How to avoid serotonin syndrome?

So been taking 75 mg of zoloft for about 3 months. How long do I have to stay off Zoloft before I do hard drugs and not get serotonin syndrome? Just miss a few days before I use or does it need to be out of your system for a few weeks? Thanks!!

Sertraline has a really long half-life - Think it's between 60 and 100 hours.

That is the time it takes for half of your dose to be gone from your system, but remember that the amount in your system has been increasing since you started taking it - It's not going to be 75mg from your last dose.

I'd wait a good few months.

That being siad; I wouldn't stop your medication just to get high (If that's your plan)

~~~> OD
o

This still all depends on what you plan on taking drug wise ? Not everything has a risk for serotonin syndrome.

wait a minimum of 2 weeks to take any of the following to prevent risk of serotonin syndrome:

ANY amphetamine (meth, ecstacy, ritalin, vyvanse, adderall, etc)
cocaine
LSD (and many other RC-type hallucinogens)
Some types of narcotic painkillers (tramadol, fentanyl)
drugs used to treat migraines (imitrex)
some OTC drugs or supplements like (st. johns wort, tryptophan, dextromethorpan, ginseng)
Lithium

It depends entirely on what you're taking.

If it's serotonergic, is it still effective in the presence of SSRIs? If it's not, does the drug have known interactions with SSRIs? If not, it might be safe to take immediately.

Anyway, the point is that without any specific information, the only sensible advice is to take a while (possibly several weeks) to ensure substantial elimination of the sertraline has occurred.

The below is just my experience but please dont accept it as fact or take any risks without your own proper research...

Yes you didn't you mention what you would take with the Zoloft to cause the Serotonin Syndrome because thats what makes all the difference. While its best to be safe its not fully accurate to assume that any popular drugs taken with Zoloft are likely to cause SS.

My very bipolar brother on Zoloft, Efexor and other shit etc as well as myself on Paxil did the popular stuff like meth, coke, alc, acid, shrooms, mdma and opiates safely on these without issues constantly for a very long time.

The SS risks are more real with the relatively rarer combinations that you need to educate yourself about individually. For example SSRI's and DXM have a high risk but (for reasons im not 100% clear about yet) SSRI's and MDMA might be far safer.

SS is a worrisome idea but far less common or easy to cause then many people think it is. Always be safe though and thats prob the reason for this post so respect for asking.

the washout period for SSRIs is 2-3 weeks, generally.

taking SSRIs chronically will generally mute the effects of most psychedelic drugs rather than cause serotonin syndrome. it's a different story if you take SSRIs after taking a huge dose of amphetamines...

either way, combining SSRIs and psychedelics or serotonergic stimulants (cocaine, mephedrone, etc) is not recommended because you run the risk of disappointing effects.

Dang thanks for all the info. So last night I took about 400mg of dxm and I feel fine. If naughtynicknails is correct about the half life of sertraline, Ill miss a few doses before my 'planned use' and hopefully I will be safer. Other then that I try and be careful and watch how much I take. So would it be safe to say drugs like amphetamines that cause a supper strong euphoria would be a bit more dangerous vs a drug that I trip on that doesn't cause euphoria? (I bet not but just wondering)

^ Thats prob not a safe assumption. I could and did take very high doses of MDMA and meth on SSRI's and it was fine but doing that with other seemingly safer non hard and popular drugs like DXM and others could be very bad and far more dangerous. Its not an obvious intuitive calculation when it comes to SS risk combinations. You have to research and know every specific substance that's risky with it before you know for sure.

a good read on the subject...
serotonin syndrome: how to avoid, identify & treat dangerous drug interactions

What makes this so difficult answer is that we are only just beginning in our understanding of the serotonin system and complications like serotonin syndrome.
Most recreational drugs effects on serotonin arent just as random agonists of serotonin. their effects can be alot more specific or unexpected then that, so introduction of a reuptake inhibitor isnt always as dangerous as you would expect.
Having said that SS though rare and though unlikely, is a serious and difficult to treat condition (though some anecdotal evidence exsists that certain antidepressants could be used to treat SS) and should be avoided wherever theres a risk.
Because not all interactions are known i would leave at least 2 weeks since last ssri dose. If your unsure of an interaction thenplay it safe and dont take it.
Lastly, dont believe all anecdotal evidence: whats safe for one person, one time. Might not be safe for another person or even for the same person another time.

What makes this so difficult answer is that we are only just beginning in our understanding of the serotonin system and complications like serotonin syndrome.

Click to expand...

Serotonin has been known since 1935, and its presence and the activity of several receptors in the nervous system were discovered in the late 1950s. It has been known since drugs were introduced that excessive amounts of anything can cause unpleasant symptoms - and serotonin-effecting drugs aren't any different, usually.

Lots of people see a term like 'serotonin syndrome' and assume that it must be complex and deep rooted. It's really not all that hard to understand once you get to what causes it, though.

Serotonin syndrome happens only when your body is forced into releasing too much serotonin* that it cannot break down or reuptake into neurons. The result is your body is totally overwhelmed and cannot use serotonin to effectively regulate the things it normally does - perception, muscle and vascular tone, and body temperature, among other things.

Serotonin syndrome is always considered to be incredibly unpleasant. It is very important to differentiate between bad experiences on serotonergic hallucinogens, or overdoses of stimulants like MDMA, and true serotonin syndrome. Many drugs that release serotonin or activate serotonin receptors can cause some of these symptoms, especially in overdose, but serotonin syndrome is in general more intense and requires medical attention.

This paper says you must have taken two drugs that elevate serotonin concentrations (releasers, MAOIs, reuptake inhibitors) and have one of the following symptoms (Hunter criteria) to be considered to have serotonin syndrome.
* spontaneous clonus - Twitching without a cause. (clonus = rapid, uncontrolled twitching of muscle groups)
* inducible clonus with agitation or diaphoresis - Twitching that is aggravated by stimulation, agitation, and uncontrollable sweating.
* ocular clonus with agitation or diaphoresis - Uncontrolled twitching of the eyes, and sweating. (This is not nystagmus, the fluttering of the eyes you get when on MDMA. This means your eyes cannot effectively track objects)
* tremor and hyperreflexia - Continuous trembling and shaking, and easily excited reflexes
* hypertonia, temperature above 100.4 degrees F (38 degrees C), and ocular or inducible clonus - Rigid muscles, high fever, and twitching of the eyes, or twitching of the body brought on by stimuli.

The famous case of serotonin syndrome that killled Libby Zion was pethidine (Demerol), a painkiller that releases serotonin, and phenelzine (Nardil), an irreversible MAOI antidepressant. The doctors at the hospital she visited were overworked, and were working on the false assumption Ms. Zion wasn't on medication at all.

Serotonin syndrome is seen with e.g. combination of MDMA and DXM, cocaine and tramadol, or MDMA and 5-MeO-DiPT. Generally, SSRIs will simply block the ability of drugs like MDMA to release serotonin. Either way it is a waste of your time taking MDxx and SSRI drugs!

5-HTP and/or tryptophan are not converted to centrally active serotonin and do not pose a risk for serotonin syndrome. Nor are direct serotonin agonists like psilocin, LSD, the NBOME series generally responsible for SS. All negative effects are not serotonin syndrome.

* If you have heard of something called a "hypertensive crisis", that's very similar. It's caused when you have too much norepinephrine (or adrenaline) released at once, with nowhere to go. This, again, usually happens with MAOIs or antidepressants, combined with stimulants. It can even happen at the same time as serotonin syndrome, making the problem worse.