thread about serotonin syndrome

[Hanran]

hello everyone, I am just wondering if somebody here has ever experienced Serotonin Syndrome (or maybe some of you know somebody else who has) and preferably would be to mention what specifically has led to have it. please.

 

as much as you can guess, I am interested in this because I am afraid. I have used SSRIs most of my adult life for my depression and my anxiety (mostly Sertraline) and I have been using 20 0mgs of Zoloft every single day for approximately one year or so now. so well, I just have worked my way up to this dosage from 50 mg taken every day and then upper to 100 mg daily and so I have never got any side effects related with serotonin toxicity (or at least none of which I am aware of). I also should mention that I am having some chronic pain from a previous injury that it is pretty much annoying and bothersome and the pain level that I have is enough for me that I need to use some pain medications out there for it (not on a regular basis but quite a bit). I need to mention that lately the naproxen that I have been prescribed for that pain has not been enough to cut it and so I've got left with no other option than to try and search for something else. now I've got to say that there is a family member who has some big pain issues and she has left me her supply of 50 mg of tramadol (this has been months ago, approximately in September) when I have told her that I needed to search into something stronger than naproxen for my pain since it is not enough. she said that I could try tramadol she has if I want and see how it worked on me. so well, since like about 2 months or so ago, I have taken 1 to 2 (I mean, I've never taken 3) pills per day in about 2 days (rarely only 1 day) to 3 days (never 4 days) in a week. I mean, I've been doing this way for like 2 months before I have been doing some research on some drug interactions because I wanted to be careful of what I am taking and I have came across the warning about the thing of combining the SSRIs that I have mentioned I've been taking for most of my adult for my anxiety and depression with the tramadol that my family member gave me to try for my pains which naproxen wasn't enough to take care of it. oh my.. I've just got to say that when I've seen that warning…. yikes. needless to say since that day I've never put another tramadol in my mouth.

 

so well, I just can say that that I have never had any symptoms of serotonin toxicity while I have been using them and generally I've never seemed to have any side effects, again, which I was able to notice, however I still have seen that this is a combination that needs to be avoided and stay as far as possible.

 

yeah, I do know that there's no one else to blame than me and I do realize that this is entirely only my mistake. I have been foolish enough to think that tramadol doesn't have anything to do with SSRIs. I mean, when I've taken them both I was thinking about drug interactions but I was honestly thinking that there is nothing to be worried about and that's because in the past I have been prescribed different opiates for my surgeries that I had, for broken rib etc. etc. over the years and so, since in all these years I've taken them for so much and I had not even a word mentioned by my doctors about absolutely any drug interaction dangers with using Zoloft with it concurrently (and all of them, doctors who prescribed opiates, knew about my Zoloft intake). but I've never thought why they never even mentioned tramadol to me. but I found an explanation (seemingly wrong explanation) to that either. I was just thinking that since tramadol it is just a 'weaker' opiate (weaker pain killer), then it must be fine, and hence the reason why doctors didn't even mentioned it to me… now I see why and now I see how wrong I was. anyway, now I do know how big of a mistake I've made and my lesson is learned to always do my research before doing anything I don't know and never to just 'assume' especially when it comes to my health.

 

but, I still need to mention that this tramadol I am now so worried about, has been a truly great pain killer for me with absolutely no side effects or 'floaty' feeling or anything in this matter (which I mean that I am still feeling competent and focused when I am using it and still be 'effective', unlike norcos that I have taken). having that said I only want to say that I would really to just keep on using it occasionally (I mean, not on a regular basis as other people take it, but only when I need it which would be one dose 2 or 3 times per week, which I do realize that is not a lot but I still realize that it might be 'enough'), and by saying that I just want to say that I am not completely clear on HOW dangerous exactly dangerous this combination of the Zoloft and the Tramadol is. I mean, having said what I said, is that 'enough'? or there must be taken higher doses for getting it? I do realize that it depends from one person to another and stuff like that, but I still think that there must be an approximate doses that would be 'enough' for this. I can mention that I have read some conflicting things that were indicating that you would need some larger amounts of one or the other drug (not mentioning both) to cause a really dangerous reaction, however I've also read somewhere else that even some small amounts also can potentially kill you or at least cause you serious issues. this is why, I am not very sure what I should think about this. I would really like to understand and to get an answer… since I have not experienced absolutely any serotonin syndrome so far then this does mean that toxicity it is unlikely to occur now? also, if I am going to do what I planned (I mentioned it earlier) then does it mean that I would never get any issues or the risks are getting higher the more time I would be on this 'low dose' and I should rather stay away from even the smallest doses?

