Possible serotonin syndrome (attack?) need confirmation.

[marmitestainz]

Hello all,

Yesterday I had one of, if not the craziest and terror inducing days of my life.

Since I've regained my savvy a bit more today I've been researching what the hell happened to me. (I'm still feeling pretty messed up)
I've come across serotonin syndrome and feel my symptoms match pretty much 100%.

I realise this will be a hard sell to a doctor, I know people in the psychiactric profession and may be able to get people to listen.
This is why I post here, if I know I'm right in my assuption I'll go ahead and see if I can get some help...

I'm on anti depressants (Mirtazapine) and I've been trialing different things to try to help my insomnia. Most recently promethazine hydrochloride (previously zopiclone).
I'd been sleeping crazy hours and was pretty much out of it for 3 days or so and had not taken anything perscription for 3 days prior to this episode.
I had been pretty much chain smoking joints however.


It all started about 3-4 in the afternoon.
I'd just been out for late breakfast with family before dropping by my uncle's where we enjoyed a beer and a little of his home made space chocolate.
He was settling in to watch the GP so not being particularly keen on watching the race I headed home just as I started to feel some effect.

Now, I'm in my 30's and have a pretty long history with weed. I'm no stranger.
I got back and picked up the episode of breaking bad I was watching after checking all the usual online social media shit and settled in.

That's when it hit me.
Panic, chest pain/discomfort and wildly beating heart. Feeling so hot I pulled off all my clothes, stripped down to my boxers as I paced around the flat.
I suddenly felt like I was going to pass out possibly and for some reason lose bowel control so I ran to the toilet and had at it.
The panic was coming in waves. I felt a little better then much worse.
I've had run-of-the-mill panic attacks before, I'm used to them now and know all about mind over matter.
This didn't help me here at all.

I knew this was something different and grabbed my phone. I hit 999 and left it there just in case I felt I couldn't hold on any longer.
I didn't want to create a scene so I pulled on my sweat soaked clothes quickly and banged on my neighbour's door. (I know him quite well).
He didn't answer and that made me feel a lot worse.

I got back in my flat and things were getting worse, I have history of heart problems in my family and that was my fear.
I couldn't hold on any longer and hit call on my phone. I explained that I thought I was having a heart attack and that I could pass out at any minute.
I was REALLY struggling to answer their questions, just shouting my details at them and QUICK QUICK!

At this point I was so consumed with the thought that I was going to die in the near future I went back out and pounded on my neighbours door. He answered.
I shouted that I thought I was either having the worst panic attack of my life or I was having a heart attack, I don't remember what happened between then and the time the paramedics arrived.

I must have poured myself a glass of water as I remember telling the paramedics that I was over heating really badly. I kept asking them for an ice pack or something but they just seemed to be moving really slowly.
I couldn't understand why they weren't rushing me to the hospital.
I couldn't stop shivering, fidgeting and pulling at my hair, I must have looked like I was having some mental break or something. I felt like if I stopped moving my heart would explode.
I remember just needing to cool down so I threw the glass of water over my head and started taking off my clothes in the ambulance until they stopped me.
I remember being really paranoid that the paramedics were somehow trying to be slow and calm because they knew I was about to die anyway and they didn't want to stress me more than needed.
It seems crazy to think that now, usually I'm really unconfrontational and easy going but I was so scared and freaked out I'd have done ANYTHING to survive.
I also was begining to feel a bit delerious in hindsight.

My mouth was REALLY dry, it felt sucked in and all puckered.
I remember them saying that my temp was over 38C, at the time I didn't know if that was bad or good but I do remember it.
They refused me more water, I guess they didn't want it all over the place.
They must have put the heart monitor stuff on me, I remember bits of it, I was just trying to calm myself down at all costs.
THey tried to calm me down to take a reading but it wasn't happening. I had my neighbour in holding on to him like you do when you're coming up real strong on some class As or something.
I barely remember the journey but what I do remember is feeling really disorientated, I knew which way was up but I felt like everything was somehow shifted around, like the world had a different orientation.

I remember being outside the hospital breifly before I was taken to a bed. I don't remember anything about getting from the door to the bed.
I remember fidgeting and pulling at my hair, later I noticed I'd pulled quite a bit of it out. Again I couldn't sit still long enough for them to take readings on the ECG. I remember more of how I felt from around this time.
The best explanation I can give is that it was like tripping on mushrooms but not quite. I also had moments of strange clarity like I was a coma patient awake but unable to comunicate.
I was still paniced although slightly less now, but I was really disasociated with what was going on.
The veiw from my bed appeared like a TV screen with some ER drama unfloding on it. Scarey at times and even amusing at others.
I kept slipping in and out of being able to respond and understand what was happening even though I was really trying to.
I had pretty much zero concept of time.

I remember convulsing a bit and feeling like I could be sick or even that I should make myself sick.
I think I must have realised that I wasn't having a heart attack and started to calm down a little, enough for them to ask questions.

I told them about the space chocolate and pretty much from then on they told me I was 'having a bad trip on weed'.
Even at that point I was able to understand that was bullshit.
One minute I seemed to be ok, or at least aware then the next I dind't understand what was going on.
I remember at one point laughing hysterically at 2 junior doctors becasue they looked like guys from a TV show.
2 minutes later everything was completely different again... Floaty and surreal.

