A couple days ago I popped 3 tramadol for a total of 150mg. This was in the evening. I felt good at first, then after a few hours I took 30mg of mirtazapine (which I take daily, before bed.) I had a really difficult time sleeping (normally I have no problem), then the whole next day I felt depersonalized, very panicky, sweaty, and overall incredibly shitty. Did the mirtazapine + tramadol give me serotonin syndrome?
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N&PD Moderators: Skorpio | someguyontheinternet
Did I develop serotonin syndrome?
- Thread starter wungchow
- Start date
Tomer
Bluelighter
I would have to say, not a chance. I think your body just responded negatively to the combination of drugs. People speak frequently about Seretonin Syndrome, but I don't think its something that is very common. You should be OK, get some rest and eat right. Obviously, don't do the combo again.
Dxmmonster
Bluelighter
- Joined
- Jul 5, 2008
- Messages
- 1,003
Impossible to tell.
The Monkey Mantra
Bluelighter
^^^ That doesn't make any sense, seep. If it antagonizes 5-HT2a (not 5-HT2, as you mentioned) it's gonna cause serotonin release. The 5-HT2a receptor is an autoreceptor; it functions as a thermostat, increasing release when it's blocked because the cell gets the message that there's not enough serotonin in the synapse.
It doesn't sound like it....
Also, when I was taking mirtazapine, I consumed plenty of tramadol without any issue...
Also, when I was taking mirtazapine, I consumed plenty of tramadol without any issue...
Lysis
Bluelighter
Nah. Tramadol is weird. I will get sweats too and sometimes I get weird panic attack like feelings at night. It doesn't make me feel depressed, but I feel cool after taking a wee too much the next day, but I have had my bad days. I find that taking a good vitamin the next day really helps my mood the next day. I don't know why, but I feel like a million bucks after a really good multivitamin (I take Solarray).
Tsukasa
Bluelighter
- Joined
- Sep 21, 2007
- Messages
- 1,871
I've had something like that too. I smoked 5-meo-mipt one night, thought to be a 5-ht2a agonist, then next morning i popped just my usual therapeutic dose of tramadol (has SNRI property), and then 3 hours later ate some cookies. Then got really bad upset stomach for two hours. The second hour it got worse, I also got weakness, trembling, shivering, mild confusion, queeziness and cold sweat. Sounds to me like a mild case of serotonin syndrome.
Hi Monkey Mantra. I have a relatively cursory understanding of this and I'll defer to your expertise if you'll explain to me why the treatment for moderate to severe serotonin toxicity involves administration of a 5-HT2a antagonist. Just yesterday I saw the doctor I work for change a patient from sertraline to mirtazapine after the patient presented with symptoms of serotonin toxicity. One of mirtazapine's advantages over other antidepressants is that it carries virtually no risk for serotonin syndrome because it (like cyproheptadine and chlorpromazine) is a strong 5-HT2a antagonist. So then, if (as you say) antagonizing the 5-HT2a receptor results in further release of serotonin, why would a 5-HT2a antagonist be indicated for the treatment of serotonin syndrome?
The Monkey Mantra
Bluelighter
Seep, try a google search on mirtazapine and serotonin syndrome. They've got a few ideas:
And another behind an NSFW:
Now, as far as exactly HOW this works, I'm not sure. You may be right that I'm totally off the mark as far as 5-HT2a antagonist activity causing SS, but it seems that mirtazapine is indeed capable of inducing it, even if it's also a possible treatment. Weird, huh? Anyway, seep, it's worth googling. If you're really interested in figuring out mechanisms, pick a paper, PM me, and I'll see if I can't get you the full version, alright?
And another behind an NSFW:
NSFW:
Now, as far as exactly HOW this works, I'm not sure. You may be right that I'm totally off the mark as far as 5-HT2a antagonist activity causing SS, but it seems that mirtazapine is indeed capable of inducing it, even if it's also a possible treatment. Weird, huh? Anyway, seep, it's worth googling. If you're really interested in figuring out mechanisms, pick a paper, PM me, and I'll see if I can't get you the full version, alright?
Thanks. Weird thing is that I can find a preponderance of counterexamples. It's worth mentioning that sometime around the turn of the millennium it was discovered that the 5-HT1 receptors play little role in serotonin toxicity and that the main culprit was an overactive 5-HT2a. Of course, there's always the possibility of paradoxical side effects (same as in my friend who swallowed 10 mg of alprazolam and 30 minutes later attacked his dealer with a lead pipe). This is really far too complex right now; psychiatry is still pretty much a nascent science and so much of the medical literature resorts to phrases such as "is associated with" and "has the tendency to cause..." and "may be effective in alleviating..." This is why I'm going to stay the hell away from psychiatry when I go to med school. I do think that eventually neurology will engulf psychiatry and a patient who seeks treatment for depression will need to undergo a battery of PETs and CTs and EEGs and MRIs and such in order to determine the exact nature of the problem and the best course of tx.
