SNRI and SSRI use with MDMA

[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

Again, and as this doctor and I both agree on: UNDER-STUDIED/DOCUMENTED, but increasingly relevant public health risk of combining MDMA and SSRIs by the youth resulting in serotonin syndrome should be addressed by the medical community which has otherwise been ignoring the situation.

Just because something is underdocumented/understudied doesn't make it not real or whatever your insinuation is... I mean, you can call the sky pink all you want, but at the end of the day its still blue.

Just my, AI, and the medical community's two cents on the matter my friend...

Ecstasy use and serotonin syndrome: a neglected danger to adolescents and young adults prescribed selective serotonin reuptake inhibitors - PubMed

The increasing incidences of recreational ecstasy use and SSRI pharmacotherapy among multiple psychiatric disorders in the adolescent population have made this an overlooked yet increasingly relevant danger, which poses a threat to public health. This can be curbed through further research, as...

pubmed.ncbi.nlm.nih.gov

Edit: On another side note... poor doctor just died 4 months ago and here you are disrespecting his work... RIP

 

[ShulginsReincarnation]

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...

No, absolutely not. I am deeply concerned that the sentiment in a harm reduction forum is that this is "made up" because of some article that the users can not even verify the existence of. This is especially concerning when most doctors are siding with me on this subject, though there was some initial ambiguity due to lack of formal clinical studies (again, mainly due to the novelty of the scenarios with which we are speaking on as well as the lack of ethics in running controlled experiments.)

That being said, it would be nice if we had anyone with a medical degree in psychiatry here who could chime in and verify what I am saying as I am afraid me citing a recently deceased psychiatrist may not qualify as "proof enough" for the parties contesting my original claim which, as I said and will forever stand by, is common sense to anyone who has any understanding of neuropharmacology. Now, granted, I do not have a formal degree though I have spent a good majority of the last two decades studying the science. When I was first presented with the question, I saw some ambiguity and hadn't had a chance to look into the medical literature until now. When I did, my claim was verified and the late Doctor Dobry himself even said that there need be more focus on this matter so that the evidence is more clear to anyone who doubts such claims.

As I said in the above, is it really appropriate to be questioning a dead man's work just months after he has passed? I think not.

Anyway, I am not going to beat a dead horse anymore. Those who review this thread will see the above, and those who are intelligent enough will figure out what the truth of the matter is soon enough. Natural selection will sort the rest for us lol

P.S. I forgot to include this when I found it earlier:

"The compound 3,4-methylenedioxymethamphetamine (MDMA) can cause serotonin syndrome by impairing serotonin reuptake from the synaptic cleft into the presynaptic neuron.11 There are 20 case reports of MDMA-induced serotonin syndrome, all occurring in individuals younger than 45 years who took antidepressants, amphetamines, stimulants, and/or opioids. Ten of the 20 patients were taking 1 or more antidepressant medications prior to MDMA use without complication, and symptoms of serotonin syndrome did not appear until MDMA use occurred. After MDMA discontinuation, the patients were able to resume antidepressant use without difficulty, which indicates that MDMA was a large contributing factor.12" (https://www.pharmacytimes.com/view/surprising-drugs-that-can-cause-serotonin-syndrome)

This is what #12 is referencing: https://pmc.ncbi.nlm.nih.gov/articles/PMC8820588/

Also, please note this is literally exact what I said before I even looked at any of this medical literature proving me correct because to me "this is common sense." Which according to others here is just some kind of rumor? Again, the lack of understanding of how drugs work on a harm reduction forum is alarming to me. Especially when critiquing someone who knows what they are talking about in a demeaning manner because they think his claims are just a rumor which may mislead a newcomer into thinking such a combination is safe and poses no harm. Not cool at all.

 

[Pissed_and_messed]

I did not find your references particularly convincing and leading to ultimate conclusion with no room for interpretation. You could use reference #12 to argument that cannabis or benzos used in conjuction with molly could cause SS. Also, chatgpt advices you to add glue into cheese in pizza if you ask how to keep it not falling apart.

If you are disappointed, you can try contacting @Didgital.

 

[ShulginsReincarnation]

I did not find your references particularly convincing and leading to ultimate conclusion with no room for interpretation. You could use reference #12 to argument that cannabis or benzos used in conjuction with molly could cause SS. Also, chatgpt advices you to add glue into cheese in pizza if you ask how to keep it not falling apart.

If you are disappointed, you can try contacting @Didgital.

