Starting fluoxetine after trying St John’s Wort

[Mrsmitchell1984]

I have just seen that serotonin syndrome occurs usually within 24 hours. So far so good for me - I don’t have any symptoms yet.

I was reading this strange case about someone who got it after stopping prozac and then starting setraline (paroxetine) so that begs the question- how do you change medications if this happens:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464814/

[Mrsmitchell1984]

So it’s been 8 hours since I have taken the fluoxetine but so far so good x

[panic_down_under]

If I have got this far then clearly I have what it takes to pull through this and come through the other side x

Most of us do. We're much tougher mentally than we let ourselves believe.

I have just seen that serotonin syndrome occurs usually within 24 hours. So far so good for me - I don’t have any symptoms yet.

Darn! Looks like I'm not going to collect on the 24 hour $1 million life insurance policy I took out on you. Back to bread and water for breakfast and half a can of dog food plus lawn clipping salad for lunch and dinner again.

I was reading this strange case about someone who got it after stopping prozac and then starting setraline (paroxetine) so that begs the question- how do you change medications if this happens

Take case reports on serotonin syndrome/toxicity with a very large dollop of salt. One of the two blokes who know more about it than anyone else, Ken Gillman, used to spend a lot of his semi retirement writing letters to med journals correcting the nonsense until he got right royally fed up with the sheer futility of it all, prompting this long spray. Very few doctors have ever seen a genuine case and most wouldn't recognise it it it bit them on the bum. And it's not just doctors. Much of the material produced by the FDA, MHRA, WHO, etc, on SS is plain wrong too.

If you want to see the extent of the problem google ' drug interaction ' and enter the name of a SSRI plus mirtazapine into the check sites listed. Almost all will highlight SS as a major interaction, but to quote Gillman, "as I have pointed out before, drugs like bupropion and mirtazapine, that have no significant serotonergic activity, are no more likely to cause ST than is vitamin C" (PK Gillman, 2010 PDF).

Moreover, mirtazapine is a moderate serotonin 5-HT2a receptor antagonist (blocker). The recommended treatments for serotonin syndrome are the 5-HT2a receptor antagonists cyproheptadine and chlorpromazine. 5-HT2a antagonists prevent the body temperature spike which does the damage in SS.

As for the specific case, gawd help us, there is so much wrong with this poor man's treatment that you have to wonder where the doctors got their degrees from, a cornflakes packet? For a starter have they never heard of SSRI discontinuation syndrome? Why wasn't his fluoxetine reinstated as soon as he was out of the ICU?

My guess is that he may have accidental overdosed on the paroxetine and that while his symptoms were alarming, he wasn't in serious trouble. The 38.5 C temperature is as high as it goes in overdose.

[pulisa]

Sally, don't google anything. You are scaring yourself with too much "information" and will just add to your anxiety symptoms.

[Mrsmitchell1984]

Thanks PDU- so I was worrying over nothing. I always think the worst will happen to me and it’s my mind playing tricks on me.

I spoke to a CBT lady today (it wasn’t cheap) but it helped she made me realise that a bad experience is making me feel low and so it is no wonder if suffer with depression.

It’s such a cruel word that some people can be so nasty and yet the innocent one ends up suffering.

She also told me that depression never lasts for ever and this episode I am going through will not last for ever too. It just feels so rubbish when you are in it x

[Mrsmitchell1984]

You are right Pulisa. I am a bit of a control freak and like to know what is happening all the time. So I guess that is why I do it.
How are you today? X

[Mrsmitchell1984]

So I am over 12 hours since I took my fluoxetine and I am still not dead. I am only on 10mg. Feel very steady today. As if - even though I still feel low- I have some sort of safety net underneath me- which is nice x

[Mrsmitchell1984]

So I am sitting up in bed and there has been hardly any sleep at all. I took the tablet around 10pm but still sleep is not forthcoming. How comes the anti histamine works one day but not the next x

[Mrsmitchell1984]

I managed to sleep last night in the end. I think I still work up a few times and it was quite an anxious sleep.

I am just about to get out of bed but I am wondering how much more of this depression and anxiety I can take.

It’s such a miserable and desperate place. X

[pulisa]

You said before that you felt better once you were up and about and doing tasks?