Today I interviewed a patient who reports SS-like symptoms and is on a regimen of buproprion 200 mg qam and paroxetine CR 25 mg qam. So our wonderful doctor increases his buproprion to 150 mg bid and tells him to also continue with the paroxetine!
Today I interviewed a patient who reports SS-like symptoms and is on a regimen of buproprion 200 mg qam and paroxetine CR 25 mg qam. So our wonderful doctor increases his buproprion to 150 mg bid and tells him to also continue with the paroxetine!
If so, then IMO this might lend credence to the proposals (which I personally favor) that the functional effect of the 5HT2A agonist psychedelics actually resemble -- in many ways -- serotonergic antagonism more than a stimulation of serotonin transmission. As 5HT2A agonist psychedelics are NOT well-known for provoking the serotonin syndrome, and it seems pretty much unheard of with e.g. LSD or psilocin alone, although there have been speculations regarding combinations.
(See also research involving "latent inhibition" and dopaminergic drugs and 5HT2A agonists. And see the apparent protective effect of 5HT2A agonists against excitotoxicity from elevated glutamate transmission ... glutamate hyperactivity being a state which, I intuitively suspect, occurs with the serotonin syndrome. 'Tho I haven't actually read anything conclusive on that so who knows really ...)
Now, 5HT2A antagonists like cyproheptadine (Periactin) seem to be helpful for blocking and stopping the serotonin syndrome when it occurs ... but see, the effect of the 5HT2A 'agonists' and the 5HT2A 'antagonists' we have don't need to be 'opposite': agonism and antagonism come in numerous flavors of course, and viewing them otherwise is oversimplification, elementary.
egor
Bluelighter
I've used mirtazipine to "abort" a couple of dull, boring trips (mostly with 2c-t-4) and never had any sings of toxicity; just an urgent need to sleep.
justanotheropinion
Greenlighter
I'm in a hurry, but i had a similar experience.
Many years ago when i was more stupid than i am now, i was taking tramadol 150mg slow-release pills. I was also taking 30mg mirtazapine/day.
Anyway, one day i had the same reactions you described, but i was also speaking jibberish, rocking back and forth, i couldn't sit still for one second, my blood pressure was through the roof (i went to a doc the next day, having panic attacks and he thought i had taken amphetamines!)...
It was like an extended panic attack, but i was very hot, mentally confused (speaking jibberish) -and unable to sit still.
Months later i was still having multiple panic attacks daily....finally they went away (benzo's for a few weeks would have been a god-send).
Now, i NEVER take tramadol, and always write on doctors forms that i'm allergic to it (I take 60mg mirtazapine/day plus multiple other Rx meds)....
Yeah.....it was all in all a HORRIBLE experience (mirtazapine + tramadol).....
Many years ago when i was more stupid than i am now, i was taking tramadol 150mg slow-release pills. I was also taking 30mg mirtazapine/day.
Anyway, one day i had the same reactions you described, but i was also speaking jibberish, rocking back and forth, i couldn't sit still for one second, my blood pressure was through the roof (i went to a doc the next day, having panic attacks and he thought i had taken amphetamines!)...
It was like an extended panic attack, but i was very hot, mentally confused (speaking jibberish) -and unable to sit still.
Months later i was still having multiple panic attacks daily....finally they went away (benzo's for a few weeks would have been a god-send).
Now, i NEVER take tramadol, and always write on doctors forms that i'm allergic to it (I take 60mg mirtazapine/day plus multiple other Rx meds)....
Yeah.....it was all in all a HORRIBLE experience (mirtazapine + tramadol).....
pofacedhoe
Bluelight Crew
both these drugs affect noradrenaline-maybe this made you feel shit as excess does tend to make people feel ill
Tryptamine*Dreamer
Ex-Bluelighter
I may have also developed serotonin syndrome today. I don't know if that is what it was, but I thought I might have to go to the hospital, or worse.
Here is what happened:
I used MDMA a few days ago. I thought I'd use something to help restore the serotonin levels in my brain. Not really necessary, as I was feeling just fine without it.
