Serotonin Syndrome

[Heather]

I'm on 200mg of Zoloft and 100mg of Trazedone. I am still having trouble sleeping. I asked the APRN if I could increase the Trazedone but she said that both Zoloft and Trazedone are SSRI's and work on the same receptors in the brain.

There's no way to tell how much serontin a person has in their system. Which can lead to serotin syndrome which can be very dangerous i.e. unstable gait, coma, even death. So, I didn't want to risk it.

Anybody else on 2 SSRI's have any problems? Anyone have any thoughts?

 

[intothelight]

Hi Heather,

I am on Trazadone, and it is my understanding it is not an SSRI since I cannot take SSRI's. You should contact your APRN to verify and talk to her about your concerns.

Deb

 

[Heather]

I am on Trazadone, and it is my understanding it is not an SSRI

She's the one that told me that it was an SSRI and showed me the info and serontin syndrome. Idk. She is a ding dong. Maybe I should check with the pharmacist because we decided to give it another month w/o adjusting meds.

But sleep and depression are worse:(. I don't want to live like this anymore.

 

[Seneca]

Trazadone is a serotonin enhancer. It's slightly different from an SSRI in that it raises serotonin instead of just keeping it in the brain longer, but probably a worse combination, since Zoloft inhibits the breakdown of serotonin, and Trazodone INCREASES the amount of serotonin in the brain.

 

[Heather]

Trazadone is a serotonin enhancer.

Maybe that's what the APRN said today then that it affected the serotonin receptor in the brain and NOT that it's an SSRI. I can't remember sh*t these days *sigh*. Very frustrating.

 

[Seneca]

Eye of Horus

http://www.drugs.com/trazodone.html

http://en.wikipedia.org/wiki/Trazodone

Wikipedia defines it kind of weirdly, which says to me that there's some confusion about the drug, since Wikipedia is usually pretty accurate with drugs.

Basically, it's called a serotonin modulator by some, a serotonin enhancer by others, and sometimes a "serotonin antagonist and reuptake inhibitor (SARI)." And other times, a tetracyclic. But never an SSRI.

So basically, it's similar enough to Zoloft to warrant extra caution. But what it is, specifically, is a strange and mysterious drug that resists labels.

 

[Seneca]

Oh, and don't forget that most doctors aren't paid to learn the technical aspects of drugs, only to monitor your vital signs and ask a few superficial questions once every month or two. ;)

 

[allitherapy]

Doctors do have to understand every drug and how they work in the body (we take an entire year course in it). Nurse practitioners learn pharmacology in about 3-4 months, sometimes as a separate class, sometimes incorporated into other coursework.

The others are correct in saying that trazodone is not an SSRI. It weakly affects the reuptake of serotonin. Zoloft (an SSRI) inhibits the reuptake of serotonin, leaving more serotonin in free circulation. Trazodone functions to increase the amount of serotonin in the body. Essentially, you are taking two drugs which have the same effect via different mechanisms of action.

Serotonin syndrome most often occurs when first starting or increasing the dosage of a medication. Symptoms usually occur very rapidly, sometimes within minutes of taking the drug.

I'm not sure who told you that serotonin levels can't be measured - that's not true. It's a simple blood test. If you're really concerned, talk to your doctor and have it done.

 

[anthony]

It is actually officially a Serotonin Antagonist, it is not an SSRI, and it is an adjunctive medication, which typically means it treats a symptom. Its purpose is to treat insomnia, and even possibly to reduce nightmares. It does not treat PTSD, there is zero evidence or trials to support such.

It is a sedative antidepressant. It is not an SSRI though, they are vastly different things.

Trazodone is an antagonist, and works at the serotonin 2A receptor.

Sertraline (Zoloft) is an SSRI, and is approved to treat PTSD.

 

[intothelight]

Heather,

I am taking 600mgs of Trazadone a day to treat the severe depression associated with my PTSD. It definitely has helped me sleep and keeps my depression from sinking to a depth where I feel suicidal. However, it is not a treatment for PTSD; it only is prescribed for insomnia and in some cases depression. It also has a very sedative effect on most people. For some reason, they are guessing anxiety, the lower dose I take throughout the day does not have that effect on me. Only the higher dose I take before bedtime.

But like any medication, especially psychiatric drugs, the effects on individuals vary; as do the effects of combinations of drugs. It is really important to communicate as to how you are feeling, what works, and what doesn't work. It took me a long time to convince people that SSRI's made me feel suicidal. It was also hard to know I couldn't take them since they are the drugs approved for the treatment of PTSD.

Keep asking the questions as you are the best advocate for yourself.

Deb

 

[Seneca]

Both Zoloft and Paxil keep my heart rate slow during panic attacks, so I can see where the indication comes from.

Heather, have you considered dropping the SSRI (Zoloft) and raising the dose of Trazodone? Have you ever tried this before?

Or, if your doctor hesitantly prescribes both of those, Maybe you could lower the dose of Zoloft?

 

[Heather]

I'm not sure who told you that serotonin levels can't be measured - that's not true. It's a simple blood test. If you're really concerned, talk to your doctor and have it done.

That was the APRN where I go for therapy she was the one who told me that......see I told you she's a ding dong.

I double checked with the pharmacist and I had my info. wrong (big surprise these days) you all are right.....not an SSRI. She said it's a trycyclic(did I spell that right) but she also said that serotonin syndrome is VERY rare.

So, none of my meds. are being changed for now. The pharmacist suggested amitryptaline which is sedating but also has anti-depressant benefits as well. But doesn't effect serotonin levels so that's something to think about when I see her next month.