 

I am still going to keep on 'digging' and search on this one and I am hoping that I am going to get in to see a doctor soon as she would be the one to ultimately educate me on the risks, doses etc. etc. but as you can understand, I still thought that I would reach out to check if somebody else here has any thoughts on this specific topic and can help me more. if somebody has some experience with serotonin syndrome or as I said, knows of somebody who does, then please chime in with an answer and let me know what you think about it. thank you very much for absolutely any insight/ information/ advice that you have for me regarding zoloft and tramadol combination and more specifically on serotonin syndrome.

 

[tameeka]

you've got to know that tramadol it is not only a pain killer alone and that's because it is having an anti depressant component in it and this is what makes it to be totally different from all other pain killers out there and which is why it makes it dangerous to be taken in combination to SSRIs, unlike other pain killers which do not have this anti depressant component and why is safe to take them with SSRIs. there are some people that use tramadol as an anti depressant (who do not have any pains, but do have depression). this being said, I can add (off the top of my head), I just forgot either it is SNRI or SSRI (or maybe both) but whichever it is from the 2 (and I am quite sure that there is going to be somebody else who would come along and would surely say which one it is) it should not be mixed with any other antidepressants as there are dangerous interactions. though there are people who do take tramadol off label for depression, you've got to know that still, tramadol it is not marketed or prescribed (nor recommended) to be taken for depression - only as a pain killer.

 

also I should say that I do believe that I have read somewhere of some people who were using both the tramadol and some antidepressants, however they were not using this combination for any length of time and surely not at any high doses. I can't really recommend you much on this as I am afraid that my recommendation can be misunderstood or even my recommendation can be entirely wrong and then issues can appear.

 

having that said, my suggestion for you would be to discuss to your physician or maybe even a pharmacist about it as they are surely the best suited to recommend and advise you on medication and medications interactions and whether the benefit of using both of them would outweigh the risk (as you must tell them that so far, you haven't had any issues and they seemed to be helpful). by doing this you're going to be given an answer if that's gonna be safe or not. however, one sure thing is that just in case you are considering to self medicate you continuously with tramadol the I strongly recommend you not to do so. as you've already read, you do know very well that it can be a really dangerous combination that can even kill you so your physician really should know that you are using them and just in case your physician would consider that the dosages of both medications and the frequency of those dosages that you take would be safe then only then you would be able to take them both continuously. but if she says that it is not safe then you don't even have to think about it further and completely forget about one or another. either you know this or not but very often, when people are self medicating with whichever drug(s) and then there is something that goes wrong, then they are too afraid to tell what they have used or if you are unconscious and cannot tell them what you have used then it might cost your life. I am pretty sure that this is not a risk you want to take, but if you sill decide to go ahead and to use both of them anyway then please, at least be careful of what you are doing, but I still recommend you not to do it. best wishes

 

[BatmanVsSuperman]

look, OP, I am not trying to recommend you anything or to say that you've got to do anything at all, I only want to share with you my story. so, I have been on sertraline 200 mg and my doctor has added tramadol for my IBS pains (I am not able to take any NSAIDs because of my stomach issues), but I have also been prescribed to take 50 mg of trazadone at night. back then I didn't know about this so I've been taking them without even thinking about anything, but now, that I do know it (found out about this a few months ago), and thinking back about it, I can say that I am actually amazed that my GP has prescribed me that combination and I have been on this combination for a bit less than a year and for the entire period I've been on it I was completely clueless. it is only the thing that I have been stick of those night sweats I used to get and that's why my combination has been switched to codeine instead of tramadol, however I can say that except for the thing of breaking into a sweat at any moment I did feel good on that combination and haven't had anything else. in fact, I can say that I have been even better than now that I am on venlafaxine and codeine… again, not trying to say that you should be on such a combo or that it is not dangerous. I just shared my story and trying to say that maybe you do have a chance to still be on this combo.

