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View Full Version : Did serotonin syndrome permanently ruin my brain? - update



*=Regulator=*
26-03-2002, 05:26
About 12 months ago due to certain situational difficulties (mainly my father having treatment for cancer) my doctor put me on Aurorix (moclobomide), which is an MAO-I anti-depressant.
Being then uneducated about the effects of combing MDMA with an MAO-I, you guessed it, I took the two together.
I had a severe hytertensive crisis as a result and ended up in hospital.
My syptoms as a result of Serotonin Sydrome were:
Tachycardia, Hypertension, Convulsions, Hallucinations.
That was about 8-9 months ago.
Directly after I began suffering from panic attacks, anxiety and suicidal depression. I was forced to leave university and move back home to live with my parents. Immediately after this I switched my medication to Aropax (Paxil - Paroxitine) an SSRI.
My depression and anxiety plataued out a bit after this and I began to piece things back together to the point where I was working full time in a good job and living a relatively happy existence (besides a terrible, abnormal lack of control after heavy drinking). I still never thought I was as happy as I had been before that trip to hospital though.
Over christmas I went away to stay with a friend and during this period I got sick and couldn't hold food down, sleep or drink. As a result of this I had to go to hospital and get a saline drip and cut my trip off early. I'm not sure if the 'sickness' was just severe anxiety as during this time I was very anxious and depressed.
After this setback I soon got better and went away again and was fine (although I drank a lot). I then decided that I was doing well enough to stop taking the Aropax and with my doctors monitoring, I began slowly reducing the dose untill I was down to half (not sure what Mg) every other day. Besides the horrible withdrawal effects I was doing OK.
Then a couple of weeks ago I found out my dad had to have more treatment for his cancer and I became very anxious and depressed again. I had one or two days where I was terribly depressed and near suicide. My doctor decided that I shouldn't have stopped taking Aropax and decided to change my medication again to Mitrazipine (it's an anti-depressant - a newer one - not sure of its generic name).
Since the changeover I have had several very bad days within close proximity of eachother where I have found myself thinking that I will never get better and had tearful episodes and had to sleep in my parents bed (embarassing for a 21 year old). This brings me up to present day
That's the background info out of the way (sorry for the length).
Anyway, I am concerned that when I went to hospital all those months ago after the e/maoi combo, I ruined my seratonin receptors/producers and that I have fucked up my head forever. I am seriously thinking that I will never get back to normal and that there is nothing I can do to fix it (I don't smoke, or do drugs and I excercise everyday). I drink on the weekends and increasingly more in the week as it is the only thing that takes away the pain in my mind. I don't know anything about neurochemistry so I'm hoping someone who knows a bit more can help out. Have I ruined my brain forever?
[ 09 April 2002: Message edited by: *=Regulator=* ]

ahkuhstic
26-03-2002, 07:16
all i can add, is that back when i started doing E two years ago, I did it MASSIVELY.. I rolled 3 nites in a row.. then like every month.. then got into it everyother week taking 3.. I stopped taking it last june and I havent ever been right since.
I have had the worst time just living day to day life, and loving myself. I went thru a 3month peroid where I was depressed to the point of saying I jsut donit want to be on this earth b/c I wasnt good enough for everyone else. Doing glass didnt help this either. After a week or so doing glass, when I was off it, I would totaly hate myself, look in the mirrow and just be disgusted.
I have gotten out of the DEEP rutt I was in by starting to work out again, I grew my hair out and got my dark skin back (stayin inside for 2yrs made me pale :|).. Anyway, point it, I would go out with friends and make their nite shitty b/c I would complain about how 'not good enough' I was etc.. It is even worse whenI smoke weed now.. and if I smoke nuggs.. HLYSHIX make sure a gun is not close..
All I can say is bro, stick it out, make yourself happy by doing the little things that will put you in a better light with yourself.
ill pray for you man
gregg

*=Regulator=*
26-03-2002, 07:34
Thanks for your support Akhusyic. Mods, PLEASE pass on any info you have about permanent brain damage from a single reaction like this or otherwise - links if appropriate - My Doc can't help, please I'm desperate!

