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psilocybin and ssri's


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#1 av8or

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Posted 25 May 2018 - 12:16 AM

I was reading a post not long ago about the toxic effects of using both together. Would someone point me in the right direction to return to the thread or feel free to clue me in more. I found that two of the meds they have me on are sri's. I have been micro dosing for several months now and was looking forward to upping the amount to several grams to do some soul searching. Any help would be greatly appreciated.

John



#2 whirledpeas

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Posted 25 May 2018 - 12:39 AM

i think the concern is possibly this:
Serotonin Syndrome

Jacqueline Volpi-Abadie, MD,* Adam M. Kaye, PharmD, FASCP, FCPhA, and Alan David Kaye, MD, PhD

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This article has been cited by other articles in PMC.




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Abstract



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Background
Serotonin syndrome is a potentially life-threatening syndrome that is precipitated by the use of serotonergic drugs and overactivation of both the peripheral and central postsynaptic 5HT-1A and, most notably, 5HT-2A receptors. This syndrome consists of a combination of mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity. Serotonin syndrome can occur via the therapeutic use of serotonergic drugs alone, an intentional overdose of serotonergic drugs, or classically, as a result of a complex drug interaction between two serotonergic drugs that work by different mechanisms. A multitude of drug combinations can result in serotonin syndrome.


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Methods
This review describes the presentation and management of serotonin syndrome and discusses the drugs and interactions that can precipitate this syndrome with the goal of making physicians more alert and aware of this potentially fatal yet preventable syndrome.


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Conclusion
Many commonly used medications have proven to be the culprits of serotonin syndrome. Proper education and awareness about serotonin syndrome will improve the accuracy of diagnosis and promote the institution of the appropriate treatment that may prevent significant morbidity and mortality.
Keywords: Drug toxicity, serotonin syndrome
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INTRODUCTION
The actual incidence of serotonin syndrome is unknown. The number of actual cases is likely much greater than the actual reported cases. Serotonin syndrome is often not diagnosed secondary to mild symptoms that are attributed to being a general side effect of treatment, unawareness of the syndrome, varying diagnostic criteria, or misdiagnosis.1,2 The number of reported cases of serotonin syndrome has increased, probably secondary to the widespread use of these drugs and to the increasing awareness of this syndrome.1,2Serotonin syndrome has been documented in all age groups.2


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PRESENTATION
The presentation of serotonin syndrome is extremely variable, ranging from mild symptoms to a life-threatening syndrome. Many reports prefer to call this serotonin toxicity rather than syndrome due to its wide range of symptoms and toxicity.3 Symptoms usually begin within 24 hours of an increased dose of a serotonergic agent, the addition of another serotonergic agent to a drug regimen, or overdosing. Most patients will seek help at a hospital within 6 hours; however, patients with mild symptoms may have a more subacute or chronic presentation, as in the case by Houlihan.4
Patients will present with a triad of symptoms that range in severity (Table 1). In mild cases, the predominating features are mild hypertension and tachycardia, mydriasis, diaphoresis, shivering, tremor, myoclonus, and hyperreflexia. Patients with a mild syndrome are usually afebrile. Patients with a moderate syndrome usually have the above symptoms plus hyperthermia (40°C), hyperactive bowel sounds, horizontal ocular clonus, mild agitation, hypervigilance, and pressured speech. In severe cases, patients have all of the above symptoms plus hyperthermia greater than 41.1°C, dramatic swings in pulse rate and blood pressure, delirium, and muscle rigidity. Severe cases may result in complications, such as seizures, rhabdomyolysis, myoglobinuria, metabolic acidosis, renal failure, acute respiratory distress syndrome, respiratory failure, diffuse intravascular clotting, coma, and death.1,2 The symptoms of hyperreflexia, rigidity, and clonus tend to be more prominent in the lower extremities.1,2
Table 1.

