SNRI and SSRI use with MDMA

[NadyaMaude]

I’m dosing at 100mg today on small dose of SSRI and SNRI. I have worked with an
MD and he is not saying don’t do it bc the chance of serotonin syndrome is low. Do you agree? I had a great experience on Wellbutrin and MDMA 2x in past. I fo take Valporic Acid too. Thanks for your responses!!!

 

[Pissed_and_messed]

Basically SNRI is not problem, except that it can pretty much nullify the trip. Wellbutrin has no serotonin activity so it didn't do the same for that reason.

I can not say anything about valproic acid, I have no idea about its pharmacology. Or if there are some concerning secondary effects from the SNRI/SSRI you are taking without telling what they are.

 

[NadyaMaude]

Aside from Wellbutrin I take the lowest dose of Prozac 10mg.

 

[Pissed_and_messed]

I recall prozac having higher affinity to VMAT2, while lacking the complete serotonin dump effect of MDMA, so it will pretty much prevent molly of working unfortunately :/

 

[NadyaMaude]

Oh dammit! I’m experiencing that now. Even with this low dose of Prozac. I wonder if it’s like agonist therapy with suboxone and opiates. There’s a ceiling effect and in order for pain meds to work with suboxone a higher dose has to be taken. I’m on suboxone and just had a surgery and this was the case. Doubling the dose worked to bypass the ceiling. But maybe this is different pharma all together. I took 80 mg to start.

 

[ageingpartyfiend]

wouldn't advise chasing the mdma dose personally

 

[kiely]

could you drop to a micro dose of mdma. maybe.

 

[Pissed_and_messed]

yeah, if 150 mg does not take you where you want, it is no use to try anything beyond it.

 

[Pissed_and_messed]

It is there with SSRIs (won't just blunt effect, but also risks serotonin syndrome as it increases amount of serotonin in synaptic cleft substantially.)

Do you have source for this claim? I have never been pointed out one.

molly already acts in sites SSRIs do, only with much more powerful response. This claim about SS apparently has its origins in some finnish publication decades ago, and eventually developed into global myth.

Continuum error-this and following posts are directed from antipsychotics and MDMA-thread.

 

[ShulginsReincarnation]

Do you have source for this claim? I have never been pointed out one.

molly already acts in sites SSRIs do, only with much more powerful response. This claim about SS apparently has its origins in some finnish publication decades ago, and eventually developed into global myth.

Not to be rude, but the source is common sense. You are mixing a serotonin releasing compound (MDMA) with one that prevents its reuptake... I really don't feel a source other than common sense is needed here, but I will try to find one for you later this evening when I have more time.

Peace.

 

[Pissed_and_messed]

SSRIs and MDMA are competing against each other on the same sites. If you have been off both for a while, combining molly and SSRI with higher affinity kills the trip, because the SSRI still does not act as serotonin releaser. If you combine molly with SSRI with weaker affinity, it possibly is not as great mistake but might somehow affect the roll anyway.

This dynamics is also reason coke stops roll, because it has higher affinity in the same sites but it releases much less serotonin.

If someone has been on SSRI for a long time, molly always has much less of effect or barely any effect because of how SSRI long-term use changes serotonergic system.

This has even been acknowledged by many professionals that work in medical science.

Everything You Need to Know About Mixing MDMA and Antidepressants

It's difficult to get high when on SSRIs, but is trying to do so actually doing you any damage?

www.vice.com

I kinda have a beef with Vice for few reasons, and hate to refer them, but I checked Russell Newcombe they interviewed. Russell seems fine. https://en.wikipedia.org/wiki/Russell_Newcombe

!NOTE! Some SSRIs have some additional effects that render them dangerous with molly, but it is not because of their SSRI function. !NOTE!

 

[ShulginsReincarnation]

SSRIs and MDMA are competing against each other on the same sites. If you have been off both for a while, combining molly and SSRI with higher affinity kills the trip, because the SSRI still does not act as serotonin releaser. If you combine molly with SSRI with weaker affinity, it possibly is not as great mistake but might somehow affect the roll anyway.

This dynamics is also reason coke stops roll, because it has higher affinity in the same sites but it releases much less serotonin.

If someone has been on SSRI for a long time, molly always has much less of effect or barely any effect because of how SSRI long-term use changes serotonergic system.

