How long should I wait to take "x" drug after having very mild Serotonin Syndrome?

[Connor the Alien]

How long should I wait to take "x" drug after having very mild Serotonin Syndrome?

Last Sunday I experienced what seemed to be some of the symptoms of SS, I had a constant muscle twitch in my left eye, slight confusion and feelings of impending doom and anxiety. I think the cause of the drug interaction was when I took 20mg of Amitriptyline on Thursday night for a slight panic attack I was having, Then on Saturday I took 150mg of Tramadol, I took 100mg first and then another 50, After a while my eye started twitching very slightly but uncontrollably. I went to the pub with my friend and didn't drink any alcohol I then went back home and went straight to sleep. After a very uncomfortable sleep full of very strange dreams, I got up to see if my eye was still twitching - it was. At this point I started panicking think I'd need to go to hospital, However I just hung around with my friend in town do if the symptoms got worse I got easily get to the hospital. I waited around with my mate for about 5 hours and my symptoms hadn't got worse so I went back home. When I got home I felt very depressed and went to sleep. I woke up the next day and the twitching had virtually gone and still had some slight mood swings however I'm not sure if they were related as I do suffer form depression and anxiety. Anyway All of my symptoms have now passed since Saturday/Sunday and it is now Wednesday, and I was wondering how long should I wait before I can again do the following drugs:

Cannabis
Cocaine
Kratom
MDMA (Don't have any real interest in taking this any time soon, just wondering)

Thanks in advance.

 

[Achten]

If I read this correctly, you had:

- previously no drugs
- Thursday: 20mg amitryptilline due to panic attack
- Saturday: 100mg + 50mg Tramadol
- Sunday: the musce twitch and other things which made you think it was SS.

I'm not a doctor but I can tell you my GP prescribed me 25 mg amitryptilline + 150mg tramadol before sleep due to neuropathic pains. I have never experienced a bad reaction. So I'm pretty sure it was not SS you experienced.
Amitryptilline makes me drowsy (I wouldn't use the word "depressed" but that's personal). And an eye twitch can occur without drug use as well.

I wouldn't worry about it too much.
My take is you have some anxiety you haven't worked through ? Try meditation, or if you really want to trip, low dose MDMA to think about those feelings. Make sure the tramadol is out of your system though. I usually wait 60hours after 50mg of tramadol, so if you took more take that into account. It's probably a bit overdoing it with the waiting time, but better safe than sorry !

To answer your question directly, from my personal POV:

- don't do cocaine. Unless you're getting pure stuff (you're not), it's a shitty drug.
- Cannabis is always nice, but if you have problems with anxiety I'd suggest a low THC - high CBD strain.
- I don't see a problem with Kratom, just remember as with any drug, less is more !
- If you're experienced working through your problems with psychedelics, as I said low dose MDMA could help. If you're not, abstain untill you feel confident enough to do it without asking strangers on the interwebs if you should.

All the best wishes !

 

[whippa craka]

You getting SS at this point would have nothing to do with the drug's you have taken a week before if you were not dependent on them. I am very surprised that 150mg of Tramadol, 2 days after 20mg Amitriptyline would of been causing SS-like symptoms.

That is very rare, and if it was SS you better be darn careful in the future taking any serotonergic drugs. You would be very sensitive and prone to seizure's, be careful.

No Interest in taking MDMA? Congrats to you.

 

[Connor the Alien]

Thanks for the advice, So chances are it wasn't SS? So would I be OK taking some MDMA next Tuesday or should I just call it off?

 

[Swimmingdancer]

I would be more concerned about the side effects of all these drugs and issues like whether they might exacerbate your anxiety, than the possibility of serotonin syndrome.

How often do you take amitriptyline?

What you experienced might have just been bad side effects combined with a panic attack, which is still not fun, we can't really know for sure whether or not it was serotonin syndrome since you didn't seek medical attention. Both tramadol and amitriptyline are known to cause the effects you described as a side effect. I can tell you what the normal symptoms of serotonin syndrome are, but bear in mind that you don't have to have all of them to have SS of course, and that many of them can happen independent from SS and be due to another cause.

Symptoms of serotonin syndrome:
Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma
Autonomic effects: shivering, sweating, hyperthermia, hypertension, fast heart rate, nausea, diarrhea
Somatic effects: myoclonus (muscle twitching), over-responsive reflexes, tremors

If you did experience serotonin syndrome or some other adverse reaction due to taking the amitriptyline and tramadol, assuming:
- it was 4 days ago
- you weren't taking them frequently/long-term
- and you are no longer taking them
then it shouldn't have much bearing on whether or not you can use cannabis, cocaine, kratom or MDMA, as the tramadol and amitriptyline should be mostly out of your system.

Furthermore, I am not aware of cannabis ever causing serotonin syndrome. I would not think that there should be any additional risks taking MDMA next Tuesday than usual. Have you done MDMA before? I think I'd avoid the cocaine, but more because of your situation and it's side effects than a likelihood of serotonin syndrome.

 

[JackiesBabyy]

What you had sounds much more like a panic attack and maybe a non-deadly hypertensive crisis and that's very easily mistaken for SS by someone who hasn't had SS. If you really had serotonin syndrome, my god, you would know. All of the drugs you listed can cause panic and blood pressure spikes though.

 

[Swimmingdancer]

If you really had serotonin syndrome, my god, you would know.

That's not necessarily true. According to this review article: "clinical manifestations of serotonin syndrome range from barely perceptible to lethal". Mild serotonin syndrome may not be fatal, but if it is overlooked and more drugs are taken it may turn into severe serotonin syndrome. It's notoriously difficult for doctors to even tell whether or not someone's symptoms are in fact a presentation of serotonin syndrome.