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

Good call then, I edited it out. What remains for me is that LSD seems to act as a certain type of catalyst. It may be a generally very safe drug physically (that was hardly the point anyway), but it can magnify other things quite a lot. Intangible things like feeling positive or being preoccupied with something difficult that happened in the past... but also for example the effects of nitrous oxide. Which has felt very unsafe to me on at least 2 occasions, like a feedback process running wild.
Now if the effects of LSD would be consistently muffled by SSRI's, something could be said about their effects overruling those of LSD but instead there seems to be interaction that from the sounds of it is unpredictable.

After having said this, I know there is little scientific about it and I still cannot contribute statistics on the dangers of SSRI's being magnified by psychedelics but what indications there are make me feel like tripping is disruptive to whatever SSRI's do and that whatever dangers there may be in the first place could be catalyzed. SSRI's often don't "take" in people... as do virtually all other anti-depressants, correct? (Maybe even all medicine, but these perhaps more so). Anyway I can imagine that if you take psychedelics while being on a regimen, this could mess with your chances.

I'd be interested to know what people have noticed taking such combinations and plan on adding a poll to the SSRIs + LSD thread.

If you have experience with this, be sure to take the poll I just created... or if it should be changed you can help by suggesting how:
http://www.bluelight.ru/vb/threads/549856-LSD-Subthread-SSRI-Interactions
 
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Is Fairnymph's FAQ on drug interactions still here on B/L? IIRC, if you take SSRI daily for an extended period, drugs like MDMA don't work very well. This is because the latter reverse the flow of the serotonin reuptake transporters, whereas the former inhibit their activity (in either direction). However, if you take SSRIs on occasion, specifically for the purpose of boosting the effect of drugs like MDMA, then you can easily get into trouble and experience serotonin syndrome. I don't know the exact mechanism of action of other serotonin-releasing drugs (like LSD) - but perhaps similar?

In other words - if you are prescribed SSRI, and take them regularly over an extended period of time, drugs which work by releasing serotonin are going to work less well (in general). The risk of serotonin syndrome is greatest when you experiment with non-prescribed doses of SSRIs, combined with extended/high dosing of drugs which work by releasing serotonin.

My best guess anyway - be safe everyone as the festive season approaches!
 
sekio said:
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.
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aMT and Mirtazipine would qualify then? I was hospitalised 18 months or so ago being a recklessly suicidal alcoholic in full flow at the time after dumping approx 150-200mg aMT into the vodka and coke I'd been binging on all night after a blazing row with the ex in a great fuck you to the world. Beyond the first half hour or so of the most intense come up I've ever experienced with aMT I have no memory whatsoever of events over the next 18-24 hours but I'm told I was in a hypomanic agitated state that required restraint in the ambulance and on the hospital bed post-admission shaking like a shiteing dog while I was pumped full of IV diazepam and put on a drip to replace the pints of sweat pouring out of me. I never got a diagnosis and was discharged the next morning but it's my belief it was serotonin syndrome. Certainly I had almost all of the symptoms listed on the wikipedia page for it barring coma and diarrhea, those symptoms being listed as:

Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma
Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea.
Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.

What else could it have been? :?
 
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Actually it wouldn't be strange to me if the aMT alone could have done such things at doses like that, if MDMA could do it alone (http://www.ncbi.nlm.nih.gov/pubmed/9737504?dopt=Abstract)

Again, like the suspicions I expressed before I just think that adding other drugs may increase such symptoms or the probability of the syndrome escalating. Vague terms but I mainly mean that certain drugs could make it worse / catalyze this reaction.

Mirtazapine maybe although I thought it was a serotonin antagonist so I'd expect it to do the opposite. Also I thought research revealed that alcohol use seems to soften the effects of MDMA, that it would protect you against thing like overheating to some extent.
 
25I_am_so_wonderfu said:
Im going to have to go w OP. Im not fully convinced it even exists
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Serotonin syndrome definitely exists - there's absolutely no doubt of that, and saying otherwise would be putting many lives at risks, the problem is that people get very confused over which combinations actually create a danger of this.

Serotonin syndrome is what causes people to die from taking PMA and PMMA - the combined serotonin releasing and MAOI faculties of the drugs result in an "overdose" of serotonin, the main problem of this being severe hyperthermia (elevated body temperature) which results in several complications that can lead to hospitalisation or death.