I, again, do not care. Anyone with an educational background in the applicable fields here is going to tell you that SSRI+MDMA = serotonin syndrome risk. If you don't care to believe in science that is fine; I dealt with enough of that during 2020 to know when its best to leave well enough alone and let nature sort things out lol

 

[Pissed_and_messed]

: On another side note... poor doctor just died 4 months ago and here you are disrespecting his work... RIP

how about not fucking use this kinda rhetorics? I have no idea what doctor and study you are talking about, but honestly I am kinda pissed off that you are getting "offended" behalf of some scientist that probably would have wanted people to carry on with method of questioning, making hypotheses, testing them and making interpretations and direct the frustration you carry on about someone questioning you, against me, with this excuse, because in the end of the day it really is about your hurt feelings that were born upon disagreement. Can you empathize how it feels manipulative and insulting that you are essentially putting words into my mouth with those words you quoted? Do you do it intentionally?

Don't try your games with me. I eat your bullshit for breakfast.

 

[ShulginsReincarnation]

how about not fucking use this kinda rhetorics? I have no idea what doctor and study you are talking about, but honestly I am kinda pissed off that you are getting "offended" behalf of some scientist that probably would have wanted people to carry on with method of questioning, making hypotheses, testing them and making interpretations and direct the frustration you carry on about someone questioning you, against me, with this excuse, because in the end of the day it really is about your hurt feelings that were born upon disagreement. Can you empathize how it feels manipulative and insulting that you are essentially putting words into my mouth with those words you quoted? Do you do it intentionally?

Don't try your games with me. I eat your bullshit for breakfast.

Again, for the third time, I don't care whatsoever about any of what's been said about how there is some conspiracy behind the scientific reasoning why people believe in the scientific conclusion behind the fact that SSRI + MDMA = increased risk of serotonin syndrome. An intelligent person can reach their own conclusions based upon what's already been said in the above. I have nothing further to say and am in no way shape or form phased by any of this; its irrelevant at this point as we aren't even discussing the question at hand that started this whole conversation.

 

[Pissed_and_messed]

Ten of the 20 patients were taking 1 or more antidepressant medications prior to MDMA use without complication, and symptoms of serotonin syndrome did not appear until MDMA use occurred

what antidepressant medication? I wouldn't be surprised if many of them were MAO-i like moclobemide which is proved to be dangerous in combination with MDMA.

 

[Pissed_and_messed]

Again, and as this doctor and I both agree on: UNDER-STUDIED/DOCUMENTED, but increasingly relevant public health risk of combining MDMA and SSRIs by the youth resulting in serotonin syndrome should be addressed by the medical community which has otherwise been ignoring the situation.

Just because something is underdocumented/understudied doesn't make it not real or whatever your insinuation is... I mean, you can call the sky pink all you want, but at the end of the day its still blue.

Just my, AI, and the medical community's two cents on the matter my friend...

Ecstasy use and serotonin syndrome: a neglected danger to adolescents and young adults prescribed selective serotonin reuptake inhibitors - PubMed

The increasing incidences of recreational ecstasy use and SSRI pharmacotherapy among multiple psychiatric disorders in the adolescent population have made this an overlooked yet increasingly relevant danger, which poses a threat to public health. This can be curbed through further research, as...

pubmed.ncbi.nlm.nih.gov

Edit: On another side note... poor doctor just died 4 months ago and here you are disrespecting his work... RIP

I would love to see whole research paper this link is referring to, how can I obtain it?

 

[ShulginsReincarnation]

what antidepressant medication? I wouldn't be surprised if many of them were MAO-i like moclobemide which is proved to be dangerous in combination with MDMA.

If you were to take the time to look into what I provide you in terms of the limited, but readily available scientific literature that this article cites for people to look into, then you would see its a variety of such: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.824288/full#B19 (there is the full article; here is a nice little chart that elaborates for simplicity: https://www.frontiersin.org/files/A...4288-HTML-r2/image_m/fpsyt-12-824288-t002.jpg) Lots of polydrug use going on here, so there needs to be more controlled study on this as was discussed before. The whole point is that this does need to be investigated further (though the article was rather biased in the way it attempted to present the matter in order to help secure funding for such studies, I agree.)

I would love to see whole research paper this link is referring to, how can I obtain it?

