctor (and those in this area generally) are hesitant to write a script for scheduled drugs.
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    Quote Originally Posted by judge-mental
    Hey doc D. what do you think about Tianeptine (stablon)? Im researching near and far, Ive got what seems to be stress induced anxiety/depression together with HPA burnout and this looks real promising...
    It's a ring expanded tricyclic SSRI. I've never used it, but it's suppose to be as effective as others in the range of 12.5-25mg/d without all the sexual sides. Doc's are eager to try new stuff on you and always have a closet full of samples, just tell him you want to try it for a month. It's probably neutral as for mental stimulation/sedation.
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    That is an extreme reaction,but it doesnt surprise me I guess once u think about it,serotonin(and the rest of the hormonal slew)are very extreme 'thangs'..doesnt take much to make an extreme shift of some sort,good or bad.When on any kind of script drug u have to know ALL the 'improper combos' bet they never told you not to mix with 5-htp and/or tyrosine did they?Good warning bro.
    Curious what you tried before you went on meds for depression?High dose fish oils,nute deficience tests/multis,anything natural or diet/mental wise before u decided to go script for it?
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    I had same thing was freezing and thinking of heatshock same time,while heart-rate was way up >200bpm.
    I was on Caffein,yohimbine and a fenoterol-asthma spray,which I uses 4times instead of 2x in a short time.

    Had fear of a heart5stroke,cause power was more than my heart could manage in my system,so I decided to eat something despite of the intense nausea and kept running on submximal levels.

    I wonder if that´s even possible with these drugs,maybe a panick-attack?
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    Quote Originally Posted by juggernaut333
    That is an extreme reaction,but it doesnt surprise me I guess once u think about it,serotonin(and the rest of the hormonal slew)are very extreme 'thangs'..doesnt take much to make an extreme shift of some sort,good or bad.When on any kind of script drug u have to know ALL the 'improper combos' bet they never told you not to mix with 5-htp and/or tyrosine did they?Good warning bro.
    Curious what you tried before you went on meds for depression?High dose fish oils,nute deficience tests/multis,anything natural or diet/mental wise before u decided to go script for it?
    I played around with 5htp and tyrosine before I went for the scripts.

    I also tried self-medicating with alcohol, which is a dead end. I love it when you run into a guy or girl who drinks every day but believes that they don't have a problem and that meds are for wusses.

    I tried cinching up my sack and toughing things out. If you really have depression, this doesn't work at all.

    Going to see my doc and getting a script was the best thing I've ever done. Unfortunately, my jackass doc started me out on lexapro at 10mg a day - way too little. If you or someone you know is having trouble, go see a doc.
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    Good posting!
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    I just ordered some Kanna from iamshaman.com and the dosage is 350 mg, but on most websites people are taking 50-100 mg. Do you think I should just split the cap in 1/2 or would the 350 be alright? Just wanting to make sure my brain doesn't get all messed up.
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    yeah i have found that after a serotonin imbalance from taking Sam-E 4 years ago, that now i can take it and its the single most effective thing i have found for my mild depression. Weird how your body adapts and can de-sensitize itself or enhance the effetiveness of certain products. For now Sam-E (200-400mg), Alcar (2-3g), Piracetam (2-4g) and lecithina nd Alpha GPC are doing me well for my depression. I am alot more focused. I also use theanine to get to sleep sometimes. Eph/Caffeine is great but not in excess only when ineed a kick in the ass at work.
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    Iv'e used Phenibut with both Wellbutrin and Zoloft(Not Zoloft and Welbutrin at the same time though) and had no problems. Although the Phen dosn't seem to be working as well as it use to, even at high doeses. I just bought some Kanna and Kratom, and plan on trying them this week. I'll let you know how it goes with the Zoloft.

    -Bri



    Quote Originally Posted by utk1976
    Doc, could you expound on this a little bit? I would like to give phenibut or PA's Gabatropin a try (or maybe even kratom), but after my 5htp/tyrosine disaster I'm a little hesitant when it comes to neurotransmitters. I would love to find something that can help me relax and/or induce sleep - but the possibility of a negative interaction is something that I wish to avoid like the plague.

    Right now I take 150/day of wellbutrin and 20mg per day of lexapro. My knowledge of the actions and interactions of these compounds is poor, but it's my understanding that bupropion increases norepinephrine and, to a smaller extent, dopamine. In contrast, lexapro is an SSRI with fewer side effects than the older tri-cyclics.