It basically wnet on like this for about 6-8 hours. My concept of time is still a little fucked up right now but from what my neighbour tells me that's about right.
Eventually I was calm enough for the ECG and discharged about an hour afterward.
I remember very little of the walk home with my neighbour and must have fallen asleep as soon as I hit the sofa.


Has anyone experienced serotonin syndrome before? does this sound like that?
Please let me know.

I was still quite panicy earlier and still feel like I'm in a bit of a dream state or something.
Chest still feel not great but heartbeat has been normal. Still feel hot but not dangerously so.
Basically feel like I've been on a week long drug and booze binge or something right now haha, it's that same kind of feeling of missed moments and not being completely there.

Sorry for spelling, no spell check on here and I'm really straining with the effort of just typing this once so proofing it is out the window.

 

[Nakifantaki]

Hey man. Sorry you had to go through that, sounds pretty scary. Did everything check out okay at the ER? EKG and labs and what not?

What you described above sounds like a major panic attack to me. That is the exact same way I felt when I smoked spice for the first time years ago. Pure panic and I thought I was going to die from a heart attack. It came in waves. I paced back and forth and sweated for hours. I also was very fidgety and had a hard time figuring out what the hell was going on at times.
Now prior to that episode for me, I had general anxiety issues but that spice threw me into the worst panic attack ever and ever since that day my anxiety has been 10 times worse. I have panic attacks that mimic my first one every now and again. I have went to 3 different cardiologists and had my heart checked. Always get a clean bill of health. I also don't some weed anymore because of that experience.

Hang in there man.

 

[BeenThereDoneCrack]

the convulsions part and loss of consciousness and muscle spasms made me think you were maybe just on the verge of a minor seizure(not what they cal a mal seizure,I have had 3 mal seizures and the last one started when i was fishing with my cousin, start losing ability to form words, next thing i know i wake up in cousins basement w/ paramedic and his parents all asking if i would please ride to the er. Not knowing what went on i refused until he left. said i was fine but didnt know what happened the slightest.i ssmoke a cigarette with my cousin and next thing i know i wake up in the ER with my dad, 4 big gashes in my forehead and nose and my tongue was basically bitten thru.. was told the seazing was so intesnse i was foaming at the mout, and this whole time i was unconscious and have no memory. spent 3 days in hospital. you may have been just right on the verge of seizure threshold and your body could tell. And then the weed prob didnt help anything but your mind got that thought of heart attack and when panic sets in especially with something that is life threatening, we assume the worst and arent thinking rationally..... Just my guess bud sucks to hear

 

[marmitestainz]

I don't know anything about results of any of the tests that were administered in the hospital. I know they did a blood test too.
I think they thought I had taken something else from the way they were speaking.
I'm not sure anyone spoke to me about it at all. I have a doctors appointment tomorrow and I think I remember them saying they would send results to my doctor.

It's 2 days after now. I've just woken up and still feel drained and spaced out.
I'm still stumbling around a bit and everything is still a bit foggy. Like being stoned with a hangover maybe... I haven't smoked any grass or taken any prescription meds since the episode. (I think this was a wake up call not to be ignored :S)

I do beleive that I may have gotten almost to the point of a seizure from overheating.
What you say rings true about the body knowing. I just HAD to cool down when I threw water over myself.
Looking back on it now it definately seems like I was starting to feel delirious at that point.

I have no history of seizures or epelepsy or anything like that.
I've also had quite bad panic attacks before in the past but they were never accompanied with over heating.
Usually a feeling of a tight chest or fast/irregular heartbeat would cause panic but I would always manage to calm myself down within a couple of hours.
I have been under more stress than usual recently but at the time I was feeling pretty good.

I remember moving uncontrolably, NEEDING to move too. That has never happened in previous panic attacks.
It has always been soothing to rub my chest or move my legs during uncomfortable situations, I have RLS.
This was way more than that. Constant trembling too.

I don't know really, I still feel like crap and I hope I haven't done any perminant damage to my brain with all the smoking etc. over the years coupled with trialing anti depressants.
I understand that the brain is a pretty robust thing, it can heal from pretty major damage so I don't think I'm ruined forever.
But it was one of the worst days of my life and I'm still felling the repercussions now.

 

[Nakifantaki]

Like your said. The brain is a robust thing - and it tottaly is! The overheating is strange... which is why I asked about your blood tests. Hopefully you can find out more from your doctor. The huge upside of this experience is that you made it through it and the fact that you are looking at it like it was a wake up call is a very good thing.

 

[Pahoahbay]

Sorry to hear about that man. Any type of panic induced state can cause a world of problems, and these often build off of one another (anxiety > increased heart rate > increased anxiety/panic > etc.). It doesn't seem like serotonin syndrome given mirtazapine's mechanism of action, and several sources claim few drug interactions. As a fellow insomniac, I can imagine that prolonged lack of sleep, on top of self medicated trials, could certainly lead to such a state. Can you provide more information on the drug combinations you were taking? Also, I would imagine it might take a couple days for your body and mind to get back to normal. Rest, eat well, exercise as you can, and see if some symptoms don't subside.