fairnymph
26-03-2002, 08:55
Neither I nor anyone could really tell whether you have damage/ how much damage you have suffered with absolute certainty. I do not think it is unlikely that severe serotonin syndrome, such as you experienced, could cause permanent damage to serotonin neurons and possibly other neurons as well. However, it is also possible that you suffered only temporary damage that has either repaired itself by now or will over time.
I think you mental health will most likely improve over time if you stay on the antidepressants, avoid drugs (including alcohol), and continue exercising. I also highly recommend seeking out therapy/counseling, which is very effective in the treatment of depression. It sounds like you have been through alot lately and by coming to terms with past and current problems you will be able to live your life much more happily. Personally, I think there is a *lot* of hope for you, especially if you actively work towards fighting your depression. From what you have told me, I doubt that any damage you may have suffered from the serotonin syndrome experience would totally ruin your life. It will just take time and effort for you to treat your depression as effectively as possible.
Below are some studies and bits of info that describe some of the damage that serotonin syndrome can cause. Again, this does not mean that you have or will have these problems.
[quote]SS may cause cerebellar degeneration, probably due to sustained hyperpyrexia [high fever/body temperature].
Read the abstract here (http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11296369&dopt=Abstract).
From: Fujino Y, Tsuboi Y, Shimoji E, Takahashi M, Yamada T. [Progressive cerebellar atrophy following acute antidepressant intoxication]
Rinsho Shinkeigaku. 2000 Oct;40(10):1033-7.
The damage could look something like the damage caused by fenfluramine, see here (http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10330689&dopt=Abstract)
There could be cardiovascular damage, though at your age this should be less of a concern:
[quote]Drug-induced elevation of serotonin concentrations may be a significant risk factor for patients with atherosclerotic cardiovascular disease (ASCVD).
Abstract here. (http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10855970&dopt=Abstract)
Goeringer KE, Raymon L, Christian GD, Logan BK. Postmortem forensic toxicology of selective serotonin reuptake inhibitors: a review of pharmacology and report of 168 cases. J Forensic Sci. 2000 May;45(3):633-48. Review.
A rather complex explanation of MDMA/ Serotonin Syndrome induced damage:
[quote]Substituted amphetamines selectively tax energy metabolism in 5-HT presynapses through their ability to exchange with 5-HT and to dissipate transmembrane ion gradients. The active carrier systems in the vesicular and presynaptic membrane operate at a permanently activated state. The resulting energy deficit can no longer adequately restored by the 5-HT presynapses when their availability of substrates for ATP production is additionally reduced by the hyperthermic and other energy consuming reactions which are elicited by the systemic administration of substituted amphetamines. The exhaustion of energy in 5-HT nerve terminals compromised all energy-requiring endogenous mechanisms involved in the regulation of transmembrane-ion exchange, internal Ca(++)-homeostasis, prevention of oxidative stress, detoxification, and repair. Above a critical threshold the failure of these self-protective mechanisms will lead to the degeneration of the 5-HT axon terminals. Based on the role of 5-HT as a global modulatory transmitter-system involved in the stabilization and integration of impulse flow between distributed multifocal neuronal networks, the partial loss of 5-HT presynapses must be expected to impair the ability of these networks to maintain the integrity of signal flow pattern, and increase the likelihood of switching to unstable information processing. Behavioral responding may therefore become more dominated by activities generated in individual networks, and hitherto "buffered" personality traits and predisposition may become manifested as defined psychiatric syndromes in certain predisposed subjects.
Substituted amphetamines selectively tax energy metabolism in 5-HT presynapses through their ability to exchange with 5-HT and to dissipate transmembrane ion gradients. The active carrier systems in the vesicular and presynaptic membrane operate at a permanently activated state. The resulting energy deficit can no longer adequately restored by the 5-HT presynapses when their availability of substrates for ATP production is additionally reduced by the hyperthermic and other energy consuming reactions which are elicited by the systemic administration of substituted amphetamines. The exhaustion of energy in 5-HT nerve terminals compromised all energy-requiring endogenous mechanisms involved in the regulation of transmembrane-ion exchange, internal Ca(++)-homeostasis, prevention of oxidative stress, detoxification, and repair. Above a critical threshold the failure of these self-protective mechanisms will lead to the degeneration of the 5-HT axon terminals. Based on the role of 5-HT as a global modulatory transmitter-system involved in the stabilization and integration of impulse flow between distributed multifocal neuronal networks, the partial loss of 5-HT presynapses must be expected to impair the ability of these networks to maintain the integrity of signal flow pattern, and increase the likelihood of switching to unstable information processing. Behavioral responding may therefore become more dominated by activities generated in individual networks, and hitherto "buffered" personality traits and predisposition may become manifested as defined psychiatric syndromes in certain predisposed subjects.
Huether G, Zhou D, Ruther E. Causes and consequences of the loss of serotonergic presynapses elicited by the consumption of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") and its congeners.
J Neural Transm. 1997;104(8-9):771-94
[ 26 March 2002: Message edited by: fairnymph ]