This has even been acknowledged by many professionals that work in medical science.

Everything You Need to Know About Mixing MDMA and Antidepressants

It's difficult to get high when on SSRIs, but is trying to do so actually doing you any damage?

www.vice.com

I kinda have a beef with Vice for few reasons, and hate to refer them, but I checked Russell Newcombe they interviewed. Russell seems fine. https://en.wikipedia.org/wiki/Russell_Newcombe

!NOTE! Some SSRIs have some additional effects that render them dangerous with molly, but it is not because of their SSRI function. !NOTE!

Yes, I am going to look more into this soon. I am getting very many conflicting bits of information from sources that should be considered reputable, and I cannot find a single definite study (likely due to the unethical nature of such a study in live organisms.) Hmm... Thanks for sharing.

 

[Conky]

SSRIs and MDMA are competing against each other on the same sites. If you have been off both for a while, combining molly and SSRI with higher affinity kills the trip, because the SSRI still does not act as serotonin releaser. If you combine molly with SSRI with weaker affinity, it possibly is not as great mistake but might somehow affect the roll anyway.

This dynamics is also reason coke stops roll, because it has higher affinity in the same sites but it releases much less serotonin.

If someone has been on SSRI for a long time, molly always has much less of effect or barely any effect because of how SSRI long-term use changes serotonergic system.

This has even been acknowledged by many professionals that work in medical science.

Everything You Need to Know About Mixing MDMA and Antidepressants

It's difficult to get high when on SSRIs, but is trying to do so actually doing you any damage?

www.vice.com

I kinda have a beef with Vice for few reasons, and hate to refer them, but I checked Russell Newcombe they interviewed. Russell seems fine. https://en.wikipedia.org/wiki/Russell_Newcombe

!NOTE! Some SSRIs have some additional effects that render them dangerous with molly, but it is not because of their SSRI function. !NOTE!

SSRIs don't kill trips from mdma or hallucinogens, they intensify negative effects those drugs cause

 

[ShulginsReincarnation]

SSRIs don't kill trips from mdma or hallucinogens, they intensify negative effects those drugs cause

Fairly certain that SSRIs always killed my mescaline experiences and I had eaten quiiiiite a bit of cactus....
Not any worse effects, but certainly no trip occurred. Just the usual side effects.

With MDMA though, it is possible because the MOA is different which I described above (though there is some evidence that may not even be correct. I still have yet to do my more thorough digging as I have not had time yet.)

 

[Shinji Ikari]

Not to be rude, but the source is common sense. You are mixing a serotonin releasing compound (MDMA) with one that prevents its reuptake... I really don't feel a source other than common sense is needed here, but I will try to find one for you later this evening when I have more time.

Peace.

Here's my own common sense approach. SSRIs are among the most commonly prescribed drugs in the world. MDMA is one of the most commonly abused drugs in the world.

Why isn't this combination killing hundreds of people every weekend? If mixing the two is so likely to result in serotonin toxicity why aren't we seeing reports of it happening all the time? With drugs this common you wouldn't think you'd have to look far for reports of ravers dropping like flies.

My country (UK) has a long standing reputation for MDMA abuse which would make most peoples buttholes clench and yet figures from the Office for National Statistics dating from the mid 90s (when harm reduction information was far less accessible and contra indications for these drugs were far less understood) show only a handful (single digits for some years) of users dying as a consequence of their use. This is all deaths where MDMA/ecstacy has been named on the death certificate.

Doesn't that seem kind of low given the assumed risk of mixing mdma with a drug which at least 10% of the population are prescribed at any given time?

In practice lots of people have tried taking MDMA while prescribed an SSRI -I have, many people I know personally have- and the result is usually little more than disappointment. I'd assume that the relevant receptors are either already occupied by the SSRI or down-regulated as a consequence of it but I'd be lying if I said I knew. I digress.

Real world experience suggests that the risks have been greatly exaggerated, and more and more academic material seems to suggesting the same.

 

[ShulginsReincarnation]

Here's my own common sense approach. SSRIs are among the most commonly prescribed drugs in the world. MDMA is one of the most commonly abused drugs in the world.

