![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by eric on March 15, 2000, at 8:32:06
I was reading some guys post somewhere else about how
he became serverly mentally impaired after trying serzone.
Im am trying to figure out what happened so I can help him get better.
Here is his postHello all,
I am a 31y/o male who doesn't drink, smoke and I have never done illegal
drugs. Over three years ago (when Serzone was first introduced in US), I
began a trial of serzone for 2 months (150mg/day). The day after taking the
first pill I noticed fluid retention in my abdomen. Also, during the trial,
I recall going to a movie and leaving totally bewildered as I was unable to
comprehend the movie. That is, I would hear the words, but for the life of
me I didn't know what they meant. As time passed on the medication, I would
find myself standing, for example, in the middle of the kitchen, not knowing
what I was looking for - I mean, I had walked in the kitchen for a reason,
presumably to get something, right?Look, I'm having trouble explaining what has happened to me -- it's very
difficult to convey what I'm going through.Anyhow, I stopped the medication after 2 mos., assuming these "side effects"
would go away like previous side effects from other AD's I had taken
Nardil for 7.5 years, then paxil for 3). Well, they didn't and over three
years later they haven't! The fluid retention is continuing -- it's all
along the periphery of my body, not settling in my legs or feet. And my
brain is just trashed. I cannot understand any movies. I cannot understand
things on television. I am unable to comprehend the written word. It's
very difficult to write as I can't keep a clear thought to write a proper
paragraph or spelling or punctuation.I never had any cognitive problems prior to that damn serzone. I have a
degree in chemical engineering (obtained before serzone) but I couldn't even
work at a Circle K now as I find it difficult to make change, or learn a new
skill (such as a cash register machine). I mean prior to serzone, I was
programming in assembler language, C prog., etc.... now, shit I can't think
of how to finish this sentence or what to say.Please I need help! I was diagnosed with severe clinical depression when I
was 18. Some of you will think that depression is causing what I'm going
through. It's not. I am indeed depressed, but I have had brief periods of
time (30 -45 minutes) that I'm able to comprehend tv a bit and my depression
gives way to the possiblity that I may be able to return to work someday.
and Nardil and then Paxil helped me, but after serzone I tried going back
to paxil and then nardil and they no ,longer worked. I'm on 60 - 80 mg of
celexa now, but it doesn't help with the damage done by serzone. Nothing
has. I've tried all the MAOI's, most of the TCA's, all the SSri's,
moclobemide, reboxetine, augmenting agents ( thyroid hormone, ritalin),
etc...I try to search on the net for other people's experiences, but I can't
reallly comprehend what I read. It sounds like I have aphasias or agnosias.
If anyone knows anyone who has experienced severe cognitive problems and
found any solutions please help me!! I am so very lonely.Please, I have had connections to the net since '95 and have hardly ever
posted. I have wanted to post about this since it happened to me, but I
feared never being able to explain it correctly and, sadly, I know I haven't
conveyed what is happening to me here. Believe it or not, I used to be able
to speak and write clearly and crisply.Thank you for any help!!!!!!!
John
john_dante@mindspring.com
Posted by saint james on March 15, 2000, at 10:42:35
In reply to horrible side effect from serzone, posted by eric on March 15, 2000, at 8:32:06
> I was reading some guys post somewhere else about how
> he became serverly mentally impaired after trying serzone.
> Im am trying to figure out what happened so I can help him get better.
> Here is his post
>
> Hello all,
>James here.....
I would start with a good workup to rule out other causes as this could be another process at work.
j
Posted by Paul Jay on March 15, 2000, at 13:05:12
In reply to horrible side effect from serzone, posted by eric on March 15, 2000, at 8:32:06
> I was reading some guys post somewhere else about how
> he became serverly mentally impaired after trying serzone.
> Im am trying to figure out what happened so I can help him get better.I found a possible explaination in the Psychopharmacology Tips section of this site -- Serotonin Syndrome. It isn't quite a clear case, but the combination of symptoms is within the range of posibility for this rather variable disorder, and I believe it sometimes goes on and on as in this case. There is a posibility of treatment if it is.
