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Do I have Seratonin Syndrome? (DXM)

Temeraroius

Temeraroius

Bluelighter
Joined
Sep 21, 2008
Messages
422
Location
New Orleans
Disclaimer, I am a little freaked out right now. So I take lexapro (10mg) daily and last night i tried a dxm trip. I ended up taking this much DXM at the following times last night

5:00 - 90mg (felt nothing)
6:00 - 120mg (Starting to feel it more now)
8:30 - 100mg (feelin strange)
9:10 - 60mg (been tripping)

This morning I did not go to class because I still felt what i thought was the dxm but could be seratonin syndrome. I have sweaty palms and feet, I am a little dizzy and a little shaky. I dont have a temperature. Do I have seratonin sydrome?
 
maybe a mild case of it. but you shouldnt worry.

it's probably still the DXM.
Lexapro sorta inhibits the enzyme that breaks down DXM. which should cause the DXM to stay in your system longer.
you should be fine. just drink plenty of water.

did you notice any difference in the trip?
cuz if I'm right about the enzyme inhibition, your dxm trip should have felt more speedy, more visual and a lot less stoney.

DXM does that(more hallucinations and kinda delusional), while DXO(the more dissociative metabolite) is more like ketamine.
 
Wow thank you so much that puts me way more at ease. Yeah the trip was less stony more drunk, i had a lot of depth perception issues but then again it was my first time using it. I remember looking at the ceiling of my room and feeling that it had all these craters n it the way the ight shines on it etc. I still feel like I am on a very low dose now and I am just kinda drunk and disoriented feeling. Any idea how as to how I can alleviate if not totally get rid of it? Would a hard bike ride or run help me metabolize the DXM? How long do you think until this goes away. It isnt HORRIBLE it is just really annoying.
 
I doubt you have serotonin syndrome. In fact, I think the whole serotonin syndrome-DXM thing is preposterous. Why? Because I've dosed lots of DXM while on SSRIs and I'm still alive, and I've never heard of anyone dying from combining DXM and MDMA.

You sound like you're just high on DXM. If you're caucasian and still really high the next day, you probably have a CYP2D6 deficiency. I do, and DXM takes a good 2 hours to come on and I'm not usually done with it for 12-14 hours after that.
 
'Afterglow'. Common lingo on all DXM-enthusiast essays and websites.

So you consumed DXM on top of a daily SSRI knowing what the effect could be (a painful death), and you did it anyway?

Why? I really would like to hear this.
 
That actually makes sense too because it took me quite a while to feel the effects. I think that in combination with SSRI is why I am still pretty lightheaded as I type this (I has now been 28 hours).
 
That actually makes sense too because it took me quite a while to feel the effects. I think that in combination with SSRI is why I am still pretty lightheaded as I type this (I has now been 28 hours).
 
That actually makes sense too because it took me quite a while to feel the effects. I think that in combination with SSRI is why I am still pretty lightheaded as I type this (I has now been 28 hours).
 
Tchort said:
'Afterglow'. Common lingo on all DXM-enthusiast essays and websites.

So you consumed DXM on top of a daily SSRI knowing what the effect could be (a painful death), and you did it anyway?

Why? I really would like to hear this.
Click to expand...

And I didnt know about the SSRI issue, even so I was fine because I hadnt taken my lexapro for a week. It was still in my system but I assume not to its fullest extent.
 
I think the only drug that actually causes serotonin syndrome is chlorphenamine (which is a serotonin, norepinephrine, and dopamine reuptake inhibitor). Notice how there's never been any DXM deaths attributed to serotonin syndrome except with coadministration of Chlorphenamine?

I mean, how about this study:
MK-801 and DXM prevent METH-induced hyperthermia and lead to a persistent hypothermic state.
Click to expand...
http://www.sciencedirect.com/scienc...serid=10&md5=88173ca9ed26e4e6ccb739f1531c6a70

Serotonin syndrome is characterized by a hyperthermic state! There's some evidence that DXM releases some 5HT through an unknown function (thought to be modulated by NMDA antagonism) but I really don't feel like there a tremendous amount of evidence to warrant the warning, since I'm sure that millions of people on SSRIs probably consume DXM containing cough preparations and we've never heard of even one death!
 
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Always remember: recreational use of DXM is still a great unknown. The brain you are risking is your own.

-The father of recreational DXM research William White

10 seconds of google:

Serotonin syndrome is a recently identified condition that can occur when combining serotonergic drugs which stimulate, or emulate serotonin. DXM releases serotonin, and while it has never been shown to cause serotonin syndrome in it's pure form, it has been shown to be a cause when used in combination with other serotonergics -particularly when combining SSRIs with DXM. Other drugs also include buspirone (BuSpar), MDMA (ecstasy) and other phenethylamines, tryptophan, harmine and harmaline.. What this means in plain English -is, if you're taking any psychoactive medication, and you take DXM -you are running an extremely high risk for all sorts of dangerous and potentially deadly reactions.
Click to expand...

I've never really understood the 'take now, learn later' attitude. I guess that's what I'm more interested in.
 
I thought I had learned, I am usually very cautious. I didnt know anything about the SSRI issues though. So considering I haven't taken my lexapro in a week, do you think it is that I have a CYP2D6 deficiency or is it my SSRIs that caused this effect?
 
Lexapro only has a 32 hour half life at most, so after 168 hours over 97% of the escitalopram (lexapro) would have been excreted. I would think there's not a huge impact from that.