Why isn't this combination killing hundreds of people every weekend? If mixing the two is so likely to result in serotonin toxicity why aren't we seeing reports of it happening all the time? With drugs this common you wouldn't think you'd have to look far for reports of ravers dropping like flies.

My country (UK) has a long standing reputation for MDMA abuse which would make most peoples buttholes clench and yet figures from the Office for National Statistics dating from the mid 90s (when harm reduction information was far less accessible and contra indications for these drugs were far less understood) show only a handful (single digits for some years) of users dying as a consequence of their use. This is all deaths where MDMA/ecstacy has been named on the death certificate.

Doesn't that seem kind of low given the assumed risk of mixing mdma with a drug which at least 10% of the population are prescribed at any given time?

In practice lots of people have tried taking MDMA while prescribed an SSRI -I have, many people I know personally have- and the result is usually little more than disappointment. I'd assume that the relevant receptors are either already occupied by the SSRI or down-regulated as a consequence of it but I'd be lying if I said I knew. I digress.

Real world experience suggests that the risks have been greatly exaggerated, and more and more academic material seems to suggesting the same.

Ughhh drives me mad when people mistake what is said like this... serotonin syndrome ≠ death in most cases. Most of the time it is just uncomfortable, and most people experimenting mixing drugs like this have probably had it at some point tbh.

I think what is exaggerated is the ideas in your head about serotonin syndrome. And, furthermore, any reports in academia indicate that it would be a mild risk if anything (I am barely finding any mention of it in actual academic journals though; just a lot of references of doctors mentioning it to the public is all.) Never once did I mention death either way; that's just a common misconception about serotonin syndrome (everyone seems to think death is an always in serotonin syndrome cases despite it being quite rare.)

There is a risk if one keeps taking MDMA hoping for a better effect while on SSRIs, sure. But, the cost factor is self limiting. And, in the UK as you say you are specifically referencing, I imagine a person would switch to ketamine if 30 quid worth of MDMA was doing fuck all for them considering the price factor being much better with the K, no? lol just a thought...

Anyway, thanks for the input as it is valid to some extent. Just a little misconstrued in a way is all, so I hope I have set that straight.

 

[Conky]

Fairly certain that SSRIs always killed my mescaline experiences and I had eaten quiiiiite a bit of cactus....
Not any worse effects, but certainly no trip occurred. Just the usual side effects.

With MDMA though, it is possible because the MOA is different which I described above (though there is some evidence that may not even be correct. I still have yet to do my more thorough digging as I have not had time yet.)

Wouldn't that be a bad trip though if all you got was side effects?

I took what was supposedly ALD 52 while on sertraline and it was the worst single drug experience I've had and I was fucked mentally for 10 days after

A sedative hypnotic or serotonin antagonist could have prevented so much suffering but I didn't have any cause I thought I'd be fine from 1 dose

 

[Shinji Ikari]

Ughhh drives me mad when people mistake what is said like this... serotonin syndrome ≠ death in most cases. Most of the time it is just uncomfortable, and

That was more of a thought exercise, I'm not suggesting that serotonin toxicity is usually or often fatal. Actually all I really wanted to question is what you're calling common sense, and why.

See I might define common sense as a singular or series of logical assumptions informed by some degree of experience. An example of this would be that combining a drug which releases large amounts of serotonin with a drug which blocks it's reuptake would result in serotonin levels being elevated to dangerious levels. This would be a perfectly logical assumption to make, but in practice that's not what happens.

That is to say that common sense will not always direct you to the correct conclusion no matter how obvious it may seem.

I should have just written that, or nothing, it was early.

most people experimenting mixing drugs like this have probably had it at some point tbh

Is that common sense too? Don't worry I'm just teasing

I'll tug on the frayed ends of your sanity no longer. See you around friend

 

[Pissed_and_messed]

This claim about SS apparently has its origins in some finnish publication decades ago, and eventually developed into global myth.

I would just add that some people were mistaking MAO-i to SSRI and that's where it all started from. I asked my friend source but might be they won't find it again, but they read it in the summer somewhere, apparently reliable source, because my friend has stout media literacy.

It is funny to think that some half-assed journalist in the country of few million people succeeded in misleading, say, at least hundreds of millions of people for decades when the bullshitball started to roll...

