What about just sticking to the xanax or other anti anxiety meds. Maybe the antidepressants don't work because you don't need them? I wonder if talking to a pharmacist would help. They are pretty good at knowing what interacts or what might work. I feel for you. I hope you find a resolution.

This is a repost of Linda's from the Hot Flash Forum. in regard to Serotonin syndrome. Lind's a Pharmacist.

Aug 23, 2011 02:55PM         Linda-n3 wrote:    

OK, I finally got some information for you all on serotonin syndrome. 

Serotonin syndrome is caused by having higher levels of serotonin in the system than your body can tolerate, and most often occurs when two drugs that affect the body's level of serotonin are taken together at the same time. The drugs cause too much serotonin to be released or to remain in the brain area.  Serotonin syndrome is more likely to occur when you first start or increase the medicine.

For example, you can develop this syndrome if you take migraine medicines called triptans together with antidepressants called selective serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SSNRIs). Popular SSRI's include Celexa, Zoloft, Prozac, Zoloft, Paxil, and Lexapro. SNRI's include Cymbalta and Effexor. Brand names of triptans include Imitrex, Zomig, Frova, Maxalt, Axert, Amerge, and Relpax.

Symptoms occur within minutes to hours, and may include:

• Agitation or restlessness
• Diarrhea
• Fast heart beat
• Hallucinations
• Increased body temperature
• Loss of coordination
• Nausea
• Overactive reflexes
• Rapid changes in blood pressure
• Vomiting

Patients may get slowly worse and can become severely ill if not quickly treated. Untreated serotonin syndrome can be deadly. However, with treatment, symptoms can usually go away in less than 24 hours.

Call your health care provider right away if you have symptoms of serotonin syndrome.

Prevention:  Always tell all of your healthcare providers and pharmacists what medicines you take. Patients who take triptans with SSRIs or SNRIs should be closely followed, especially right after starting a medicine or increasing its dosage.

A good idea is to ask your pharmacist to review ALL your medications with you if you are taking more than 3 or 4 (including supplements!).  The chance for drug-drug interactions goes up with each additonal drug, and for those of us who are on 5 or more, there is a very high likelihood that there are at least a couple of potential interactions just waiting to happen!!!!

Adverse drug reactions kill a lot of people every year, so we need to be very informed about what we are taking, why we are taking it, any potential interactions between our drugs/food/supplements, and whether we are taking them correctly.  If you need the meds, take them so they give you the best benefit with the lowest risk.  And DON'T DISCONTINUE ANY MEDICATION WITHOUT TALKING TO YOUR HEALTH CARE PROVIDER!!!

If anyone wants more of the physiology of this, let me know and I will produce another tome for your reading pleasure! 

Linda

This is another repost from Hot Flash Forum of mine. It's about the drug classifications for the antidepressants. This will be useful when your doc tries paintball therapy approach. (see next post for definition of paintball therapy)

Hi AGD, welcome. There are multiple neurotransmitters in the brain. Serotonin, norepnephrine, dopamine, these are the major players. Will do a quick search after I post this and add if there are more that I either didn't know about or have forgotten. I will also try to find a complete list of drugs in each group versus just naming a few and add them.

SSRI-selective serotonin reuptake inhibitor

  citalopram (Celexa, Cipramil, Emocal, Sepram, Seropram)
escitalopram oxalate (Lexapro, Cipralex, Esertia)
fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin (EUR))
fluvoxamine maleate (Luvox, Faverin)
paroxetine (Paxil, Seroxat, Aropax, Deroxat, Paroxat)
sertraline (Zoloft, Lustral, Serlain)
dapoxetine (no known trade name

SSNRI or SNRI--selective serotonin norepinephrine reuptake inhibitor

Venlafaxine (Effexor XR, Effexor)
Desvenlafaxine (Pristiq)
Duloxetine(Cymbalta)

milnacipran(Savella) 

TCA-----tricyclic antidepressants---older class of drugs, not much used anymore b/c of to widespread side effects And the advent of first the SSRI's then the SNRI's

DRI's --dopaminergic reuptake inhibitors-------wikepedia lists a huge amount of drugs in this class. The most well known one for general population use is Wellbutrin.

bupropion(Wellbutrin, Zyban)----I would have sworn on a bible it was a SSRI 

I said I'd do a complete list. So, here it is. I'm so glad my mind does not need to learn this stuff again. I started learning them in the days of MAOI's --the 70's. Poor young ones of today.