I've used 37.5mg of venlafaxine, 50mg 5-htp, and 150mg bupropion twice daily the last few days. I took those things maybe 5 hours ago. An hour later I used 175mg diphenhydramine, 1.2g neurontin, 22.5mg hydrocodone, some poppies, and 120mg DXM. I started to feel bad just a little later. I felt my blood pressure might be a bit high and I felt overheated. A minute or so later, I felt this feeling come over my body. It felt similar to the feeling I get when ayahuasca is kicking in. Weird sensations were felt all over. It was like pricks, tingling, and mild electric shocks. I got lightheaded and my body started heating up quickly. I felt I might pass out at times. My heart rate was going up and down pretty quickly, sometimes normal and sometimes at least 120bpm. My mind was altered in a way that was much different from anything I've felt from the drug combo I used. I checked my BP 5 or 6 times, with ranges from 174/98 to as low as 119/73. I felt like I was going to vomit. I took a half of a prochlorperazine pill for nausea, holding it under my tongue. This had been going on for a little over 2 hours by this time. I decided to check my temperature, and it was running 100.1. I started feeling improvement within 10 minutes of the prochlorperazine. I did the same with the rest of the prochlorperazine pill. My symptoms improved drastically over the next 30 minutes.
I don't know if this was serotonin syndrome. It may have been a bad panic attack, though some of the physical symptoms were different from other panic attacks I have had.
I got the same feelings once from mixing 600mg of DXM with 2.5mg of DOC, 45mg hydrocodone, and 100mg diphenhydramine. The symptoms were worse than today.
I also had a somewhat similar reaction to mixing HBWR and MDMA. I felt like my temperature and possibly my blood pressure was severely elevated with this one. My pupils were huge and wouldn't shrink even with bright light. There weren't as many of the weird body feelings this time and I vomited and dry heaved for several hours. Otherwise, it was similar to the above cases. It is hard to tell with this and the DOC+DXM if I had any alteration in consciousness from possible serotonin syndrome due to their power. I thought I was dying both of those times.
The experience I had today was definitely not normal for the drugs I used.
I'm still feeling a bit strange, but my mood is excellent.
Here is what happened:
I used MDMA a few days ago. I thought I'd use something to help restore the serotonin levels in my brain. Not really necessary, as I was feeling just fine without it.
I've used 37.5mg of venlafaxine, 50mg 5-htp, and 150mg bupropion twice daily the last few days. I took those things maybe 5 hours ago. An hour later I used 175mg diphenhydramine, 1.2g neurontin, 22.5mg hydrocodone, some poppies, and 120mg DXM. I started to feel bad just a little later. I felt my blood pressure might be a bit high and I felt overheated. A minute or so later, I felt this feeling come over my body. It felt similar to the feeling I get when ayahuasca is kicking in. Weird sensations were felt all over. It was like pricks, tingling, and mild electric shocks. I got lightheaded and my body started heating up quickly. I felt I might pass out at times. My heart rate was going up and down pretty quickly, sometimes normal and sometimes at least 120bpm. My mind was altered in a way that was much different from anything I've felt from the drug combo I used. I checked my BP 5 or 6 times, with ranges from 174/98 to as low as 119/73. I felt like I was going to vomit. I took a half of a prochlorperazine pill for nausea, holding it under my tongue. This had been going on for a little over 2 hours by this time. I decided to check my temperature, and it was running 100.1. I started feeling improvement within 10 minutes of the prochlorperazine. I did the same with the rest of the prochlorperazine pill. My symptoms improved drastically over the next 30 minutes.
I don't know if this was serotonin syndrome. It may have been a bad panic attack, though some of the physical symptoms were different from other panic attacks I have had.
I got the same feelings once from mixing 600mg of DXM with 2.5mg of DOC, 45mg hydrocodone, and 100mg diphenhydramine. The symptoms were worse than today.
I also had a somewhat similar reaction to mixing HBWR and MDMA. I felt like my temperature and possibly my blood pressure was severely elevated with this one. My pupils were huge and wouldn't shrink even with bright light. There weren't as many of the weird body feelings this time and I vomited and dry heaved for several hours. Otherwise, it was similar to the above cases. It is hard to tell with this and the DOC+DXM if I had any alteration in consciousness from possible serotonin syndrome due to their power. I thought I was dying both of those times.
The experience I had today was definitely not normal for the drugs I used.
I'm still feeling a bit strange, but my mood is excellent.
Doctor War
Bluelight Crew
That was a very dumb thing to do...
sarbanes
Bluelighter
- Joined
- Mar 8, 2007
- Messages
- 481
I've had mild SS, and it's absolutely horrible. It's like a heavily induced panic attack, and even worse (psychologically) than a bad acid trip. Tachycardia, hyper vigilance, myoclonus, diarrhea (rihanna, what a horrible name she has...sounds like a rhino virus), best to have some beta blockers handy, and some sedatives. Also, phenytoin sodium seems to help. Also, careful combining tramadol with buprenorphine, 1,4-BDO, and many anti-histamines. There is one antihistamine which can help though...cyrpoheptadine. The best thing for SS IMO is to stop taking what is causing it (of course), and then to plug a beta blocker. Plugging is the single most under rated mode of administering drugs. And I don't mind the bitter taste one bit, so that's not the reason alone that plugging is so great.