The whole research paper can be obtained by paying for it here: https://www.degruyter.com/document/doi/10.1515/ijamh-2013-0052/html

You just follow the links on PubMed just like you would when trying to obtain any other documentation like this when using that platform...
Or, you can request it from the authors here: https://www.researchgate.net/public...ribed_selective_serotonin_reuptake_inhibitors

OOOORRRR, you could use a little critical thinking and deductive reasoning skills to find it available for free here and save 30 EUR: https://ia600704.us.archive.org/view_archive.php?archive=/24/items/wikipedia-scholarly-sources-corpus/10.1515%2Fform.1991.3.219.zip&file=10.1515%2Fijamh-2013-0052.pdf

But, to summarize it for you: It says doctors treating adolescents should not prescribe SSRIs to those who use MDMA due to potential risk of serotonin syndrome, that this needs studied more but that its best to err on the side of caution because it seems all kinds of drug combos can cause such when it comes to MDMA, that often times poly-drug abuse is present in those that use MDMA (obviously since ecstasy is notoriously impure and very often cut with amphetamines which were present in most cases in the #12 that was cited before,) that this is even more reason not to prescribe SSRIs because its going to make the risk of serotonin syndrome even higher yet as if the mixing of drugs wasn't bad enough and that its the doctors' responsibility to make sure their patients aren't in any additional danger due to being prescribed psych meds since many times those needing such are drug users as well. It does not not say that a sole combination of MDMA + SSRI is a potential risk factor for serotonin syndrome development. It says that as of right now it is unclear, but would only make sense from a logical standpoint that there would be an increased likelihood of such development in those cases and that other factors may be present that exacerbate the risk (just to be extremely clear since that has apparently been a struggle for me thus far according to you.)

I probably missed something, but you can have a look at the article since I dug it all up for you to critique in the name of science since you were not willing to take the extra 30 minutes to look into what I presented yourself. Other than what you've already presented, do you have any other arguments as far as why we should be telling people its safe to combine SSRIs and MDMA when there is more reason than not to tell them to be safe and not do so as harm reductionists? I have presented my case, and while it does indicate further research need be done, it also gives really solid logic behind why to tell people not to combine the two until we know if its safe or not since what is considered by many "common sense" tells us it is more likely to be unsafe than safe at this point in time. Naturally, many may do it with no adverse effect, but then you may get a handful that present with convulsions or hyperthermia or whatever other serotonin syndrome related issue you can think of as well. Who knows?

Of course this "common sense" may change if science indicates that our fundamental knowledge of the underlying neuropharmacology behind this educated guess is wrong, but that has yet to be changed. And, until it is, we typically stick with what's most likely the case until we can prove otherwise if what is most likely the case is something that indicates even a potential of something being unsafe in even a small portion of the population. That's what is known in the medical field as taking "harm reduction measures" in case you weren't firmiliar with such...

 

[ShulginsReincarnation]

I would love to see whole research paper this link is referring to, how can I obtain it?

Oh, also, I forgot to ask, where is this alleged Finnish article you keep referring to as far as the basis of your logic behind why you think MDMA + SSRI = potential serotonin syndrome is not a real possibility? That it is simply a work of fiction that everyone on Earth believes because they are so much less informed than you about such? heh...

 

[Pissed_and_messed]

I don't care to talk with you. You are passive-aggressive, hostile, condescending, manipulative, repeat bunked arguments, can't accept disagreements, follow flawed logic and all that.

 

[ShulginsReincarnation]

I don't care to talk with you. You are passive-aggressive, hostile, condescending, repeat bunked arguments, follow flawed logic and all that.

No, I am not passive aggressive, I am being assertive in my tone.
You simply have nothing to back your nonsense story behind why you are going against very basic harm reductionist principles.
Meanwhile, I spend an hour to back my claims because you are too lazy to research scientific facts before speaking.

A damn shame.

 

[Pissed_and_messed]

I removed my own unnecessary insult.

@Didgital, I am fucking drunk and tomorrow probably hangover. I suggest that part of this thread is split into completely new thread. I might or might not participate in this process or might do it all by myself if I feel good enough and you are busy having free-time.

This has also been done now.

 

[Pissed_and_messed]

OOOORRRR, you could use a little critical thinking and deductive reasoning skills to find it available for free here and save 30 EUR: https://ia600704.us.archive.org/view_archive.php?archive=/24/items/wikipedia-scholarly-sources-corpus/10.1515%2Fform.1991.3.219.zip&file=10.1515%2Fijamh-2013-0052.pdf

thanks.

paper demonstrated hypothetical route to SS based on assumption that SSRI and MDMA would provide blood serotonin levels rise following x+y logic, while the scientist in the article I offered stated they are acting against each other, and then there was mention of SSRIs effect on liver enzymes, which I covered in my !NOTE! which I had colored red to gain extra attention for harm reduction purposes. I didn't explain the precise mechanism but essentially covered this also. Research paper also mentions possibility of people megadosing to gain desired effects, which was again also covered in the vice article in which they interviewed actual scientist, again.