Generally the worst combinations are those involving MAOIs. An MAOI is a Monoamine-Oxidase Inhibitor, Monoamine-Oxidase being a group of enzymes that break down the monoamines (e.g. serotonin, dopamine, norepinephrine, and related substances) - an inhibitor stops this breakdown, so it's easy to see how in a combination this can quickly lead to problems.

If you have taken a drug that raises concentrations of serotonin in the body, whether a releaser or reuptake inhibitor, and then throw an MAOI into the mix, stopping the product from breaking down, it quickly results in a flood, and there is soon way too much in the body for your body to handle, resulting in serotonin syndrome.

I can't off the top of my head list all the types of combinations that are dangerous and that aren't, but as far as I'm aware there isn't any real contraindication when it comes to combining SSRIs + Psychedelics in terms of the safety factor, the main concern is that combining the two will almost certainly dramatically reduce the effects of your trip. IIRC activation of some of the 5ht receptors that are activated by some psychedelics can also result in serotonin syndrome in combinations but only at excessive doses.
 
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atara said:
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.
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Ayahuasca contains an MAOI, DXM is an inhibitor of CYP2D6 for which both drugs are substrates, tramadol is just weird 8(, and St. Johns Wort is another SSRI. So yes, these specific combos are problematic and contraindicated, but this doesn't really prove that they are dangerous with all psychedelics.

Sorry dudes and dudesses, but I'm with the OP. Pharmacologically, there is little or no risk of combining prescription SSRIs with most non-MAOI serotonergic psychedelics (ones such as LSD, 2C-x, DOx, most tryptamines aside from the alpha-alkylated ones etc.) We have yet to discover whether these psychedelics such as LSD compete for the CYP2D6 and related enzymes, so that's not really an argument.

[Not that I'm defending the use of SSRI drugs here, because I know through experience the long-lasting and extensive damage they can cause when used daily.]

But serotonin syndrome definitely exists. It's a clinical term, and the condition is absolutely real. Just ask someone who has been through it, and there are a few BL members who have.
 
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I believe I had also some degree of serotonin syndrome last summer.

I had been drinking little over one bottle of DXM (600mg per bottle) during one day and evening and the next morning I was going to work and I tought I don't have much DXM left in my system anymore and most of it is anyway DXO (which I supposed isn't very stron SNRI). I hesitate a while but was so sleepy that I thought I couldn't go work without tramadol and so I took it.

Well about hour later I get agitated, very anxious and my body started shaking. I immediately recognized it was something else than panic attack because those I've been suffering for years. Well the worst lasted about two hours and my shirt got wet all over. It was like I had been in shower with clothes. When I drank protein shake later the day it all got back but not so bad anymore. That was only I tried to eat that day and I was feeling so sick I didn't even had any appetite.

It was propably just a minor reaction but enough for me to tell that I don't combine anymore serotonergic drugs. I might be over sensitive anyway.

Edit: I might also add that I took ephedrine and caffeine that morning but ephedrine&caffeine with tramadol hasn't NEVER caused me that kind of reaction. So thats why I wasn't sure should I even mention that because its easy to blame it but no, I don't believe it was interaction between tramadol and ephedrine - those effects are far too familiar to me.
 
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So from what I am getting at on here is that you can get serotonin syndrome from combining SSRi's with MDMA (ecstasy), and also DXM, but why is it :X !?!?!?!?! Because from what I am understanding it seems that the Myth has been busted, regarding the classical hallucinogen, plus (new ones); (DMT,2CB,LSD,Magic Mushrooms, Peyote (Mescaline), 5-MEO-DMT, and NBO-me series) (PCP analogs to ). ((But for some reason DXM and MDMA can kill you from an SSRI+MDMA(or DXM) combo; why is that?)) Really!!! Why is that??? because they hit the same receptors in the brain? but classical and certain RC's do not act like this like 2-CB/DMT/LSD??? or Mescaline or Psilocybin? It just seems weird. I know MDMA is a serotonin release agent, but i heard it only reacts with SNRI's,SARIs, NRI's, NDRIs, NDRA,s , TCAs, TeCAs, and a huge candidate, MAOI's_ So taking just an SSRI, should not affect me, right?

Thank you/Regards,

- K_Psycho
 
Survived Abortion said:
Ayahuasca contains an MAOI, DXM is an inhibitor of CYP2D6 for which both drugs are substrates, tramadol is just weird 8(, and St. Johns Wort is another SSRI.
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I wouldn't St Johns wort in the same class as MAOI as ayahuasca. St Johns wort is NOT going to activate DMT even if you ate every last speck of St Johns Wort in the known universe.

