Methamphetamine SSRI SS Risks

[blight12]

I am hoping for a quick confirmation from an advanced perspective.

My reseach indicated that SS is not a risk when combining meth and SSRI's. It seems to be the accepted opinion.

A while back I posted some issues i had experienced with meth, always day 2 or 3 into a binge I would develop and extreme and clearly different state of physical distress that was obviously different from the extreme symptoms that might occur and be normal.

It was difficult to explain since the descriptions of the issues are all similar to the normal issues and unpleasant symptoms, however my experience was noteworthy to me due to the extreme difference in the extremity and the way these normal sounding symptoms would be experienced.

My question above is motivated by recently randomly taking a good like at SS symptoms, never had done so previously. I was surprised to see that they seemed to match up exactly to my issues (in terms of milder SS scenario) and even saw mention of the extremity difference allowing for identification over other issues which might sound the same.

So I must therefore confirm 100% if this is possible or not. Thanks.

 

[pizzystrizzy]

It may not be very common, but I'm sure it is possible. In some cases, SSRIs by themselves can cause serotonin syndrome.

Here is some evidence -- Schep, L. J., Slaughter, R. J., & Beasley, D. M. G. (2010). The clinical toxicology of metamfetamine. Clinical Toxicology, 48(7), 675–694. doi:10.3109/15563650.2010.516752

Serotonin toxicity, although not reported specifically
for metamfetamine, has been reported with dexamfetamine
in combination with venlafaxine and citalopram.196 As metamfetamine
both increases presynaptic release and prevents reuptake
of serotonin,197 there is a theoretical risk of serotonin toxicity
following its use in association with other serotonergic agents.

 

[TCMVegas]

One thing to consider is that the presence of SSRIs affects the uptake of methampheatmine through SERT into serotonergic axon terminals. IIRC, SSRIs block approximately 90% of these reuptake transporters, though that figure certainly varies a lot by dose. So the pessimistic take on the combination is that you're mixing two drugs which increase synaptic serotonin, so there could be a dangerous interaction. The optimistic view is that the SSRI blocks SOME of the efficacy of methamphetamine on increasing serotonin release.

It's hard to know based upon the information provided if you may have experienced serotonin syndrome. I have stayed awake for days on low-to-moderate doses of ampheatmine (20XR's every 6-8ish hours), while also on 10mg of fluoxetine daily. This is probably well under your meth dosing, yet I certainly experienced subjectively-strong dissociation, visual trails, paranoid delusions, lack of working memory, etc.

The meth is almost certainly doing you more harm (even just from a psychological standpoint) than the SSRI is doing you good. Although anecdotes make the combination seem possibly-sane, there is real risk involved as AFAIK it's outside of the realm of well-researched combinations (haven't checked pubmed). Doctors don't really prescribe serotonin releasing agents (excepting meth of course, but that's really old school and rare) so they probably haven't been researched with SSRIs (though I want to emphasize, I could be wrong, haven't spend time digging in to it). Hope this helps!

 

[blight12]

Thanks for the feedback. Its difficult to explain the experience and how clearly its something more extreme.

I can say with certainty that i am familiar with the extreme meth side effects. When started I begin with large doses due to ignorance on the potency difference between street coke and decently pure crystal.

I had all the typical meth side effects, never went as far as psychosis, but close enough. None of that is similar to the experiences i refer to. Thing is i used to get so high that I would forget everything, reality, including my SSRI meds. Do 500mg of crystal a day, a gram of good crystal over 2 days. It was great, far less issues then now with responsible usage.

Later on I reduced dosages and implemented proper care like supplementation, hydration, my daily meds etc. And from then on non insane responsible dosages and health considerations I suffer these wierd situations when I know immediately something other then a dopamine stim like meth or related SNS activity has begun to make itself known.

This experience was also a purely physical experience for me, non of the mental wiedness like with meth psychosis. This was like a really scary physical experience of unhleath or danger or warning sings and what made it more obviopus was that it clearly had no relation to SNS activity at all which is always the issue with normal stims and can easily be identified.

I guess its like how you will know if you took meth or mdma blindfolded you will also know when the shit hits the fan, what the likely culprit or class of drug is that is causing it.