Here are some relevant items:
(nefazodone=serzone, fluoxetine=prozac - an SSRI, nardil - a MAOI, paxil - an SSRI)Subject: SSRIs + nefazodone
I had a patient who I switched from fluoxetine to nefazodone on what I thought to be a slow double taper, however, the patient experienced either a serotonin syndrome or possibly effects from a metabolite whose metabolism was inhibited. The patient eventually cleared, but only after several rough days with ataxia, slurred speech, a subjective feeling of confusion, GI pain and bloating.
...I agree that overlapping the SRI and nefazodone can be useful, but recall that serotonin syndrome has been documented to occur with the coadministration of trazodone and nefazodone with SSRIs. I would use low starting doses of nefazodone and go up very slowly.
From: Biological Therapies in PsychiatryWhen a patient is switched to or from a monoamine oxidase inhibitor (MAOI) antidepressant, at least 2 weeks must elapse to avoid an interaction that can precipitate the potentially lethal serotonin syndrome
Subject: Word-finding difficulties from SSRIsWord-finding difficulties in patients taking SSRIs is not uncommon, and has been described as a serotonin-overload effect.
Subject: Serotonin syndrome>I'd be very grateful if you could explain what to have patients look for to identify serotonin syndrome.
I usually tell them to report to me any confusion or unusual muscle jerks.
Subject: Serotonin syndromeSerotonin syndrome is a potentially life-threatening complication of psychopharmacologic drug therapy. The syndrome is produced most often by the concurrent use of two or more drugs that increase brainstem serotonin activity and is often unrecognized because of the varied and nonspecific nature of its symptomatology. Serotonin syndrome is characterized by alterations in cognition, behavior, autonomic nerous system function and neuromuscular activity. Patients with serotonin syndrome usually respond to discontinuation of drug therapy and supportive care alone, but they may require treatment with a specific antiserotonergic drug such as cyproheptadine, methysergide, and/or propranolol.
...Serotonin syndrome usually develops shortly after either an increase in the dose of one or the addition of another serotonergic medication. In half of the published cases, symptoms began within two hours of a change in medication. In only 25% of the cases was the onset of symptoms more than 24 hours after a change.
...The diagnosis of serotonin syndrome is based entirely on a strong clinical suspicion and the exclusion of other medical and psychiatric conditions. The typical patient with serotonin syndrome demonstrates altered behavior and cognitive ability, autonomic nervous system dysfunction, and neuromuscular abnormalities. Some patients report recurrent mild symptoms days to weeks before symptoms become more severe. In a few cases, patients rapidly progress to multiple organ failure and death.
...No specific tests are available for the diagnosis of serotonin syndrome. Elevated serotonergic drug levels are not required to produce serotonin syndrome, and in over 90 percent of cases in which drug levels were measured, levels were within accepted therapeutic limits.
...Consider use of antiserotonergic medications...Cyproheptadine is consistently the most effective agent in humans.
Posted by Cindy W on March 15, 2000, at 13:52:26
In reply to Re: horrible side effect from serzone, posted by Paul Jay on March 15, 2000, at 13:05:12
> > I was reading some guys post somewhere else about how
> > he became serverly mentally impaired after trying serzone.
> > Im am trying to figure out what happened so I can help him get better.
>
> I found a possible explaination in the Psychopharmacology Tips section of this site -- Serotonin Syndrome. It isn't quite a clear case, but the combination of symptoms is within the range of posibility for this rather variable disorder, and I believe it sometimes goes on and on as in this case. There is a posibility of treatment if it is.
>
> Here are some relevant items:
> (nefazodone=serzone, fluoxetine=prozac - an SSRI, nardil - a MAOI, paxil - an SSRI)
>
> Subject: SSRIs + nefazodone
>
> I had a patient who I switched from fluoxetine to nefazodone on what I thought to be a slow double taper, however, the patient experienced either a serotonin syndrome or possibly effects from a metabolite whose metabolism was inhibited. The patient eventually cleared, but only after several rough days with ataxia, slurred speech, a subjective feeling of confusion, GI pain and bloating.
> ...I agree that overlapping the SRI and nefazodone can be useful, but recall that serotonin syndrome has been documented to occur with the coadministration of trazodone and nefazodone with SSRIs. I would use low starting doses of nefazodone and go up very slowly.
