SSRI's and psychedelics - There is no serotonin syndrome its a myth..

[Visionary_Kpsycho]

I have done mushrooms, 2cb, lsd, all on 10mg of ciprelex.....

No serotonin syndrome, just an extreme lack of psychedelic effects, making me take more of the drug. (like 3.5 of mushrooms felt like a gram)

Whoever says you get serotonin syndrome from a combination does not know what there talking about.

Does everyone on here agree so we can bust this myth, cause theres a large population out there who will not take psychedelics for this very reason (those on ssri's)

I am not saying all anti depressants are like this (like MAOI's) but I am saying SSRI's do not kill you when on psychedelics.

I have not tired MDMA on SSRI's but have heard the same, diminished effects, but no serotonin syndrome.

This is Bluelight, a harm reduction forum, so lets bust this myth or have a good conversation as to why it would/would-not cause serotonin syndrome.

 

[DoctorShop]

Pretty sure SNRIs and SSRIs don't cause serotonin syndrome. They can however, lessen the effects of the psychedelic substance.

 

[RobotRipping]

most psychs aren't serotonin releasers (amt is) so you may get diminished effects and that's about it. No worries about serotonin syndrome

 

[Renz Envy]

Why are you pursuing a possibly fatal medical condition using yourself as a guinea pig?

 

[Hiltoniano]

most psychs aren't serotonin releasers (amt is) so you may get diminished effects and that's about it. No worries about serotonin syndrome

Yea but don't forget that most psychedelics do act on serotonin. Mushrooms and LSD for sure.

 

[RobotRipping]

yeah for sure but no worry about release of serotonin and SSRI, like dxm + mdma or amt, it'd be helpful to have a list of serotonin releasing psychs that are commonly used.

 

[DoctorShop]

why are you pursuing a possibly fatal medical condition using yourself as a guinea pig?

because psychs don't cause serotonin syndrome.

 

[Swimmingdancer]

So your "evidence" for the broad statement that it's impossible to get Serotonin Syndrome from combining SSRIs and psychedelics is simply that you personally have done mushrooms, 2CB and LSD while taking 10mg of escitalopram and didn't get serotonin syndrome? To me, that doesn't prove anything, (I could claim that taking benzos with opioids is completely safe just because I personally have done it without problem). Now I'm not saying I believe that SS is likely with most psychedelics, but I think we need more concrete scientific evidence when discussing this issue. It bothers me when people on Bluelight make definitive pronouncements about something's safety simply because of their individual experience.

Also I don't think we can lump all psychedelics together on this issue. For example "classical psychedelics" like LSD are unlikely to cause Serotonin Syndrome (although there have been one or 2 reported cases it's debatable, since there is no test for SS). Empathogen/entactogens (such as MDA, aMT, etc) are serotonin releasers and are likely to cause Serotonin Syndrome. Also note that DMT is frequently used with an MAOI (and some DMT containing plants also contain MAOIs), so in that case there would be a risk.

BDD -> PD

 

[Thorns Have Roses]

You are correct insofar that tripping while on your average ssri regimen is perfectly possible and seemingly safe, a few of the dodgier psychs notwithstanding (see: SRAs, MAOIs, super-potent vasoconstrictive mofos).

That said, what it takes to induce serotonin syndrome varies from person to person, and it's impossible to say exactly what it will take to induce it unless you're taking a combination so contraindicated it borders on suicidal. It is advisable to avoid serotonergics in general when on ssri's, and if you need to be on such serious drugs, you ought to reconsider the cost/benefit ratio of psychedelic use.

 

[Swimmingdancer]

You are correct insofar that tripping while on your average ssri regimen is perfectly possible and seemingly safe, a few of the dodgier psychs notwithstanding (see: SRAs, MAOIs, super-potent vasoconstrictive mofos).

That said, what it takes to induce serotonin syndrome varies from person to person, and it's impossible to say exactly what it will take to induce it unless you're taking a combination so contraindicated it borders on suicidal. It is advisable to avoid serotonergics in general when on ssri's, and if you need to be on such serious drugs, you ought to reconsider the cost/benefit ratio of psychedelic use.

^Very well-said. Serotonin syndrome is poorly understood and there could be other potential complications aside from SS, and everyone is so different. There have been reports of problems from people taking SSRIs after LSD, for example.

 

[Solipsis]

I think SSRI's alone can produce serotonin storm on rare occasions. Together with LSD I suppose the threshold will be lowered / prevalence increases. Enough not to call it rare when it happens? No idea but impossible is different.
SNRI's make me cringe by the sound of them (in the context of combining with acid), remembering that tramadol can be pretty brutal together with LSD. Tramadol is a weird critter though so YMMV anyway with that...

Saying it can happen doesn't make it a common complication or immediate concern such as with say MAOIs / TCA's + MDMA.

So, it's unlikely - yet it may be that next time you try it SS happens to you, then it doesn't seem all that unlikely anymore. That is kind of how it works with gambles, wth else can there be said?

 

[atara]

Why are you pursuing a possibly fatal medical condition using yourself as a guinea pig?

This.

