Today Tonights report on E+"antidepressant"=seritonen syndrome 30.11.01

I saw this report earlierr this evening concerning the recent deaths which have been attributed to a combination of antidepressant medication and E leading to seritonen syndrome.
A question: What antidepressants could they havebeen reffering to, trycyclic(MAOI's) or SSRI's?
Because I wasn't aware of any contraindications with SSRI's, but I have heard there being an MaOI contra. But then I was thinking not many E users would be treated by their Dr's with trycyclic anti's because it'd be dangerous, because the dr couldnt gaantee the patient wasnt going to try E again.
anyway any replies to fill me in would be nice...

If I may make an analogy, let's compare the word 'serotonin syndrome' to the term 'blood pressure'. Saying someone has serotonin syndrome is like saying someone has high blood pressure, it's an imbalance of a normal system in the body. Everyone always has serotonin. The levels vary from day to day, depending on a multitude of factors. We should make a distinction between "non-fatal" and "fatal" seratonin syndrome. Certain chemicals disrupt the normal ebb and flow so the levels may change dramatically.
Serotonin: Release --> Reuptake --> Breakdown by MAO
Seratonin is usually released and uptaken in the brain at a certain RATE. Simplistically, serotonin (5-HT) is broken down by monoamine oxidase (MAO), but this breakdown process occurs after reuptake. If the rate of reuptake is slowed (eg. by a selective serotonin reuptake inhibitor (SSRI) such as anti-depressants or St. John's Wort etc., or by MDMA) then the 5-HT level can increase. By the same token if the rate of MAO action is slowed (eg. by a monoamine oxidase inhibitor (MAOI)) then the 5-HT level can increase. Also, if the rate of serotonin release is altered (eg. by an excess of 5-HT precursors such as 5-HTP) then the level of serotonin can increase.
So, I think we're heading toward the conclusion that a number of these kinds of chemicals will be contraindicated (bad to combine) because they will drastically alter the rate of one part or more of the above cycle: MAOI+MDMA, SSRI+5HTP, etc.
A broad statement might be something like this: Anything that releases serotonin faster should be avoided with anything that slows its uptake or breakdown. I know this may not stricly be true in all cases however in terms of harm minimisation I think the less the seratonin system is pushed to the limit, the less likelihood of seratonin syndrome becoming dangerous.
There are some excellent posts on the Medical Q&A board detailing effects and information about serotonin syndrome, just search on that board.
BigTrancer
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Load universe into cannon. Aim at brain. Shoot.

Thanks BT, you were right in assuming the term seritonen syndrome might be a bit perplexing.
So, could you consider the effects of MDMA acting on the seritonen system, a non-fatal form of seritonen syndrome?
There are still lots of things I'm unclear on, need to brush up on some basics. Ill go over the slides at dancesafe.org, you've explained seritonen syndrome well.
Seeya mate

The first time I every tried ecstasy I suffered a mild case of serotonin syndrome. I was on a cause of zoloft at the time. Stupid me, I had no idea what i was doing...
The first cupple hours of my roll were extremely good but then it went bad. I was mashed up on a bed rolling around for the next 24 hours.
Not fun...

Very good point you bring up Niq... have a search on the web and look up the similarity between the symptoms of mild serotonin syndrome and MDMA intoxication: you could be surprised.
BigTrancer
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Load universe into cannon. Aim at brain. Shoot.

In addition to BT's excellent summary, just wanted to add a few things. I didn't catch the show you mentioned, but I suspect they were referring to MAOI's. Now there is hardly anyone taking MAOI's anymore (they are fantastic at treating depression and anxiety, but too risky with all the food and drug interactions) so it is unlikely anyone will actually combine the two. Moclobemide (a reversible inhibitor of monoamine oxidase) is safer than a MAOI, but theoretically it could cause SS, and is definitely contra-indicated with amphetamines.
The dancesafe slideshow talks about SSRI's blocking the re-uptake transporter, meaning MDxx can't latch on, and is therefore often ineffective. Most of the other A.D's on the market have some re-uptake inhibition properties, including TCA's, nefazodone, and venlafaxine (NOTE: before people start posting to tell me these drugs are not SSRI's, note that I said "properties").
Therefore, it is possible that MDxx will be ineffective for people on these A.D's too. If the MDxx, can't work, it can't cause SS. But then there are those people who say they do still roll on SSRI's and other A.D's, so whether they are at higher risk for SS is not clear to me.
There is another risk from combining A.D's with MDxx. Some A.D's inc. inhibit (reduce the action) of one or both of the enzymes responsible for breaking down MDxx in your liver. This means it will take longer for your body to metabolise the MDxx, so levels can accumulate, causing toxicity. MDxx is mainly metabolised by CYP2D6, and to a lesser extent CYP3A4.
ANTIDEPRESSANTS THAT INHIBIT CYP2D6:
* SSRI's, nefazodone, venlafaxine, clomipramine and possibly other TCA's, moclobemide
ANTIDEPRESSANT'S THAT INHIBIT CYP3A4
* SSRI's, nefazodone, ?others
You will notice that SSRI's and nefazodone appear on both lists, meaning combining with MDxx could result in decreased e metabolism=levels of e increase in your body=problems, including SS. Having said that, there are plenty of BL'ers who will put their hands up to having taken these sort of combo's...
There are different levels of SS, and the symptoms of mild SS are indeed similar to that of MDxx intoxication. Severe SS is of course a medical emergency.
(I hope this makes sense - it is the 2nd attempt after my pc died, and I am starting to confuse myself )
[This message has been edited by babydoc_vic (edited 01 December 2001).]