 

[Beinale]

hey there OP, you've said that you are nearly left with no other options for pain killers since naproxen isn't enough for your pains, you don't want to take narcotics for whichever the reason and you can't take tramadol since you are on zoloft and are afraid of serotonin syndrome, having that said, I just recommend you to search for kratom if you haven't so far. I'm sure I've seen some topics here about kratom. generally there is a lot of information about kratom online. I recommend you to look more into it because it is an all natural alternative to opiods with some less side effects but with some similar pain killer properties. obviously it is less effective if we're talking about a big pain than opioids and tramadol but since you don't seem to be in a really big pain then I honestly think that kratom can be enough for your pains (and as I said, it is all natural and has less side effects). you've just got to be careful because kratom also has addictive properties (but narcotics and tramadol, obviously, also have, and I am pretty sure that you knew that opioid narcotics and tramadol were addictive as well, and even more addictive than kratom and plus to that, you've mentioned that you need to use something for pain only 2 or 3 times per week which would help you to avoid addiction to it). I just thought that it is still important to mention. plus, if you would decide to look more into it then I'm quite sure you'll read this and you're going to read much more.

 

[ninaflemming]

hi Hanran, as tameeka said, it is not advised to use both these 2 drugs together and especially not to self medicate with both of them and that's why I don’t want to say anything in this matter. I still think that you need to talk to your doctor and let her know everything. but even so, I should say that I have been SSRIs for a lot of years now (also because of my anxiety and depression issues) and I've self medicated with tramadol for quite a while now with absolutely no Serotonin Syndrome or anything in this matter. however I still should mention that I've been trying to be really careful because indeed it can be realy dangerous… what I am trying to say is that I have never taken more than 100 or maximum 150 mg of tramadol in just one day (which means 2 or maximum 3 pills a day), and that's…. a low dose as much as I can understand it. I can say that I am still using it occasionally but I am not using it on a daily basis and I am not taking it for anti depressant effects, even though I should admit here that lately I have been pretty tempted to do it. I can say that I do personally know of some people who have been prescribed both medications - tramadol and a SSRI by a physician… and my closest people who did was my mother of 87 years old and a close friend of mine with RA. also, I am not that sure, however I just can suspect that a low dosage must have something to do with it… I mean, a low dosage of Tramadol. I can say that seizures from tramadol seem to happen more common than serotonin syndrome, however this is only anecdotal and not anything scientifically proven.

 

again, please, just try to understand me correctly as I really have no intention here to hurt anybody and I really do not want to encourage you to do anything that might be any harmful for you, I am only sharing my experience here and to be honest, I am not very sure if what I am doing is the right thing to do and if I am correct or not, that is why I still think that the safest option for you now is to talk to your doctor!

 

[Hanran]

ninaflemming, thank you very much for your sharing and thanks everybody else for each of your post/ opinion/ advise etc. I appreciate them all a lot! of course I've been searching information about this one myself and to be honest I can say that the more I am looking into it then indeed the more it seems that you are right (or at least what I think about it) on the fact that the seizures are being the more common side effect of the tramadol use… and this, to be honest, scares me. indeed, it is surely a roll of the dice to take SSRIs and tramadol (as in, we do know very well that a physician is never going to tell you that it is completely safe to combine them and I am damn sure that if there is going to be a doctor who would agree to take both of them, he/ she is still going to tell that it is dangerous), however it does seem that a lower dosage of both medications these medications it is the key to there being a much smaller risk even if you decide to take both of them concomitantly. at least of anything serious enough to warrant hospitalization. I may use a 50 mg tramadol maybe once or twice more before I am going to go and I would see my doctor in order to talk about them, as I am feeling the benefit is going to outweigh the risks for me personally (though I am still pretty scared, to be honest), but anyway, once again, I am pretty damn sure that she is going to tell me that it is just a no go that's just to be safe. I really hope this won't end up bad for me.

 

[Summy]

hey there, people, I just want to tell you that I am having a friend who is a paramedic and I've been talking about this with him and he told me that he most definitely vouch that the incidences of the serotonin syndrome results in seizures it is much more common than comes it is coming out on the internet. what I am trying to say is that on the internet you don't find everybody who has a case of serotonin syndrome and this is why I can say that it is much more common than you think it is. it is a very serious issues you should be avoiding.