    Can you shed any light on how phenibut would intereact with the other two?
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    Hey doc, do you mean Lexapro causes more serotonin output rather than blocking the recpetors? If so, what about a combination of Prozac and Lexapro? I am currently taking Prozac 70mgs/Klonopin 1.5mgs/Buspar 40mgs a day with Adderall XR 20mgs on work days.
    Thanks.
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    Quote Originally Posted by thecrunk
    Hey doc, do you mean Lexapro causes more serotonin output rather than blocking the recpetors? If so, what about a combination of Prozac and Lexapro? I am currently taking Prozac 70mgs/Klonopin 1.5mgs/Buspar 40mgs a day with Adderall XR 20mgs on work days.
    Thanks.
    Right, it increases turnover by uptake inhibition, so more serotonin is released than normal. You really don't need it with the Prozac. BTW, that's a lot of Prozac! A lot of Buspar too which may be oppositional to the Prozac. You could sub Lex for Prozac but both could be used together at lower doses, like 10mg Lex w/ 20mg Pro.
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    Dr. D, what would be best for social anxiety? Some days I am fine as can be and other days suck. Prescription or OTC, something that I could use for a while as a crutch until I didn't need it anymore. Thanks.
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    Quote Originally Posted by DR.D
    Right, it increases turnover by uptake inhibition, so more serotonin is released than normal. You really don't need it with the Prozac. BTW, that's a lot of Prozac! A lot of Buspar too which may be oppositional to the Prozac. You could sub Lex for Prozac but both could be used together at lower doses, like 10mg Lex w/ 20mg Pro.
    I am not sure I am understanding 100% here...Lexapro actually stimulates the release of serotonin while Prozac inhibits the reuptake right? The Buspar is taken 20mgs twice a day. The reseason the Prozac is so high is because I have OCD.
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    Quote Originally Posted by darius
    Dr. D, what would be best for social anxiety? Some days I am fine as can be and other days suck. Prescription or OTC, something that I could use for a while as a crutch until I didn't need it anymore. Thanks.
    SSRI's work great. Prozac is good but it plays out after a few months. Luvox @ 25-50mg/d is the best IMO. Also, benzo's like lorazepam work well for this too in my experience. Don't get discouraged, there is something out there that will work for you, you just have to find it.
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    Quote Originally Posted by thecrunk
    I am not sure I am understanding 100% here...Lexapro actually stimulates the release of serotonin while Prozac inhibits the reuptake right? The Buspar is taken 20mgs twice a day. The reseason the Prozac is so high is because I have OCD.
    You may do better with a benzo than Buspar. Xanax or Ativan may be better for you from the sound of it. The Prozac works just like the Lex, only the Lex is the latest fad. I liked it, but it was not as effective as older drugs like Zoloft and Paxil. Still, either will be fine for OCD. You may want to give the Prozac a 2 wk break and then start again. It seems to be more effective if you cycle it. You can increase the Lex an extra 10mg in the meantime if you do that.
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    I was prescribed prozac years ago, and stopped taking it after two weeks thinking I don't need meds.

    here we are today and i am pretty sure I should get to the docs for some meds. How do you figure out which script to ask for? Obviously there are lots out there.

    Is there somewhere that tells you which ones are good for certain symptoms?
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    Quote Originally Posted by hamper19
    I was prescribed prozac years ago, and stopped taking it after two weeks thinking I don't need meds.

    here we are today and i am pretty sure I should get to the docs for some meds. How do you figure out which script to ask for? Obviously there are lots out there.

    Is there somewhere that tells you which ones are good for certain symptoms?
    What do you have in mind? I've mastered this game, if you need some help. What are you trying to obtain, or what are the main symptoms?
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    Hey Dr D, my wife is currently trying to cycle off of Effexor. It did help temporarily with depression but did next to nothing for the bad anxiety she has with it. Is there the potential for Serotonin Syndrom if I start her on Rhodiola rosacea before all of the Effexor is out of here system.

    Also, she's kinda sick today(started halving doses a day or two ago)..are there any reports of people having a hard time ending cycles of this drug?