But serotonin syndrome definitely exists. It's a clinical term, and the condition is absolutely real. Just ask someone who has been through it, and there are a few BL members who have.

It would be helpful to have some idea how common it is tho. It's no use every bluelight member and his mother saying "I felt like a had a bit of serotonin syndrome the other day". Self-diagnosis of barely understood conditions is fraught with complications - the main complication being the self-diagnosis is complete bollocks.
 
Renz Envy said:
Why are you pursuing a possibly fatal medical condition using yourself as a guinea pig?
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As if drug use were ever a completely safe activity. Anyway, I believe it is akin to taking SSRI's with antipsychotics which also raise seratonin. Dangerous to a point, but not really worthy of danger since doctors regularly prescribe the two together. The real danger with SSRI's are opiods. Demerol or stronger really. Thats it.
 
Ismene said:
I wouldn't St Johns wort in the same class as MAOI as ayahuasca. St Johns wort is NOT going to activate DMT even if you ate every last speck of St Johns Wort in the known universe.
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Survived Abortion wasn't saying that, they were saying St John's Wort is an SSRI. (Although even that is sometimes debated, as it's mechanism of action is not fully understood, but it has been shown to increase serotonin levels). St John's Wort might have some slight MAOI activity, but it is extremely weak and not clinically significant, hence why it wouldn't activate DMT.

However, St. John's Wort affects cytochrome P450 enzymes, causing some drug interactions by that mechanism, and many herbal/medical sources recommend that people avoid taking St John's Wort in conjunction with serotonergic drugs, due to concerns about possibility for serotonin syndrome. For the latter reason, it seems prudent to avoid, or be extremely careful when combining it with drugs that strongly boost serotonin, and to do some research before combining it with other types of drugs.

Ismene said:
It would be helpful to have some idea how common it is tho. It's no use every bluelight member and his mother saying "I felt like a had a bit of serotonin syndrome the other day". Self-diagnosis of barely understood conditions is fraught with complications - the main complication being the self-diagnosis is complete bollocks.
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Serotonin syndrome in general, as it is technically defined, is common. It just means an excess of serotonin/serotonergic activity. FATAL/potentially fatal aka severe serotonin syndrome - which is what people on BL often mean when they refer to it - is not all that common. Just because SS can be dangerous when severe doesn't mean that you can't get a mild case of serotonin syndrome. It is just a collection of symptoms which are believed to result from too much serotonergic activity. Self-diagnosis is not much worse than professional diagnosis actually (a Dr may just be more able to rule out other causes). There are no tests to diagnose it.

To be diagnosed with serotonin syndrome, you must simply have recently taken a serotonergic drug, have ruled out other causes (such as drug withdrawal, infection, severe dehydration, etc) and have at least 3 of the following symptoms:
-Agitation
-Diarrhea
-Heavy sweating not due to activity
-Fever
-Mental status changes such as confusion or hypomania
-Muscle spasms (myoclonus)
-Overactive reflexes (hyperreflexia)
-Shivering
-Tremor
-Uncoordinated movements (ataxia)

They still can't know for certain that you have it, and one factor that can make it hard to diagnose is that drug side effects or overdose can cause a lot of these symptoms, so do you count any unwanted serotonergic side effects from taking too much as "serotonin syndrome" or not?

Treatment generally just consists of discontinuing medications which may be contributing to it. Symptoms like agitation may be treated with benzos. In severe life-threatening cases, serotonin antagonists, drugs to paralyze the muscles, and/or supportive care (like a breathing machine) may be used.

The relative risk and severity of serotonergic side effects/syndrome with individual drugs and combinations is complicated, poorly understood, very difficult to predict, and varies between individuals, hence why it is always safest to err on the side of caution.
 
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^Thankyou Swimmingdancer for breaking it down.