theBug
26-03-2002, 09:06
Im not a doctor, But I dont think you could have done permenant receptor damage, You probably still have some degree of chemical imbalance, which is in tug o war with the various anti depressants youve been on. The idea of perminantly changing your brain is very scary and can lead to depression alone. I became very depressed & filled with anxiety when I kept having visual tracers and things swimming after acid once. This lasted quite some time but now it has totally faded. I know its a totally different situation but it drove the same fear into me, and it passed.
I started taking e during a time when I was smoking weed very heavily, It seemed to change it for me, I started getting very depressed and tense, I forgot all the good things in life and concentrated on complete shit. I ignored all the warning signs and kept smoking until one day I ended up admitting myself to hospital with extreme hallucinations, Tachycardia & Hypertension.
Since then I feel that im not the same, and probably never will be, however I also feel that im rediscovering many great things in life, I have a new appreciation, and while things fall down every now and then. I feel that im on a road to recovery and will eventually feel better and be wiser than before. So far ive also managed to do this without any medication.
I really hope the best for you, Your in a situation which is a self perpetuating circle of feeling bad, however there is an exit and you will find it.

superbabydoc
26-03-2002, 12:57
I spent a few hours searching google, medscape, emedicine and medline (not all of medline, but a bit) and couldn't turn up anything on long term effects of SS. I'm highly impressed that fairnymph found what she did. Anyhow, I agree completely with all the advice she gave you.
I have a couple of things to add. I think you should consider the psychological trauma of the SS - I'm sure it was a terrifying experience for you. Do you find yourself thinking about the actual episode at all? Also, you are living through an incredibly stressful experience with your dad being sick (which was the trigger for the depression anyhow). Given the pre-existing depression, and the ongoing stressors you are experiencing, I think it is highly probable you would be suffering depression now even without the episode of SS.
Some people just don't respond to SSRI's, so changing to mirtazapine was a good idea. There are still plenty of alternative anti-depressant meds available if it doesn't work for you - there's still Effexor, tri-cyclic anti-depressants and mianserin just to start. Anti-depressants may also be augmented with lithium or other drugs. Remember it takes weeks for anti-depressants to kick in.
Also, given that the stress of your dad's illness triggered the first episode, and that he is still ill at present, perhaps you need more than just medication. I'm thinking you need to talk to a therapist/psychologist about your grief, plus all the other stuff you're going through. Most psychiatrists don't really do therapy, so consider seeking a psychologist for this (you could ask the psych. about it).
I am confident you haven't fucked your brain - there are still heaps of treatment options available to treat your illness. Good luck with it

*=Regulator=*
27-03-2002, 01:51
First, thank you for your EXCELLENT reponses and care.
Fairnymph and BabyDoc, I am particularly touched and honoured that you spent so much of your own time looking for relevant journal articles. You guys do a wonderful job - this has truly helped me. THANK YOU!
[quote]Originally posted by babydoc_vic:

I think you should consider the psychological trauma of the SS - I'm sure it was a terrifying experience for you. Do you find yourself thinking about the actual episode at all? Also, you are living through an incredibly stressful experience with your dad being sick (which was the trigger for the depression anyhow)
Babydoc: I think that is certainly a factor. When I went to hospital I was having such severe convulsions that I had to be taken out of my friends car and put in the ambulance by COPS, who were laughing and making jokes about it. Like "Hahaha that's why they call it exstasy!"
I had to be restrained in the back of the ambulance and on the ambulance bed. I was 100% convinced I was going to die, and to, that people could laugh while this was happening to me deeply disturbed me. I know they were doing their jobs and that being detached is probably a way of dealing with witnessing traumatic events for them, but try telling me that at the time! I have horrific images in my head that do still haunt me.
I was and am, deeply ashamed that I wasted legitimate hospital resources as a result of my own stupidity, and I am ashamed that my friend witnessed me in such an out of control state.
I also think that glimpsing my own mortality was very traumatic for me. So, yes, I guess I do have some seriously unresolved issues to deal with as a result of the SS.
Anyway, I am feeling a little better today. I think the Mitrazipine is starting to work and I am seeing a Pyschiatrist soon - I'll keep you posted.
Thanks again to those who responded!

superbabydoc
27-03-2002, 01:59
P.S: I meant to also say you are clearly feeling very guilty over the experience (your last post reminded me of this). Guilt is a nasty, toxic emotion. You need to accept that you didn't mean for this to happen, therefore you shouldn't feel guilty about using the health resources. You had just as much right to use them as anyone else. You work, you pay taxes don't you? It was an accident, not intentional. So don't feel bad about going to hospital.
Let us know how it goes (and whether my predictions about what the psych will say) are right or wrong!