SSRIs are primarily cautioned against in combination with e.g. ayahuasca, DXM, tramadol, Saint John's Wort where it is fait accompli that they can lead to serotonin syndrome. True psychedelics, to wit LSD, 2C-B, and mushrooms, rarely have dangerous interactions with SSRIs, but read on:

SSRIs come from a wide range of families of compounds and are not tested as extensively as the pharmaceutical companies might want you to believe before they come to market, so whenever we work with some huge, nebulous bunch of chemicals like this we hope to err on the side of caution. It is always possible that a psychedelic or other recreational drug will interfere with the metabolism of an SSRI that you are taking, leading to a much higher serum concentration than you would otherwise expect, and... bad things.

In your case:

Citalopram and escitalopram are associated with dose-dependent QT interval prolongation and should not be used in those with: congenital long QT syndrome; known pre-existing QT interval prolongation; or in combination with other medicines that prolong the QT interval.

After all escitalopram isn't exactly recreational, so why would you want to fuck around combining it with LSD when it's only going to make it worse?

Let me put it this way: citalopram killed 14 people in Sweden from 1994-99. That is more than every RC combined in Sweden in the past five years.

 

[Solipsis]

QT syndrome

Quicktime?

citalopram killed 14 people[/url] in Sweden from 1994-99. That is more than every RC combined in Sweden in the past five years.

Whoa! Interesting comparison!
That brings us back to the cost/benefit evaluation doesn't it...
(well, statistically maybe still not super scary but I would be so wary combining that)

 

[Swimmingdancer]

as can LSD by itself apparently

Any sources on this actually ever happening?

 

[choco1ate]

you should try upping the dose with more serotogenic drugs just to be sure

 

[IamMe90]

Let me put it this way: citalopram killed 14 people in Sweden from 1994-99. That is more than every RC combined in Sweden in the past five years.

This is an example of dishonest use of statistics and has nothing to do with combining SSRI medications with 5ht2a psychedelics.

 

[sekio]

Serotonin Syndrome does exist, don't say it doesn't.

Generally one needs to combine a strong serotonin (and usually also norepinephrine/dopamine) releasing agent, such as AMT, MDA, MDMA, and a strong serotonin/norepinephrine reuptake inhibitor, like 5-MeO-DiPT, escitalopram, MXE, DXM. (or drug that blocks metabolism of the releaser), and you need to have large concentrations of both in the blood.
A related event is hypertensive crisis, caused by coingestion of norepinephrine releasers and reuptake inhibitors (i.e. pseudoephedrine and DXM, pseudoephedrine and cocaine)

 

[Solipsis]

Any sources on this actually ever happening?

That's not coming from anecdotal evidence, no. It appears to be implicated at least: http://www.njmonline.nl/getpdf.php?id=322
You can dig out the literature reference chain yourself on it, starting this one being cited (that I have not yet checked): Hall M, Buckley N. Serotonin syndrome. Aust Prescr 2003;26:62-3

 

[Swimmingdancer]

That's not coming from anecdotal evidence, no. It appears to be implicated at least: http://www.njmonline.nl/getpdf.php?id=322
You can dig out the literature reference chain yourself on it, starting this one being cited (that I have not yet checked): Hall M, Buckley N. Serotonin syndrome. Aust Prescr 2003;26:62-3

Yeah, I have actually seen those articles and done that already, lol. Of the 2 sources Bijl cites for that list that includes LSD, one doesn't mention LSD at all, and the 2nd is in German and I can't even find it. The citations on Hall's article don't mention LSD. There are a few other sources which list LSD, without any details, on a list of drugs that can potentially cause Serotonin Syndrome, but they tend to just link to each other in a roundabout circle; I have been unable to find any actual case reports of this ever happening.

The best source I can find is one study from 1979 that says:

LSD and the novel ergot derivative lisuirde produced serotonin syndrome [behavior] in rats. The results suggest that dopaminergic modulation of the serotonin syndrome occurs before the serotonin receptor involved in this behavior.
[source]

The only mention of a possible/suspected case report I could find was this: Francis B, Harchelroad F (1996). "LSD/Fluoxetine induced serotonin syndrome". J Toxicol Clin Toxicol but it wants me to pay $43 to view it and I can't find it anywhere else on the internet. And fluoexetine by itself can cause SS.

 

[atara]

This is an example of dishonest use of statistics and has nothing to do with combining SSRI medications with 5ht2a psychedelics.

Uh, no it isn't. Pointing out that there are risks involved in the use of SSRIs, especially risks related to vasoconstriction, is of great and significant importance in discussing the relative safety of combining them with 5-ht2a agonists, which are all vasoconstrictors.

Now, the bit where I compare it to total RC deaths in Sweden over the past five years? That was just for fun, but it emphasizes that I am not pointing out some minor, abstract risk, instead a real one.

The only mention of a possible/suspected case report I could find was this: Francis B, Harchelroad F (1996). "LSD/Fluoxetine induced serotonin syndrome". J Toxicol Clin Toxicol but it wants me to pay $43 to view it and I can't find it anywhere else on the internet. And fluoexetine by itself can cause SS.

This was actually a conference presentation title -- "presented during the Annual Meeting of North American Congress of Clinical Toxicology on October 10-15, 1996 in Portland, Oregon" -- and as a result there is no copy online.