Posted by Cindy W on March 15, 2000, at 13:52:26
In reply to Re: horrible side effect from serzone, posted by Paul Jay on March 15, 2000, at 13:05:12
> > I was reading some guys post somewhere else about how
> > he became serverly mentally impaired after trying serzone.
> > Im am trying to figure out what happened so I can help him get better.
>
> I found a possible explaination in the Psychopharmacology Tips section of this site -- Serotonin Syndrome. It isn't quite a clear case, but the combination of symptoms is within the range of posibility for this rather variable disorder, and I believe it sometimes goes on and on as in this case. There is a posibility of treatment if it is.
>
> Here are some relevant items:
> (nefazodone=serzone, fluoxetine=prozac - an SSRI, nardil - a MAOI, paxil - an SSRI)
>
> Subject: SSRIs + nefazodone
>
> I had a patient who I switched from fluoxetine to nefazodone on what I thought to be a slow double taper, however, the patient experienced either a serotonin syndrome or possibly effects from a metabolite whose metabolism was inhibited. The patient eventually cleared, but only after several rough days with ataxia, slurred speech, a subjective feeling of confusion, GI pain and bloating.
> ...I agree that overlapping the SRI and nefazodone can be useful, but recall that serotonin syndrome has been documented to occur with the coadministration of trazodone and nefazodone with SSRIs. I would use low starting doses of nefazodone and go up very slowly.
>
>
> From: Biological Therapies in Psychiatry
>
> When a patient is switched to or from a monoamine oxidase inhibitor (MAOI) antidepressant, at least 2 weeks must elapse to avoid an interaction that can precipitate the potentially lethal serotonin syndrome
>
>
> Subject: Word-finding difficulties from SSRIs
>
> Word-finding difficulties in patients taking SSRIs is not uncommon, and has been described as a serotonin-overload effect.
>
>
> Subject: Serotonin syndrome
>
> >I'd be very grateful if you could explain what to have patients look for to identify serotonin syndrome.
> I usually tell them to report to me any confusion or unusual muscle jerks.
>
>
> Subject: Serotonin syndrome
>
> Serotonin syndrome is a potentially life-threatening complication of psychopharmacologic drug therapy. The syndrome is produced most often by the concurrent use of two or more drugs that increase brainstem serotonin activity and is often unrecognized because of the varied and nonspecific nature of its symptomatology. Serotonin syndrome is characterized by alterations in cognition, behavior, autonomic nerous system function and neuromuscular activity. Patients with serotonin syndrome usually respond to discontinuation of drug therapy and supportive care alone, but they may require treatment with a specific antiserotonergic drug such as cyproheptadine, methysergide, and/or propranolol.
> ...Serotonin syndrome usually develops shortly after either an increase in the dose of one or the addition of another serotonergic medication. In half of the published cases, symptoms began within two hours of a change in medication. In only 25% of the cases was the onset of symptoms more than 24 hours after a change.
> ...The diagnosis of serotonin syndrome is based entirely on a strong clinical suspicion and the exclusion of other medical and psychiatric conditions. The typical patient with serotonin syndrome demonstrates altered behavior and cognitive ability, autonomic nervous system dysfunction, and neuromuscular abnormalities. Some patients report recurrent mild symptoms days to weeks before symptoms become more severe. In a few cases, patients rapidly progress to multiple organ failure and death.
> ...No specific tests are available for the diagnosis of serotonin syndrome. Elevated serotonergic drug levels are not required to produce serotonin syndrome, and in over 90 percent of cases in which drug levels were measured, levels were within accepted therapeutic limits.
> ...Consider use of antiserotonergic medications...Cyproheptadine is consistently the most effective agent in humans.
Suggest you see a pdoc immediately, who knows about psych drugs as well as medical problems, to find out if your fluid retention and other problems are due to Serzone, serotonin syndrome, or something else. Hope things get better for you!
poster:Cindy W
thread:27082
URL: http://www.dr-bob.org/babble/20000312/msgs/27121.html