Symptomatology Triad Associated With Serotonin Syndrome

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Fluoxetine and its metabolite norfluoxetine have longer half-lives (1 week and 2.5 weeks, respectively) than other selective serotonin reuptake inhibitors (SSRIs) and can therefore precipitate this syndrome even if discontinued for up to 6 weeks before the patients begin taking another serotonergic agent. These drugs, along with irreversible monoamine oxidase inhibitors (MAOIs), can cause symptoms to persist for days to weeks even with treatment.1,2


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DIAGNOSIS
Serotonin syndrome is a diagnosis of exclusion. No single diagnostic test can confirm this syndrome.2,4The diagnostic gold standard for serotonin syndrome is diagnosis by a medical toxicologist.3 In a clinical setting, however, the suspicion of serotonin syndrome and diagnosis must occur rapidly so treatment can prevent the morbidity and mortality associated with this condition. Therefore, a diagnosis of serotonin syndrome is entirely clinical and is based on the history and physical examination along with history of the patient's use of a serotonergic drug. Important components of the history include prescription drug use, over-the-counter medication and dietary supplement use, illicit substance use, any recent changes in dosing, or the addition of new drugs to a drug regimen. The onset and description of symptoms and the presence of any comorbidities are of utmost importance. Certain comorbidities, such as depression and chronic pain, may alert the clinician to the use of drugs that can precipitate serotonin syndrome. Also, a higher incidence of serotonin syndrome has been reported in patients with end-stage renal disease who are on selective serotonin reuptake inhibitors (SSRIs) and hemodialysis. These patients are prone to developing serotonin toxicity, suggesting that this increased toxicity could be related to a decrease in renal functioning.5 An integral part of the physical examination for diagnosing serotonin syndrome is the neurological examination.6

Source: https://www.ncbi.nlm...les/PMC3865832/

Edited by coorsmikey, 25 May 2018 - 01:02 AM.

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#3 whirledpeas

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Posted 25 May 2018 - 12:40 AM

for gawds sake again... I am not so great at postings sorry hopefully you can access the link or look up serotonin syndrome. 

 

take care


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#4 Cuboid

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Posted 25 May 2018 - 03:07 AM

This is of interest to me too. Been on SSRI's of one flavour of another for over a decade for depression and anxiety - helps I think but certainly not been really effective. Interested in micro dosing, and wanting to do a 'therapeutic' dose, of psilocybin.
Getting off the prescribed SSRI's is no trivial task.
Disclaimer: I'm not qualified to give medical advice.

As far as I understand it, from reading various sources, we don't yet understand fully what all the effects of psilocybin are on the brain & bodies serotonin system. It may be the case that post synaptic hyper activation by psilocybin at 5HT1A receptor sites causes release of serotonin which in conjunction with elevated levels due to SSRI treatment may tip the balance into serotonin syndrome territory. YMMV - depends on exactly how you are responding to your medication type and dose. I'm on a very low dose of antidepressant because I really struggle with the side effects of moderate, let alone high, doses of such. Does this mean I'm very sensitive and even a low dose elevated my serotonin levels significantly? Impossible to know.
In trying to adjust my micro dose of psilocybin I have noted it takes more than double the average persons dose level for me to reach perceptual effects. Is that the elevated serotonin levels competing with the psilocybin at receptor sites? Am I just naturally insensitive to psilocybin? Are my mushrooms just not potent? So many unknown variables. And even unknown unknowns!

So for micro dosing I'm just making gradual changes to dosing and proceeding with utmost caution.
For therepuetic trip dosing; well, I'm too cautious to go there until I'm off the SSRI's.
General hope being that I can get better through micro dosing to the extent I can cope with tapering off the SSRI then be 'ready' medically and psychologically for a therapeutic trip which I hope will make a massive difference to my outlook. Its a long journey which I started about a year ago.