But still i cant know for sure but it seems that its possible. I get the blocking effect of SSRI;s. I tried taking stupid doses of MDMA on them and never got shit from it beyond a stim high so thats what i was expecting with meth as well, however we know SRI drugs can be different like DXM and SSRI's are dangerous where MDMA and SSRI's are not. So maybe meth could become an issue once enough of the drug has built up by the 2nd day, when it usually manifests for me? How knows.

 

[pofacedhoe]

with mdma and ssri's its because mdma is very receptor specific, while dxm is not as far as i know with regards to serotonin

 

[fairnymph]

Which SSRI?

 

[ebola?]

with mdma and ssri's its because mdma is very receptor specific, while dxm is not as far as i know with regards to serotonin

I wasn't aware that there were known sub-variants of the serotonin transporter (contra what we see with the many different types of serotonin receptors). I know that genetic variation can affect transporter structure and function, but I thought that there was only one type of SERT protein found in any given individual. Can you please elaborate?

I honestly couldn't tell you why DXM interacts with SRAs differently from other SSRIs. It could be that DXM has a low affinity for the transporter (it's not exactly the most potent compound in terms of any of its activities), allowing MDMA and the like to bind.

ebola

 

[pofacedhoe]

I wasn't aware that there were known sub-variants of the serotonin transporter (contra what we see with the many different types of serotonin receptors). I know that genetic variation can affect transporter structure and function, but I thought that there was only one type of SERT protein found in any given individual. Can you please elaborate?

I honestly couldn't tell you why DXM interacts with SRAs differently from other SSRIs. It could be that DXM has a low affinity for the transporter (it's not exactly the most potent compound in terms of any of its activities), allowing MDMA and the like to bind.

ebola

what i meant was mdma is quite specific for one or two serotonin receptors similar to ssri's which are kind of receptor specific whereas dxm was a very non selective SRI. i am now confused- does what im saying make sense?

in my mind therefore (if what i'm saying makes sense) then dxm and mdma would have an additive effect whereas mdma and ssri's would not be additive

also http://www.bluelight.ru/vb/threads/...-a-poor-affinity-for-SERT?highlight=vmat+mdma

 

[arctica]

What were the symptoms exactly? I had a mild case of SS from 200mg Zoloft/450mg Wellbutrin/200mg Seroquel + other stuff + 50mg Imitrex PRN. I had a low grade fever (100ish) for maybe 5 days, my pupils were blown, anxiety, tremor, migraine, nausea/vomiting/GI upset, hyperreflexia. Also, I felt like total crap, like I had the flu.

Has anyone heard of Cyproheptadine (Periactin) used to treat SS? It apparently blocks serotonin production. I was already in the hospital, so when I was diagnosed the docs just took me off everything cold turkey and kept an eye on me. My symptoms resolved right away, and were instantly replaced by WD symptoms, obviously, so I didn't feel a lot better. But different.

A friend of mine also had a much worse case of SS (in the ICU for 3 days) after a suicide attempt/OD on psych drugs. I don't think they did anything for her either, besides gastric lavage/supportive care.

 

[ebola?]

what i meant was mdma is quite specific for one or two serotonin receptors.

Well, let's see. MDMA has significant affinity for 5ht2b, whereas its activity at other serotonin receptors seems negligible (per http://www.plosone.org/article/info:doi/10.1371/journal.pone.0009019#s3, though I'm not sure if the results are that valid for low-potency compounds).

similar to ssri's which are kind of receptor specific whereas dxm was a very non selective SRI.

As far as I know, there aren't any SSRIs in clinical use that have significant affinity for any serotonin receptors, nor does DXM (though I'm not sure if people have conducted studies looking for such activity). When people talk about selectivity of SSRIs, they're talking about selectivity for SERT over other monoamine transporters, something that shouldn't figure in heavily to the incidence of serotonin syndrome.

http://www.bluelight.ru/vb/threads/...-a-poor-affinity-for-SERT?highlight=vmat+mdma

Ah. I would pay close attention to the methodological critiques at the end of the thread. If MDMA doesn't have significant affinity for SERT, then how do we explain how SSRIs attenuate its effects?

ebola