 

[Quiroz]

hey there Summy, could you, please, tell me what would be the approximate of minimum dosage for such a thing, in your own opinion (or better said in your paramedic friend's opinion? I've got to say that I do not doubt what you are saying one bit. I've got to say that it is pretty scary, though, but anyway, I would really appreciate if you could answer this question, it would be amazing to know such kind of information because at least we would know what the lowest safe dose is. thanks.

 

[unchain]

hi. I just want to say that I am currently on 2 different anti depressants as I am taking a dose of Celexa in the morning (I wake up at 5 AM just to take my dosage) and then I am using Doxepin at night, at exactly 9 PM (I'm trying to take both drugs in the same time each day). my doctor told me that I need to take them this way due to the fact that if I would take both of them the same time (or at a lower interval of time) then this would be way too much for my body and I need to take them this way. I just want to say that by doing this way it has prevented me to have any bad side effects of SSRIs. I do know that none of these meds I take aren't tramadol and maybe they don't have any drug interactions as tramadol with SSRIs have, however I just what to say that in my opinion, if you are going to do the same then you would be safer (just in case you still decide to take both tramadol and your SSRI drug, and as I see, you do intend to take both of them). hope this helps.

 

[Summy]

hey there Quiroz, I am honestly not even going to try to give you any ballpark number and that's because I just can't… the reason is that this number varies extremely much from a person to another and it depends on a lot of factors, that's why I think that saying ANY number would be wrong if talking about all people. maybe there do exists such a number but only for a specific person, and the number, as stated earlier, varies to another person. plus, I really doubt that somebody can determine this number for you, that is the reason why my recommendation for you or anybody else would simply be, of course, not to mix SSRI and tramadol or tapentadol (which is a CII narcotic) but I do know that there would be people who won't listen to my advice, unfortunately. but you NEED to know that you shouldn't and that's because it is just way too dangerous to take such a risk. I do understand that you might feel good and you might think that you are going to be well and so on and so forth, but I honestly think that this temporary feeling of 'well being' is outweighing the risk of a seizure or even death. you might think that a seizure, after all, isn't that scary. you've got to read about it more and you're going to see that it is REALLY that scary. I guess I've read what people experience during a seizure somewhere online. that is… terrible to say the least. and trust me that even if the seizure is able to be controlled somehow immediately, you still can have a permanent damage (or as I said it earlier, even die) from rhabdomyolsis which can easily lead you to multiple organ failure and this would be a slow and really painful death - and now think about it, is it worth it? the scariest thing is that this can happen out of a sudden out of nowhere. you don't even expect it. you feel fine and the next minute you've already in a seizure. it is just not worth it in my opinion. if naproxen isn't enough, you don't like oxy and, as you can see, you can't use tramadol, then you would be better off using something like codeine for this purpose, much more better than tramadol.

 

[Quiroz]

thank you a lot for your opinion, I really appreciate it and I honestly think that I am going to listen to your advice just in case I would ever think to try tramadol while I am taking a SSRI (good thing I am not in need of tramadol). honestly, I am really thinking in terms of something like SSRIs and aspirin or something like this (or maybe just something very sporadic use of something like tramadol). the point is that I have only seen some people who have been prescribed such drugs as Celexa and aspirin every day and maybe p.r.n. tramadol and I've only been wondering how, in fact, risky that is, not necessarily an every day use of tramadol. but then again, thanks a lot, I honestly think that you are right on that and oftentimes it is not worth to take such a risk when your own life is gambled.

 

[Summy]

I've got it (the fact that not on a daily basis use) but I should say that it is still dangerous to be used like that, mostly depending on the dosage of each drug you take and, again, on each person individually. that's what I've tried to tell to Hanran as well because she (or he?) mentioned that is not using tramadol on a daily basis.

 

but anyway, if there are still such people who STILL won't listen then at least I just can say that I personally would look into maybe a low dosage of either lorazepam (0.5 to 1 mg) or diazepam (an approximate dose of 5 mg) to take it with tramadol… that's just in case you do end up using the tramadol with an SSRI and there is absolutely no other way (which I think that there must be one). no, by taking them it is not going to stop the serotonin syndrome itself, but at least it is going to help to prevent seizures from it and hence this is going to give you some time to get to the ER where you are able to get help and be monitored (and treated). hope this helps.