 

[ShulginsReincarnation]

That was more of a thought exercise, I'm not suggesting that serotonin toxicity is usually or often fatal. Actually all I really wanted to question is what you're calling common sense, and why.

See I might define common sense as a singular or series of logical assumptions informed by some degree of experience. An example of this would be that combining a drug which releases large amounts of serotonin with a drug which blocks it's reuptake would result in serotonin levels being elevated to dangerious levels. This would be a perfectly logical assumption to make, but in practice that's not what happens.

That is to say that common sense will not always direct you to the correct conclusion no matter how obvious it may seem.

I should have just written that, or nothing, it was early.


Is that common sense too? Don't worry I'm just teasing

I'll tug on the frayed ends of your sanity no longer. See you around friend

"Question: "mdma plus ssri is serotonin syndrome?"

ChatGPT/Answer:

Thought for a second
Combining MDMA (3,4-Methylenedioxymethamphetamine) with SSRIs (Selective Serotonin Reuptake Inhibitors) can indeed increase the risk of serotonin syndrome, a potentially life-threatening condition. Here's a detailed overview:

Understanding MDMA and SSRIs
MDMA: Commonly known as ecstasy or molly, MDMA is a psychoactive drug that primarily increases the levels of serotonin, dopamine, and norepinephrine in the brain. Its effects include enhanced mood, increased energy, and altered sensory perceptions.

SSRIs: These are a class of antidepressants commonly prescribed to treat depression, anxiety disorders, and other mental health conditions. SSRIs work by increasing the levels of serotonin in the brain by inhibiting its reuptake into neurons.

Serotonin Syndrome Explained
Serotonin syndrome occurs when there's an excessive accumulation of serotonin in the central nervous system. This can lead to a range of symptoms, including:

Mild to Moderate Symptoms:

Agitation or restlessness
Confusion
Rapid heart rate and high blood pressure
Dilated pupils
Loss of muscle coordination or twitching muscles
Heavy sweating
Severe Symptoms:

High fever
Seizures
Irregular heartbeat
Unconsciousness
In severe cases, serotonin syndrome can be fatal if not treated promptly.

Why Combining MDMA and SSRIs Increases Risk
Both MDMA and SSRIs elevate serotonin levels but through different mechanisms:

MDMA causes a massive release of serotonin from nerve cells.
SSRIs prevent the reabsorption (reuptake) of serotonin, increasing its availability in the synaptic cleft.
When taken together, the combined effect can lead to dangerously high serotonin levels, significantly increasing the risk of serotonin syndrome.

Additional Risks of Combining MDMA with SSRIs
Reduced Euphoria: SSRIs may diminish some of the pleasurable effects of MDMA, leading individuals to take higher doses to achieve the desired effects, further increasing risks.

Dehydration and Hyperthermia: Both MDMA use and SSRIs can affect body temperature regulation, increasing the risk of overheating and dehydration, especially in environments like clubs or parties.

Cardiovascular Strain: The combined stimulatory effects on the heart can strain the cardiovascular system, posing risks for individuals with underlying heart conditions.

What to Do If You Suspect Serotonin Syndrome
If you or someone else is experiencing symptoms of serotonin syndrome, especially after taking MDMA and SSRIs together, seek immediate medical attention. Early intervention is crucial for effective treatment.

Preventive Measures and Recommendations
Consult Healthcare Professionals: Always talk to a healthcare provider before combining medications like SSRIs with other substances, including recreational drugs like MDMA.

Avoid Mixing Substances: Combining different drugs can lead to unpredictable and dangerous interactions.

Educate Yourself: Understanding the effects and risks associated with each substance can help make informed decisions about their use.

Conclusion
Mixing MDMA with SSRIs poses a significant risk for developing serotonin syndrome, among other potential health complications. It's essential to approach the use of any psychoactive substances with caution and under the guidance of healthcare professionals to ensure safety and well-being.

If you're considering using MDMA or are currently prescribed SSRIs and have questions about potential interactions, please consult a medical professional for personalized advice.






You said:
So, why is someone telling me its not a risk because the two drugs compete for a binding site?

ChatGPT/Answer:

Thought for a couple of seconds
It's understandable to be confused when receiving conflicting information about drug interactions. The assertion that MDMA and SSRIs do not pose a risk because they compete for a binding site stems from a partial understanding of how these substances interact within the brain. Let's delve deeper into this to clarify why combining MDMA with SSRIs still carries significant risks, including the potential for serotonin syndrome.