MAOIS--monamineoxidase inhibitors-------way old class of drugs, lots of bad side effects essentialy, use stopped with advent of TCA's. TCA's essentialy stopped withadvent of SSRI's (prozac was the first). There has been a new Maoi approved within the last year , but forget it's name. All I remember thinking about the drug was OH MY why would the FDA allow it , they were that much trouble.

Depending on my degree of laziness, I may add more--sounds stupid, but sometimes I am lazy. This will be much edited, but I will fill in the gaps versus saying where it's edited.

AOi-------Lots of stuff LOL. You're probably shaking your head. The problem with drugs, is too many docs not knowing them as well as they should. Hundreds of thousands of drug interactions and reactions occur every year b/c of this. When you are seeking a Psychatrist to help you with therapy, ask if the do genetic testing to determine if the drugs will work for you.

I have linked to the 2D6 thread. Read from my Feb.2014 posts on. It's then that I found my 3's were abnormal. It then became a mission to get the word out far and wide.

https://community.breastcancer.org/forum/73/topic/798301?page=1

This is a link for fentanyl to the dailymed.nlm.nih.gov site. It is the best drug reference site available, but it does not have a drug interaction checker. Your Fentanyl is going to have some interaction with any of the antidepressants/ antianxiety meds. This is b/c they all affect brain chemistry.

In order to protect yourself from docs that aren't well versed in the drug particulars, you will have to study some. Good Luck sassy

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d7aade83-9e69-4cd5-8dab-dbf1d7b89bb4

Knowing your genetic of 2D6, 2C9, 2C19, 3A4, 3A5, Vrock1 could save your life from drugs that can't be metabolized properly, and can identify drug interactions that can be prevented.

Hi glennie

Clin Neuropharmacol. 2004 Sep-Oct;27(5):219-22.

Serotonin syndrome induced by a combination of bupropion and SSRIs.

Munhoz RP.

Author information 

Abstract

Aoibheann, <<< love the name.

I'm so sorry for what you are going through. It seems to me that many women with breast cancer (let alone stage 4) have PTSD which to me is a normal response to a life threatening shock to the system. I wonder if the psychiatrists aren't used to dealing with it? I have PTSD (another matter pre breast ca.) and clonazepam and ativan are my miracle drugs. I am not sure if the posts above say the same thing (or maybe the opposite...i have a concentration problem so couldn't follow them) but I just feel for what you are going through and hope you can find some relief. I'll be thinking of you.

OP=original poster/post

Yup.

Aoibheann, I was prescribed ativan for nausea during chemo and I also get nausea from vertigo and the ativan helps it. It doesn't make me sleepy at all. I only use .5 mg. I also use gravol ginger and that helps the stomach issues.

I'm so sorry you are having to endure this.

Ab doing a split screen response to your last post. Going to address each concern and concerns of others.

PTSD is an absolute real scenario for all of us. It is different than depression. I loved my counselors definition of it, hope I can do justice to his description. The difference is he did it on a reverse board(white board versus blackboard), It was evident in seconds that we experience this condition.

Depression --onset point the line goes straight  down.

PTSD--onset event point followed by a period of improvement, then another event that causes a memory and reaction that triggers the old memory. He used an undulating line. Up and down curvy line. Hey, that's us. We move from one thing to another. Think about your travels. What's different about PTSD is if we have the proper support, we can have a better outcome. It's not that PTSD is less of a shock to our minds, but they are different. We have been repeatedly traumatized by BC. Just a few days ago I got my sixth year in a row of word that I'm back on the treadmill. My reaction ---go out to dinner and then drink a small bottle of wine.

----------- next thought

"I have a lot of reading up to do!  I thought it might be Serotonin syndrome, going on the internet drug interaction checker, but hosp dismissed it. " Guess what your were right. You were on a SSRI and a SNRI each time you had a bad reaction. You go off the drug and your symptoms disappear. There is more to Serotonin syndrome than just withdrawal. If you don't metabolize the drug right you can get into trouble on a standard dose of the drug.