fairnymph
27-03-2002, 02:24
I think babydoc made an excellent point about the psychological trauma from an experience like yours. Fortunately, psychological trauma can usually be treated effectively, unlike some forms of neurological damage.
If it's any consolation, despite your problems, you seem far more intelligent and mentally stable than the majority of people I know. With a good attitude and some optimism, you are likely to go far.

djremix
27-03-2002, 12:57
sorry to hear about your ordeal man, hope things brighten up soon :)
just as a sidenote, did your doctor try benzo's first?(valium, xanax etc?) or he put you straight on ssri's?
also consult with him wether or not nootropics(piracetam mostly) could be of help? as i have found it is has amazing synergy with working out especially on mood and outlook. enough to "bump" your state of mind in the right direction. and all thius on a very low dose of them.
personally, i am VERY weary of anything that could make me dependant, drugs, people, SSRI's. the thought of needing something to feel normal is it itself wrong, at least to me.
i am sure other people are different and do actually need something, i think it is still wise to try all options first.
focus on the good things and make the most out of them.
* on a side not, please dont take this the wrong way, but would something like this qualify as "post traumatic shock"? the same type they are experimenting treatment with mdma?

*=Regulator=*
28-03-2002, 01:47
DJ Remix: When I first slid into depression, the anxiety was the more extreme manifestation than the feelings of hopelessness. I was on Benzos big time at that stage. I couple of times I went into a no-appointment Doctor's surgery and basically collapsed crying at the reception - both times they took me straight in and shot a huge amount of valium into my arm.
When the anxiety was at its worst when waiting for the vals to kick in I had to stand in the shower and count the tiles or I would start screaming.
I will ask about nootropics(piracetam) when I see my Doc next - Thanks for the tip!
As far as the guilt goes, I went through various coping strategies after the event such as sending gifts and thankyou notes to the paramedics who helped me.
These posts and some inner reflection (seems to be all I do at the moment!) have led me to realise that I was and am deeply disturbed with the events of that night and need to adequately deal with them. The feeling of "glimpsing death" (in the ambulance I was convulsing and screaming over and over "AM I GOING TO DIE?" "PLEASE DON'T LET ME DIE" "TELL MY FAMILY I LOVE THEM" "I"M DYING, HELP") is difficult for me to cope with. I don't think many people experience the certainty of death over any prolonged period of time. Mostly it would be more like "Arghh there's a truck in front of me" - BANG - DEAD or it misses and the feeling of death is just a moment - Not a 4 hour drawn out, screaming ordeal.
DjRemix - As far as Post Traumatic Stress disorder goes I don't think I would fit the DMV for that - Maybe I would - It's something to explore with the head Doctor next week...
Fairnymph - :-) Thanks for your kind words, they truly mean a lot to me!
Thanks everyone! I'll keep you all posted.

djremix
28-03-2002, 21:48
just one more thing.
yes it sounds silly and stupid but i think its still VERY true.
remember that night when u were thinking you are dying?
whenever you think back at that night, remember the pain, and realise that you are still ALIVE and therefor still able to enjoy some happiness.
so use it as a second chance, something which a lot of people dont get...especially at life
:)

*=Regulator=*
09-04-2002, 05:56
Ok, update time.
I went to see the psychiatrist yesterday afternoon at 1:30. Before going I met my mum at work so I could park my car in her space. I was agitated and got into a bit of a fight with mum which is a pretty shit precursor to therapy.
The appointment resulted in me realising a couple of things:
1- Just because someone is a Doctor does not mean they are omnipotent. Thanks to the incredible educational value of Bluelight, I found myself educating the Psychiatrist on the contraindication of MAO-Is and MDMA and the effects of seratonin sydrome. This was not the ideal start to the session. However, I think the situation I am in now is more important than the technicalities of how I got here, so I'll see the Doctor again.
2- I don't think I fried my brain when I had SS, I think I unlocked a predisposition for a mental disorder. I think anyone in my situation would be depressed. A number of factors have contributed to my clinical depression. I now attribute more of my depression to external factors than I have in the past.
Anyway, the session was just rapport building and an attempt to get my medication sorted out. The doctor left me on 45mgs of Avanza (Mitrazipine). Although I suggested it is not working nearly as well as the Aropax, he didn't want to me to go back to it untill I have been on the Avanza for at least 4 weeks. Fair enough.
The Dr does conversational therapy, not psychotherapy. I am going to see him for another couple of weeks - at least until I am stabilised by the medication. At the moment, I am depressed, which is better than how I was feeling this morning. I'll post next Monday.