I am not sure how lucid you are to your shortcomings in your argumentation, but it seems like you are just talking much and twisting facts and trying to have the last word and starting the argument from the point where you have already established how I have mistaken in something even if you failed in that, to look like I was the ignorant and bigoted and mistaken party.

 

[Mr. Krinkle]

No, I am not passive aggressive, I am being assertive in my tone.
You simply have nothing to back your nonsense story behind why you are going against very basic harm reductionist principles.
Meanwhile, I spend an hour to back my claims because you are too lazy to research scientific facts before speaking.

A damn shame.

yea ya believe he's on staff too?


JFC

 

[ShulginsReincarnation]

yea ya believe he's on staff too?


JFC

That's what concerns me, and this is the perfect example of why I never directly refer people to this website when trying to teach harm reduction principles. There is no telling what kind of non-sense they are going to come across on here (or any internet forum for that matter; not trying to totally bash BL as its one of the many places I began my journey in this field when the internet was still relatively new to most people, and it still serves as an invaluable resource to keep me up to date on trends in the world drugs markets. But, it is no more unique than any other internet forum in terms of the ridiculous tom-foolery you will come across that having been said.) I would much prefer that I, someone who has been at this for as long as I have, draw conclusions and relay relevant information in a manner which a newcomer can make better, more well informed decisions based upon than what is presented here in its raw form.

A harm reduction forum should be a safe place for everyone, but sadly that's just not the case.

 

[Pissed_and_messed]

A harm reduction forum should be a safe place for everyone, but sadly that's just not the case.

that is our goal and that means people have a right to call out bullshit. Don't act like a victim here when it was you who started hostility. You are still allowed to talk because poor rhetorics is not against the rules. This proves that it works like you claim it is not working.

 

[emkee_reinvented]

I don't care to talk with you. You are passive-aggressive, hostile, condescending, manipulative, repeat bunked arguments, can't accept disagreements, follow flawed logic and all that.

Whatever and whoever it was aimed, doesn t matter.

But this quote/ anecdote or well worded wisdom.
Should be a automatised internal answer when crossing such a thread.
Short and clear, might add a few ime or imo if needed.

Good waking post, lesson on.

Like when you think you have a conflict with a passive-agressive.
Impossible, as they wont wanna reach mutual ground.
They just suck the life out of you, try then not getting mad.

Having such a reply at hand, and then leaving the conversation.
Good over evil.

 

[Shinji Ikari]

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

I didn't say that (you were replying to me?) and I explicitly stated that I don't know if it's receptor competition down regulation or otherwise that causes the blunting effect with MDMA.

I think the risk of an adverse reaction gets exaggerated especially in larger louder communities like Reddit where you see "can I take X when I'm on SSRI" posts every day, but that's not the same as saying "combining MDMA and SSRIs is safe" and if course I'm not suggesting that anybody try that.

Again, and as this doctor and I both agree on: UNDER-STUDIED/DOCUMENTED, but increasingly relevant public health risk of combining MDMA and SSRIs by the youth resulting in serotonin syndrome should be addressed by the medical community which has otherwise been ignoring the situation.

I agree.

Just because something is underdocumented/understudied doesn't make it not real or whatever your insinuation is...

What do you think I'm insinuating? Common sense isn't much of a citation because it's informed by individual experience and is therefore inherently subjective. Apologies if I wasn't clear on that.

No, I am not passive aggressive

A casual observer might consider some of your posts in this thread to have been passive aggressive or condescending.

It would have been nice to have a nuanced conversation here because I'm sure there's a lot I could learn by talking to you. You strike me as an intelligent person with a genuine passion for harm reduction and drug science who could become a real asset to this community.

Which is why it's a shame that you seem more interested in turning this into a slam dunk about how right you are rather than entering into a genuine idea exchange and sharing your knowledge in an approachable way.

Well anyway, see you around.

Edit: correcting typos.

 

[Mr. Krinkle]

if Pissed and Methed wasn't such an asshole sometimes, he'd be alright

i think that's the main point