>
>
> From: Biological Therapies in Psychiatry
>
> When a patient is switched to or from a monoamine oxidase inhibitor (MAOI) antidepressant, at least 2 weeks must elapse to avoid an interaction that can precipitate the potentially lethal serotonin syndrome
>
>
> Subject: Word-finding difficulties from SSRIs
>
> Word-finding difficulties in patients taking SSRIs is not uncommon, and has been described as a serotonin-overload effect.
>
>
> Subject: Serotonin syndrome
>
> >I'd be very grateful if you could explain what to have patients look for to identify serotonin syndrome.
> I usually tell them to report to me any confusion or unusual muscle jerks.
>
>
> Subject: Serotonin syndrome
>
> Serotonin syndrome is a potentially life-threatening complication of psychopharmacologic drug therapy. The syndrome is produced most often by the concurrent use of two or more drugs that increase brainstem serotonin activity and is often unrecognized because of the varied and nonspecific nature of its symptomatology. Serotonin syndrome is characterized by alterations in cognition, behavior, autonomic nerous system function and neuromuscular activity. Patients with serotonin syndrome usually respond to discontinuation of drug therapy and supportive care alone, but they may require treatment with a specific antiserotonergic drug such as cyproheptadine, methysergide, and/or propranolol.
> ...Serotonin syndrome usually develops shortly after either an increase in the dose of one or the addition of another serotonergic medication. In half of the published cases, symptoms began within two hours of a change in medication. In only 25% of the cases was the onset of symptoms more than 24 hours after a change.
> ...The diagnosis of serotonin syndrome is based entirely on a strong clinical suspicion and the exclusion of other medical and psychiatric conditions. The typical patient with serotonin syndrome demonstrates altered behavior and cognitive ability, autonomic nervous system dysfunction, and neuromuscular abnormalities. Some patients report recurrent mild symptoms days to weeks before symptoms become more severe. In a few cases, patients rapidly progress to multiple organ failure and death.
> ...No specific tests are available for the diagnosis of serotonin syndrome. Elevated serotonergic drug levels are not required to produce serotonin syndrome, and in over 90 percent of cases in which drug levels were measured, levels were within accepted therapeutic limits.
> ...Consider use of antiserotonergic medications...Cyproheptadine is consistently the most effective agent in humans.
Suggest you see a pdoc immediately, who knows about psych drugs as well as medical problems, to find out if your fluid retention and other problems are due to Serzone, serotonin syndrome, or something else. Hope things get better for you!
Posted by Paul Jay on March 15, 2000, at 21:14:47
In reply to Re: horrible side effect from serzone, posted by Paul Jay on March 15, 2000, at 13:05:12
> > I was reading some guys post somewhere else about how
> > he became serverly mentally impaired after trying serzone.
> > Im am trying to figure out what happened so I can help him get better.
>
> I found a possible explaination in the Psychopharmacology Tips section of this site -- Serotonin Syndrome. It isn't quite a clear case, but the combination of symptoms is within the range of posibility for this rather variable disorder, and I believe it sometimes goes on and on as in this case. There is a posibility of treatment if it is.
>After searching on Altavista I find no specific mention of ongoing Serotonin Syndrome. There are a few cases in the Psychobabble archives, but it sounds like doctors tend to dismiss them. It doesn't sound like they were finding much relief; but antiserotonergic medications might be worth a try anyway. In any case, trying to get an idea of the biological nature of the problem sounds like the best place to start.
Posted by eric on March 15, 2000, at 21:41:44
In reply to Re: horrible side effect from serzone, posted by Paul Jay on March 15, 2000, at 21:14:47
Thanks for trying to help. I think it is terrible that his suporvising doctor allowed this to happen to him, I dont know the guy, but i would really like him to get better. Do you meant that ongoing serotonin syndrome isnt possible? or you have heard of it?
> After searching on Altavista I find no specific mention of ongoing Serotonin Syndrome. There are a few cases in the Psychobabble archives, but it sounds like doctors tend to dismiss them. It doesn't sound like they were finding much relief; but antiserotonergic medications might be worth a try anyway. In any case, trying to get an idea of the biological nature of the problem sounds like the best place to start.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.