    Thanks in advance.
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    Hey Bio!
    I'd start her on the RR now if it were me. I don't see a problem. Effexor has a relatively short t1/2(less than 12hrs). I have talked to people that have experienced withdrawl from phasing out Effexor, but it seems to be dose related. Was she using 75mg/d reg release? She might should have cut 25% every 3 or 4 days. The faster phase out may precipitate more sickness, but it should pass quickly. I wouldn't go back, but she needs to take a quarter dose, after she starts feeling better, before she totally quits. Linear dose reduction works well. If she stays in one phase longer than another, that's OK.
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    Thanks D!

    Yeah, I was afraid of that. It was a nurse practioner that has been supervising the dosage and I had to wonder why 2 days into cutting her dose in HALF she got sicker than hell..came home from work and went right to bed..slept for 14 hours. lol Poor gal, she's a trooper.

    I believe it was the 75 mg dose and she was given a batch of 37.5 mg to cycle down with for this week, then drop to every other day for a few days I think.

    I might just start her on a custom mix of 300mg Glycine and 100 mg Rhodiola to be taken 3X per day as soon as the raws get here. I'm going to try her on Inusitol for any anxiety attacks that crop up.

    Thanks again. I'll post any pos/neg results of this.
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    Not to hijack this thread, Dr. D. what is your opinion on Celexa, I take 20 mg a day and it has helped me out alot with general depression, still have anxiety at times, Doc gave me some xanax and that helps alot, thanks..........
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    Quote Originally Posted by bioman
    Thanks D!

    Yeah, I was afraid of that. It was a nurse practioner that has been supervising the dosage and I had to wonder why 2 days into cutting her dose in HALF she got sicker than hell..came home from work and went right to bed..slept for 14 hours. lol Poor gal, she's a trooper.

    I believe it was the 75 mg dose and she was given a batch of 37.5 mg to cycle down with for this week, then drop to every other day for a few days I think.

    I might just start her on a custom mix of 300mg Glycine and 100 mg Rhodiola to be taken 3X per day as soon as the raws get here. I'm going to try her on Inusitol for any anxiety attacks that crop up.

    Thanks again. I'll post any pos/neg results of this.
    Please do post results, Bio, and I hope she recovers quickly. Your counter measures sound like a good plan.
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    Quote Originally Posted by RipdnTxs
    Not to hijack this thread, Dr. D. what is your opinion on Celexa, I take 20 mg a day and it has helped me out alot with general depression, still have anxiety at times, Doc gave me some xanax and that helps alot, thanks..........
    Man, I liked the stuff a lot! It was the most "activating" SSRI I've ever tried. No sedation at all and good disposition and potency. I could not take it though. I would start to get a sore throat after about a week. Kind of like M1T, it could have been my favorite but I couldn't stand the sides! If it works for you without causing the immunity issues, I strongly recommend it. It has less benefit with anxiety as some of the other, more sedating SSRI's do, as you found out already! The Xanax is good for stress, I suggest you take it early though (no later than 6pm) or just use it situationally. It's got a long halflife that always kicked my butt the next day if I used it too late. Ativan is my benzo of choice when I require one.
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    Basically I just have episodes of being really depressed for no reason, or I could wake up one morning and think life is great for no reason. More often it is I feel like ****, and basically would rather stay in bed and be anti-social all day long.

    Also my my races pretty much always, and I have weird thoughts...i mean i don't like hallucinate or antyhing, but just think about weird ****. I find it very difficult to fall asleep at night, b/c I can't get my brain to slow down for me to fall asleep.

    My main concern is that I really don't want to wake up and feel like **** anymore..I took off the past 2 mondays from work simply b/c I had no desire to leave my bedroom.

    Is there something OTC I can use?
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    HAMPER-

    Sounds like the sort of depression I have.

    I have had GREAT success with addressing my depression with supplements. Before anyone flames me, all I can say is that what I'm taking is indeed well researched and does work for a growing number of people. I am not advocating that you NOT take prescriptions, but if this works, it's just better for you overall and it's dirt cheap to boot. All of these vitamins/minerals have specific roles in brain chemistry. A deficency in any of them can result in depression or other psychological disturbances.

    Folic acid... take 400 mcg/day
    chromium...200-500 mgs/day
    vit B6 100 mg/day
    vit B12, preferably sublingual tabs or shots...1000mcg/day or every other day with injectibles.
    Selenium 100 mg/day

    This turned my deep depression around 180 degrees and it has yet to come back save for a few minor, short bouts. If it does not help..well at least you're taking your vitamins and you can then get a 'script while still using these.

    ALCAR with these is like icing on the cake.
  

  
 

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