On 2D6 thread is a description I think of what Dh experienced b/c of a too abrupt withdrawal of the drug. Mo said just stop it. I said NO you have to stop over several weeks. He didn't--his response was Doc C said I could just stop it. He weaned a too fast, 10 days should have been 5 weeks Zoloft BTW-----he lost all feeling in the muscles and skin. The week before he died he said " I can see myself petting Shats (Schatzi), but I can't feel her."  Broke my heart.

You say they don't do genetic testing in Ireland-Duh pay for weeks of hospitalizations, but don't consider a better way of doing things. But you don't have to muddle on your own. You can look at the metabolism section of each of your drugs  at dailymed.nlm.nih.gov.  you can make a cross reference chart of the metabolism pathways. I did this for DH's drugs in 2010. I did this b/c he reacted to his chemo so awfully in 2009. That's how I found Genelex. But testing didn't cover the 3's then and the docs wouldn't agree to testing even for the 2's. I did a chart and showed how his drugs were competing for the same pathways. His MO dropped his mouth and eyebrows went up and said I don't even know this.

Dh's admitting orders read " Medications per wife" Through the staff into a tissy each admission. I said with firmness---you take this list and call the MO, they did, he ordered them. DH didn't have his genetics done, but I based on my evaluation of reducing drugs going through paths by switching to a drug that was similar, might reduce problems.

Shocked the La Caca out of everyone when it worked.

For example, His chemo's went through 3A4 predominantly. 50% of all drugs go through 3A4 &3a5. He was on Coreg/caravidol(sic)3A4 a  beta blocker while on chemo, I switched him to metoporol/Lopressor betablocker only a 2D6. Multiple other drug changes. He never had the bad experience again

The other unique change was the effect chemo had on his insulin needs. Chemo caused precipitous drops in blood sugar. Forget his usual dose. but he was on a standard daily doses etc. Chemo----Nurses were crazy when I would say give him x dose, but they had too------doc ordered it. Chemo--he needed miniscule doses------------no one could explain it------and their was only one person watching it--me.

By prognosis he had five to six months, he lived 16 months.  He lived beyond the average 12 months of those with a bone marrow transplant.

The point being, is I asked all his docs and the pharmacists to compare the drugs by metabolism routes per the drug info data, they refused.  Duh, The info's there for a reason. I did it by hand, with the help of Genelex, Physicians Desk Reference, and drug monographs.

The Psych doc not listening ---DUH, ROTFLOL---that's their profession. The first rule of medicine is DO NO HARM. There was a doc that was a teacher of Er residents, that I had the privilege to hear him say "The second rule of medicine should be--If you listen to your patients they will tell you what's wrong"

Send me your drugs list by PM and I will plug them into my Genelex drug checker route because I have a subscription with them. Plus, your past drugs while you were on the drugs that were standard while you were taking when  you were going through your experiences. I can enter and delete drugs. Done it for many BCO folks. It's not as good as having your genetics, but better than not. It'll help when you try to do the comparison by hand charting creation, like I had too in 2010.

Fentanyl patch for pain control is a great choice depending on need, but genetics are huge in it's works. Drug interactions are huge too b/c it also has a a prodrug  and has a sertonergic affect.

Your last sentence to me about NSAIDS and oral Pain killers. Also, raises a question about genetics...............

So which is best fir pain relief? Dolantina (IV Tramadol) or Fentanyl if you are not taking anti deps, which i still refuse to take?

Wow thank you, i have been hypothyroid for 17 years but this year reduced my thyroid meds by 25% as I no longer needed the 100, blood tests didnt say this, my body did and subsequent thyroid blood tests are fine.

I hate Tramadol, it works well for pain but messes with my head and makes me supervdepressed in only a couple of days, I also feel woozy and like I have a hangover. Fentanyl via IV seems fine, I can be a little dizzy but mentally ok and it seems to leave my system faster.........we dont get genetic tests here so I can only go by my inner wisdom......i cannot take Triptans either due to what is believed to be a genetic blood vessel disease (its a rare disease and research indicates genetic causes but it makes us more sensitive to other drugs, cannot take anti inflammatories either).

I would value your opinion, hypothyroidism was in my family.