CYP 2D6 is a pretty common deficiency among caucasians (6-10% of caucasian population).
 
nuke said:
I doubt you have serotonin syndrome. In fact, I think the whole serotonin syndrome-DXM thing is preposterous. Why? Because I've dosed lots of DXM while on SSRIs and I'm still alive, and I've never heard of anyone dying from combining DXM and MDMA.
Click to expand...
lol anecdotal evidence ftw 8)
 
Haha yeah I will assume it the deficiency because I woke up this morning and felt AMAZING though still just slightly high. I feel really full of energy and awake. I am sure what I am feeling is the so-called afterglow along with a tiny bit of intoxication from the DXM.
 
CYP 2D6 is a pretty common deficiency among caucasians (6-10% of caucasian population).
Click to expand...
I used to take DXM and the effects would always last at least 24 hours or longer. The effects were very bizarre, very stimulating (in an uncomfortable sort of way), and made sleep impossible for up to 2 nights.

When taken in higher doses, I would get very intense and quickly changing visuals. It was awesome the couple times when I got hallucinations (I still remember freaking out with excitement as I lay in bed and floated from scene to scene, some places I'd been to before and some I hadn't but I still "knew" where I was) but as time went on the negatives really took over the trip.

These days I couldn't even take 90mg without getting really sweaty, uncomfortable, and with an extreme amount of muscle rigidity.

Come to think about it, a lot of the effects I would get sounded like seratonin syndrome, so I guess it's possible it could cause it, particularly in CYP2D6 deficient people.
 
Gaian Planes said:
lol anecdotal evidence ftw 8)
Click to expand...
Produce some evidence for me of serotonin syndrome occured when only an SSRI was coadministered.

How about this one?
Introduction. The ability of dextromethorphan to potentiate serotonin levels and lead to serotonin syndrome is well known but few case reports are published. The lack of published cases suggests therapeutic doses of these drugs are not enough to cause serotonin syndrome. We present two cases of serotonin syndrome associated with supra-therapeutic doses of dextromethorphan and therapeutic levels of a selective serotonin reuptake inhibitors (SSRI). Case Series. In case one, serum drug levels from admission revealed a dextromethorphan level of 950 ng/mL (normal<5), escitalopram of 23 ng/mL (normal<200), chlorpheniramine of 430 ng/mL (normal<20) and undetectable levels of aripiprazole and benztropine. In case two, serum drug levels from admission revealed a dextromethorphan level of 2820 ng/mL, sertraline of 12.5 ng/mL (normal<200), and caffeine of 1.4 mug/mL (normal</= 9 mug/mL). Discussion. To our knowledge, these are the first cases to use serum levels of dextromethorphan and a SSRI to confirm dextromethorphan-induced serotonin syndrome. Conclusion. Our cases suggest supra-therapeutic dextromethorphan doses with a therapeutic amount of a SSRI are required for serotonin syndrome. More work is needed to answer this question more completely.
Click to expand...
Nope!

This one?
An 18-year-old male developed a severe serotonin syndrome after recreational ingestion of Coricidin HBP (chlorpheniramine 4 mg and dextromethorphan hydrobromide 30 mg). Propofol infusion rapidly normalized his agitation, neuromuscular hyperactivity, and autonomic instability. Confirmatory analysis demonstrated a dextromethorphan serum concentration of 930 ng/mL. Dextromethorphan can produce serotonin syndrome in the absence of another serotonergic drug.
Click to expand...
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A case of serotonin syndrome precipitated by abuse of the anticough remedy dextromethorphan in a bipolar patient treated with fluoxetine and lithium.
Click to expand...
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

We describe a patient treated with trazodone, isocarboxazid, and methylphenidate hydrochloride who developed confusion, agitation, poor concentration, rigidity, myoclonus, involuntary movements, orthostatic hypotension, and hyperreflexia. CK was normal, and the syndrome resolved spontaneously over 12 hours. The serotonin syndrome occurs following the use of serotomimetic agents (serotonin reuptake inhibitors, tricyclic and tetracyclic antidepressants, tryptophan, 3,4-methylenedioxy-methamphetamine, dextromethorphan, meperidine, S-adenosylmethionine) alone or in combination with monoamine oxidase inhibitors. It is characterized by various combinations of myoclonus, rigidity, hyperreflexia, shivering, confusion, agitation, restlessness, coma, autonomic instability, low-grade fever, nausea, diarrhea, diaphoresis, flushing, and rarely, rhabdomyolysis and death.
Click to expand...
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

No, no, no.

And here's the single one I did find:
There is a new, potentially fatal disorder that is infrequently reported. The apparent rareness may be because of a lack of recognition of the syndrome or its predisposing factors. Fluoxetine (Prozac, Dista Products Co, Division of Eli Lilly Co, Indianapolis, IN), sertraline (Zoloft, Roerig Division, Pfizer Inc, New York, NY), and paroxetine (Paxil, SmithKline Beecham Pharmaceuticals, Philadelphia, PA) belong to a new class of antidepressant medication: the serotonin reuptake-inhibitors (SRIs). The relative safety profile of the SRIs has led to their widespread use. However, a syndrome of excessive serotonergic activity, the "serotonin syndrome" (SS), has recently been recognized. It is characterized by changes in mental status, hypertension, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, and tremor. A high index of suspicion is required to make the diagnosis in these acutely ill patients. The most common agents implicated in SS are the monoamine oxidase inhibitors in combination with L-tryptophan or fluoxetine. A case of a patient with significant peripheral vascular disease who developed SS while taking paroxetine and an over-the-counter cold medicine is reported. There have been no prior reports of this interaction. Discontinuation of the offending agents, sedation, and supportive care are the mainstays of treatment. The interactions of serotonin with platelets and vascular endothelium are also discussed.
Click to expand...
http://www.ncbi.nlm.nih.gov/pubmed/...l.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

I'm not saying it can't happen, but it does seem to be a rarity.
 
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