(Also, yes, I know its psilocin that's active on the receptors not psilocybin, yes the psilocybin is dephosforylated or something into psilocin when digested, I'm just too lazy to fight my phones auto spelling thingy throughout the above post)
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#5 av8or

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Posted 25 May 2018 - 05:55 AM

Thank you...… luckly I have plenty of time to read. For some good news, I had my last cancer treatment today(2 years) and it knocks me down for about 4 days. Between that and the coming rain, I should be able to get briefed on the subject. Thanks again

John


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#6 phlegmbae

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Posted 25 May 2018 - 02:22 PM

As far as I understand it, from reading various sources, we don't yet understand fully what all the effects of psilocybin are on the brain & bodies serotonin system.

 

 

Hell! We aren't even sure how those SSRI's work yet, or what their long term effects are! But the doctors keep doling them out to everyone.


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#7 Soliver

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Posted 17 June 2018 - 11:14 PM

Much Ado About Nothing.

 

Don't take Zoloft, etc., the same day as mushrooms and you're AOK.

 

Even so, probably not a thing - "serotonin syndrome" is - from what I can tell - something of an urban myth.

Not that it can't happen, but ... damn.  Tell your friends to skip the Zoloft on dose day and move forward.

 

:)

 

soliver


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#8 bronco1500

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Posted 30 July 2019 - 11:52 PM

I take Ssri (cymbalta) 90mg daily for a spinal chord injury, not depression. 0.25 gram dose every other day and I can most def tell I have taken it. 6 months in & I thank God I found his medicine.

Ymmv
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#9 mrmushroomwolf

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Posted 06 August 2019 - 08:06 AM

Much Ado About Nothing.

Don't take Zoloft, etc., the same day as mushrooms and you're AOK.

Even so, probably not a thing - "serotonin syndrome" is - from what I can tell - something of an urban myth.
Not that it can't happen, but ... damn. Tell your friends to skip the Zoloft on dose day and move forward.

:)

soliver

Sorry but it's not that simple. Zoloft is only one in a family of SSRIs. The half life for these drugs is fairly long. For some, it may take a few weeks before they are clear. Also, skipping doses of SSRIs leads to withdrawal symptoms as well as increased risk of suicide and depression. It's generally a bad idea to mess with your dosage of SSRIs without medical supervision. I say that with my tongue firmly in my cheek since I went off my meds altogether because I think they were worse than the mushrooms. I doubt my doctor would approve.

All that to say I think we should be careful about advising people to just skip a dose or to alter their meds. That may not be right for all and can have negative effects.

Just my two cents

- MMW
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#10 ElPirana

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Posted 06 August 2019 - 09:55 AM

Much Ado About Nothing.
Don't take Zoloft, etc., the same day as mushrooms and you're AOK.
Even so, probably not a thing - "serotonin syndrome" is - from what I can tell - something of an urban myth.
Not that it can't happen, but ... damn. Tell your friends to skip the Zoloft on dose day and move forward.
:)
soliver

Sorry but it's not that simple. Zoloft is only one in a family of SSRIs. The half life for these drugs is fairly long. For some, it may take a few weeks before they are clear. Also, skipping doses of SSRIs leads to withdrawal symptoms as well as increased risk of suicide and depression. It's generally a bad idea to mess with your dosage of SSRIs without medical supervision. I say that with my tongue firmly in my cheek since I went off my meds altogether because I think they were worse than the mushrooms. I doubt my doctor would approve.
All that to say I think we should be careful about advising people to just skip a dose or to alter their meds. That may not be right for all and can have negative effects.
Just my two cents
- MMW
Definitely care needs to be taken when changing SSRI doses. My wife’s been on SSRI’s for at least the 15 years I’ve been with her, and I have seen firsthand some bad effects when she has stopped taking them. Each person probably needs to feel out what’s right individually and not take it lightly.
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#11 Schrist1

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Posted 18 September 2019 - 07:49 PM

Very interesting talk about ssri's. I take 10mg lexapro (Escitalopram) daily. I never thought about the seratonin being a issue. Thanks for sharing all the info .. Scott
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