Stimulants Serotonin syndrome risk from amphetamines + ssri/snri

[Lucy Bookit]

I'm on effexor xr (300mg per day--the highest dose you can be on) and am now on adderall (30mgx2 per day). I have had not problems. In the past when I used it, I never had a problem either. (I'm also on Lamictal for my depression, which doc is now calling an unknown mood disorder and it's working wonders for me.)

Anti-depressants are all trial and error. Also, adafinal and modafinil are highly expensive without insurance (1600 per month or 1200 per month at least in the states... they aren't covered by my insurance which is why I'm on adderall, just fyi).

 

[sacsky]

Can you describe what Lamictal is doing exactly? Does it also make you less depressed or does it have a different effect?
I am looking for add-on options. I came across Lamictal in the past but I really don't know if I should get into add-ons without even having an AD which works in the first place.
Also, does Lamictal have many scary side effects? If a drug has too scary side effects I don't dare to take it.

ADs + benzos causing SS? This sounds really strange to me. Many people who are on ADs also take benzos against anxiety.

 

[Lucy Bookit]

I was wrong about the benzos. From what I'm reading MANY different drugs can cause this, but it's highly unlikely. The way it was explained to me is that you'll realize it's happening and that's when you need to worry. It's very unlikely though. I forget what I was taking at the time, but I've always taken benzos and ADs so I thought that was it. (I've also taken them with resperidol, seroquel, trazadone, and abilify for a short time--no SS every--as well as many other medications for arthritis/asthma/fibromyalgia/hypersomnia.)

The lamictal can be taken alone or as an add on. My bf has taken it for years alone for bipolar (he also takes adderall for adhd), and I've taken it with my effexor/adderall for a few months. I haven't noticed any real side effects. For me, it helps me balance my mood because I was having intense random bouts of suicidal ideation, and it really has helped that stop so I feel a lot better. I'm actually going to start tapering off of effexor xr finally. I wouldn't worry about this combination. I think you should definitely talk to your doctor about the adderall, and all of your concerns so that he can allay your fears.

I hope this helps.

 

[sirfoxey]

Sorry for my late reply. I am on 220 daily and have found it has worked rather well for me. Took about 3 months for me to notice a difference.

 

[sacsky]

@ lucy

Yes I'll ask him about adderall. But since he has no experience with amphetamines I assume that he will not be willing to prescribe them.

So basically the lamictal only helps against suicidality but not against depression itself? Then I'm not sure if it would help me. I needed something against depression.

@ sirfoxey

3 months is damn long. Usually I dont take ADs for that long cause I don't want to waste time. Also when you're on an AD for that long and then notice it doesn't work then the
chances of discontinuation symptoms are also bigger. I took Lexapro for a few months, it didnt work, and when I stopped I got brain zaps.

 

[sirfoxey]

i have tried a number of them prior to this. The first one had me spiral so far down it was the cause of the hospital admission. Finally we got there, with a good end result

 

[Lucy Bookit]

Yeah, I agree with sirfoxey. Effexor helped me greatly--the best AD I've used. Now it's beginning to wane in effectiveness for me, mostly because of a lot of personal situations that happened this year (my grandma passed, got laid off, my parents sold my childhood home, and moved to a new state). Lamictal smoothes out my moods so I feel sad when it's appropriate, and I don't spiral down into intense depression (for me this is almost always leads to feeling suicidal). However, ADs work for people in different ways, and lamictal/effexor may not be right for you.

I'd say talk to your doctor about modafinil/adafinil, and once you explain the cost, he'll be more willing to switch (this is what happened for me). I am surprised he doesn't know about adderall, if you have been on ritalin in the past. Was this through the same doctor?

 

[sacsky]

Yes it's the same psychiatrist. The thing is that amphetamines are usually only used in adhd children where I live. For adults there's only MPH,strattera and wellbutrin. This stinks.
Because of this he also has no experience with amphetamines.

For me it's also an issue to tell if an AD even works. I mean unless it makes me feel exceptionally good I cannot tell it. I have days where I feel 5/10 and I have days where I feel like 2/10.
The problem is that when I'm on an AD and have normal 5/10 days then I cannot tell if I would have felt the same way without AD. Basically I can only tell if an AD works when I experience really
bad days cause then I can tell that obviously it doesn't work.
Maybe ADs work for me and they are so weak that I don't recognize their effect.

I simply needed something to keep me stable and functionable. I am overwhelmed by things very often and then it can happen that I'm depressed for days and can't pull myself out of it.
This is a huge problem in times where I needed to function and study for example but I can't cause I'm too depressed.
I have various health issues, which if I'm reminded of them, can instantly depress me. For example if my eczema flares up then this can be enough to totally depress me. I can't simply "get over"
certain things. Every time I am reminded of them or start to examine my body I become depressed again. It has been like this for years. Every time when I feel like I discovered something abnormal
I instantly become afraid and feel absolutely exhausted. On such days I just want to lay in bed and do nothing.

 

[sirfoxey]

I would say that my AD initially only worked about 30% but it was enough to drag me out of the deep deep hole I was in. Then with a combination of tweaking my drug combination with my psychiatrist, extensive work with my psychologist, change in life style such as diet and exercise I noticed that I was about 60-65% better and really feeling like life was much better. Week by week the percentage continue to rise and as it has my psychiatrist and I have adjusted my combination of medications to ensure I am not over medicated.
It really takes a lot of dedication and work, but I do believe with the right medical staff and educating yourself with all the drug and medical options so you can have informed conversations with your team of health professionals you can get the right combination of medication to have you feel on top of the world.

 

[PsychedelicWizard]

Amphetamine does not affect serotonin in a way that would lead to SS even if used in conjunction with SSRI's. SS is seriously overblown on these forums (and others, too) - it's definitely a serious condition but it is not as common as the internet would have you believe.

Wouldn't your doctor advise you of this risk anyways?

It doesn't even matter what you tell these people, they are always going to be afraid of their own shadows.

 

[adrenalinerushes]

crazy how much the internet makes people hyper aware of a syndrome that i have never seen or heard of anyone experiencing. even on forums and stuff, i don't see people saying they've had it. i know people who have mixed ssri's and snri's and all types of stimulants, high doses too, and still no serotonin syndrome. not to say that it isn't real or that it can't happen, it can and it might happen. just my personal thoughts about the topic i guess. i am prescribed a cocktail of all sorts of serotonin altering meds and have always been and no doctor or psych or pharmacist has ever said those two words.

i wonder the actual likelihood of it is, i want to see numbers and percentiles. i would bet it's a very low amount compared to what people in forums and such would imagine.

sounds like if you were having SS you would definitely know. i assume your body would even give you warning signs that you're about to go into SS, therefore maybe you could stop it by taking a benzo or beta blocker or something, or at least stop popping addies. just my opinion tho and thinking out loud.

 

[Trying2Iso]

I dropped 60 of addies while on 300mg/day of Fluvoxamine
no SS.

 

[sacsky]

I got scared cause of a warning at a drug interaction website!

It's normal to check for drug interactions at websites. You can't blame me for being scared when the site says there is a major interaction between cymbalta & adderall.