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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by honeybee on May 30, 2006, at 12:16:11
So, my doctor and I are having a discussion about my going back on medicines (after too long trying to do it without). One of my beefs with Effexor was that I had repeated, continual, night sweats, with them, oftentimes soaking through my pjs and the sheets around me. I'm a tiny human, and it was quite a remarkable event for me to produce so much sweat, so often.
Now, I talked to my pdoc about this and he said, "nothing to worry about, just the body dealing with the serotonin circulating in the body," as though it were a throw away issue. But I wonder what the long term effects of this kind of increased serotonin in the body might be (if it's symptomatic). That's when I remembered Phen-fen and that early reports were that the valve problems associated with it were thought to be associated with the higher levels of serotonin in the body. Later examination of the data suggested that the incidence of heart valve problems was not greater than the rest of the population. But now, of course, I'm all worried about the potential effects of serotonin on the heart.
Does anyone have any thoughts about this?
Thanks,
honeybee
Posted by linkadge on May 30, 2006, at 15:52:15
In reply to Serotonin and Heart Valve Disease, posted by honeybee on May 30, 2006, at 12:16:11
"Later examination of the data suggested that the incidence of heart valve problems was not greater than the rest of the population. But now, of course, I'm all worried about the potential effects of serotonin on the heart."
Thats a good way to do it. Take the drug off the market cause you know it causes damage, and then deny the whole thing ever existed.
There have been several people who have come to similar conclusions, that taking SSRI's may affect cardiac function.
I recall the recent study showing cardiac patients who took antidepressants were more likely to die sooner than those who didn't.
Linkadge
Posted by honeybee on May 31, 2006, at 11:05:54
In reply to Re: Serotonin and Heart Valve Disease, posted by linkadge on May 30, 2006, at 15:52:15
I saw that, too. What was odd was that the study's leader said that it was a "surprise." I'm not quite sure, considering the possibility of blood levels of serotonin going up, why it was a surprise.
I recall posts explaining that 5-HTP is often prescribed, in Europe, with a drug called Carbidopa, that prevents oversaturation of the body with serotonin. Why isn't that done in the states, is my question. And why don't psychiatrists monitor 5-HIAA levels in the urine in patients, then, as well.
(And why did the study find that all classes of anti-depressants, not just the SSRIs, have this same increase of mortality...?)
questions, questions.
Posted by honeybee on May 31, 2006, at 11:34:44
In reply to Re: Serotonin and Heart Valve Disease, posted by honeybee on May 31, 2006, at 11:05:54
I like "Nevertheless, vigilance for the unexpected is the duty of prescribers."
http://www.psychiatrist.com/pcc/brainstorm/br5812.htm
Does Too Much Serotonin Break Your Heart?
Both drugs and diseases can increase the release of circulating serotonin. For example, some malignant carcinoid tumors secrete serotonin and can cause waves of serotonin release into the systemic circulation, which in turn can make the patient flush.6 Over time, these tumors are associated with cardiac valvular damage, especially on the right side of the heart, which presumably gets bombed with the serotonin before the serotonin moves to the lungs where metabolic enzymes chew it up.6
Recent reports indicate that similar cardiac valvular pathology is associated with fenfluramine administration.7 It is not known whether this is a chance association or whether fenfluramine causes this damage. Whether release of serotonin onto these valves by fenfluramine is the mechanism of this damage is a possibility, but it is unproven.
Fenfluramine is associated with other toxicities, both cardiovascular and CNS; that is, there is an increased incidence of primary pulmonary hypertension not only in fenfluramine users, but also in those with obesity, i.e., those most likely to take fenfluramine in the first place.8 Long-lasting depletion of serotonin from the brain due to destruction of serotonergic axon terminals is also observed in rats exposed to fenfluramine brain concentrations about 10 times higher than those in man.9 Although there have been no reports of long-lasting or permanent serotonin depletion in brains of human fenfluramine users, or any proven changes in behavior, this possibility has always been a nagging concern for the long-term safety of fenfluramine use.
Since fenfluramine also causes long-term depletion of serotonin in circulating platelets, as do the SSRIs, there is some pharmacologic overlap between these two classes of drugs. Although fenfluramine and its active metabolite are predominantly serotonin releasers, they are also reuptake inhibitors like SSRIs, in addition to being inhibitors of serotonin synthesis and perhaps directly active at some serotonin receptor subtypes.2-4,9 So far, there is no rationale or empiric observations to create any concern that the SSRIs cause cardiac problems similar to those associated with fenfluramine. Nevertheless, vigilance for the unexpected is the duty of prescribers.
In summary, there is good news and there is bad news about serotonin. The right amount in the right places is a powerful therapeutic tonic. But, too much in the wrong places can be hazardous to your health. u
Posted by linkadge on May 31, 2006, at 17:19:15
In reply to Re: Serotonin and Heart Valve Disease, posted by honeybee on May 31, 2006, at 11:05:54
It would have been intersting to see which patients were on what. I think that SSRI's are more commonly prescribed in cardiac patients.
I think the study excluded the possiblility of it just being the depression which caused the increased mortalitiy. Ie. I think the study uncluded just as many depressed cardiac patients not taking medications.
You're right. For some reason, Europe has different practices when it comes to the use of 5-htp. I don't know whats up.
We just havn't had the drugs around long enough to know their full effects.
Linkadge
Posted by linkadge on June 2, 2006, at 19:02:01
In reply to Re: Serotonin and Heart Valve Disease, posted by linkadge on May 31, 2006, at 17:19:15
We just assume they're safe, but we don't really know for sure.
There aren't many other substances which inhibit the serotonin uptake system so potently.
We can't fully asess the TCA's effects in this regard since it would be hard to separate serotonergically mediated cardiac events from those which could be attributed to their effects on cardiac conduction.
Linkadge
This is the end of the thread.
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