Understanding the Basis of the Claim
Competition for the Serotonin Transporter (SERT):

SSRIs work by blocking the serotonin transporter (SERT), which is responsible for reabsorbing serotonin from the synaptic cleft back into the presynaptic neuron. By inhibiting SERT, SSRIs increase the availability of serotonin in the brain.
MDMA also targets SERT but in a different manner. It enters the neuron via SERT and then reverses its function, leading to a massive release of serotonin into the synaptic cleft.
The Logic Behind Reduced Risk:

The argument is that since SSRIs occupy SERT, MDMA has fewer transporters to bind to, potentially diminishing its ability to release large amounts of serotonin. This competition might lead some to believe that the risk of excessive serotonin levels—and thus serotonin syndrome—is reduced.
Why This Reasoning Is Incomplete
Persistent Serotonin Elevation:

Even if SSRIs occupy some SERT sites, MDMA can still cause significant serotonin release through the available transporters. The interaction doesn't entirely prevent MDMA from increasing serotonin levels; it may only modulate the extent.
Additional Mechanisms of Serotonin Increase:

MDMA doesn't solely rely on SERT to elevate serotonin. It can affect other serotonin receptors and pathways, contributing to increased serotonin activity even in the presence of SSRIs.
Cumulative Effects:

Both MDMA and SSRIs independently elevate serotonin levels through different mechanisms. When combined, their effects can add up, leading to higher overall serotonin activity than either would achieve alone.
Variability in Response:

Individual differences in metabolism, the specific SSRI used, dosage, and overall health can influence how these drugs interact. Some individuals might be more susceptible to serotonin syndrome even if there's partial competition at SERT.
Risks Beyond Serotonin Syndrome
Diminished Therapeutic and Recreational Effects:

SSRIs may reduce the euphoric effects of MDMA, potentially leading individuals to consume higher doses of MDMA to achieve the desired effect, which increases the risk of adverse reactions.
Cardiovascular Strain:

Both substances can increase heart rate and blood pressure, placing additional strain on the cardiovascular system, especially dangerous for those with underlying heart conditions.
Dehydration and Hyperthermia:

MDMA is known to impair the body's ability to regulate temperature and can lead to dehydration, especially in settings like parties or clubs. SSRIs can exacerbate these effects, increasing the risk of heatstroke and related complications.
Serotonin Syndrome: A Closer Look
Serotonin syndrome is a potentially life-threatening condition resulting from excessive serotonin activity in the brain. Symptoms range from mild (shivering and diarrhea) to severe (muscle rigidity, fever, seizures). The combination of MDMA and SSRIs heightens the risk because:

Excessive Serotonin Release: MDMA's action can lead to a substantial release of serotonin, which, even if somewhat modulated by SSRIs, can still reach toxic levels.

Inhibition of Serotonin Reuptake: SSRIs prevent serotonin from being reabsorbed, ensuring that once released by MDMA, it remains in the synaptic cleft longer, perpetuating its effects.

Conclusion
While it's true that SSRIs and MDMA both interact with the serotonin transporter, the claim that they compete for a binding site and thus eliminate the risk of serotonin syndrome is misleading and incomplete. The interaction between these substances is complex, and combining them still poses significant risks, including the potential for serotonin syndrome and other adverse effects.

Recommendations
Consult Healthcare Professionals: Always seek advice from healthcare providers before combining any medications or substances.

Avoid Combining Psychoactive Substances: Mixing recreational drugs with prescription medications can lead to unpredictable and dangerous interactions.

Educate Yourself: Understanding the pharmacology and potential interactions of substances you consume is crucial for your safety.

If you or someone you know is considering using MDMA while on SSRIs, it's imperative to consult a medical professional to fully understand the risks involved."

Look, I presented it to ChatGPT and the end result was the above... The AI seems to be talking shit about you to some extent lol

I'm sorry, but not sorry because it is quite funny that the AI, doctors, and myself all have the same conclusion and when I ask the AI its thoughts on why someone would think otherwise it simply said that the person who believes such should "educate themselves" hahaha

I'm done with the internet for the day now lol