Visionary_Kpsycho said:
So from what I am getting at on here is that you can get serotonin syndrome from combining SSRi's with MDMA (ecstasy), and also DXM, but why is it :X !?!?!?!?! Because from what I am understanding it seems that the Myth has been busted, regarding the classical hallucinogen, plus (new ones); (DMT,2CB,LSD,Magic Mushrooms, Peyote (Mescaline), 5-MEO-DMT, and NBO-me series) (PCP analogs to ). ((But for some reason DXM and MDMA can kill you from an SSRI+MDMA(or DXM) combo; why is that?)) Really!!! Why is that??? because they hit the same receptors in the brain? but classical and certain RC's do not act like this like 2-CB/DMT/LSD??? or Mescaline or Psilocybin? It just seems weird. I know MDMA is a serotonin release agent, but i heard it only reacts with SNRI's,SARIs, NRI's, NDRIs, NDRA,s , TCAs, TeCAs, and a huge candidate, MAOI's_ So taking just an SSRI, should not affect me, right?

Thank you/Regards,

- K_Psycho
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Forget all the above nomenclature, you're just confusing yourself even more whilst propagating further "myths".

SSRIs do not cause serotonin syndrome in combination with MDMA or other similar non-MAOI serotonin releasers. The mechanism of serotonin release actuated by MDMA is mutually exclusive with the effect of SSRI drugs, because serotonin releasers work on the very same transporter as do the SSRIs. Serotonin releasers rely on the reversal of that transporter in order to increase intersynaptic serotonin, whereas SSRIs rely on the stoppage of that transporter. They cannot both work at the same time (other than where neighbouring receptors are occupied by one drug or the other).

SSRIs predominantly overrule the situation so that serotonin release never occurs (or occurs to an almost imperceptible degree). This has been demonstrated in clinical trials (please do read):

http://jpet.aspetjournals.org/content/323/3/954.full
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3344887
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957712/pdf/IJPsy-42-195.pdf

SNRIs aren't a problem either. Tricyclic antidepressants are only a problem from the standpoint of cardiac functioning, because TCAs predispose you to certain cardiac anomalies. This applies to all stimulants. And this, as you can see is something completely other than the issue of serotonin syndrome.

DXM is another matter, and the problem here is due to interaction with the CYP2D6 and CYP3A4 enzymes.

See this thread http://www.bluelight.ru/vb/threads/648356-List-of-Dangerous-amp-Potentially-Unsafe-Combinations for a list of further SSRI combos (amongst many others) that we, as a community, have agreed upon as dangerous. The list is not exhaustive and can be updated when necessary.
 
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yonkers said:
Does anyone know if remeron is an ssri?
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It's not an SSRI. Mirtazapine (Remeron) is an NaSSA - noradrenergic and specific serotonergic antidepressant, (structurally, mirtazapine can also be classified as a tetracyclic antidepressant (TeCA)). Unlike most conventional antidepressants, at normal therapeutic doses mirtazapine only has mild affinity for the serotonin, norepinephrine, or dopamine transporters and thus lacks significant effects as a reuptake inhibitor (RI) of these neurotransmitters, nor does it have any significant MAOI effects. How it works is kind of complicated. You can read more about its mechanisms of action on Wikipedia.

yonkers said:
is it safe to take dxm while taking this drug?
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Maybe someone more knowledgeable than me can answer this question before you go ahead and do it, but as far as I can tell I don't think there should be a risk of serotonin syndrome. If you look up mirtrazapine and dextromethorphan on a drug interaction checker it will say there is an interaction though: "Concomitant use of agents with serotonergic activity may result in serotonin syndrome and patients taking this combination should be monitored closely". But I think they have that as a standard warning on all antidepressants.

One study on combining mitrazapine and MAOIs reported that it did not result in any incidence of serotonin-related toxicity. One case report claimed that mirtazapine might actually even be useful in treating serotonin syndrome. Mirtazapine is often prescribed by doctors in combination with an SSRI, SNRI, or TCA.
 
Just to be on the safe waters couldn't you take 3 days off Mirtazapine? For what are you taking it? Sleep aid or as anti-depressant? If you have been using it for long time as sleep aid it would be problematic to quit.

Anyway I'd advise you to tell your doctor Mirtazapine doesn't fit you. It's trash. It's the first thing people get offered for any problem in here. It only causes more problems.
If you are fine with it then stick but ask yourself about the side effects.
 
25I_am_so_wonderfu said:
Im going to have to go w OP. Im not fully convinced it even exists
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fuckingmagnets.jpg
 
Thanks for the info swimmingdancer. I take it mainly for sleep but its also supposed to help with anxiety and depression (which is doesnt). Ive missed doses before so not taking them a few days before a trip isnt a bad idea at all.
 
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