serotonin syndrome - know and avoid

Depression Treatment & Serotonin Syndrome – Avoid

serotonin syndrome - know and avoid
Avoid serotonin syndrome with careful medication review by doctors and pharmacist.

Last week we reviewed medication treatment of depression and anxiety. Medications impacting serotonin to help regulate mood were a focus. Did you know you could get too much serotonin? When we overdo it, there is a condition called serotonin syndrome that can occur.

I saw a patient that really made me think about this. He is on three antidepressant medications and a couple of other medications that can interact with those. All of them will increase his serotonin levels. I immediately alerted his primary care provider.

Three main scenarios

There are three key ways serotonin syndrome typically occurs:
1. Too many antidepressants, often from more than one doctor. If those doctors don’t know what the others are doing, more than one can start treating the same condition.
2. Self-treatment in addition to prescribed treatment. In particular, St John’s wort increases serotonin. Because there is no regulation for products such as St John’s wort, one bottle can have a different amount than another, so one bottle might lead to too much serotonin while another does not. Several over-the-counter medications can also increase serotonin to dangerously high levels when used with antidepressant medication.
3. Interactions with other medications. There are several other medications for completely different medical conditions that can increase the serotonin effects of antidepressant medications.

Symptoms

When someone has too much serotonin then a condition called serotonin syndrome can occur. The symptoms, especially early on and with a mild version, can be mistaken for a viral illness. These milder symptoms are fever, chills, diarrhea, muscle aches or spasm or rigidity. Other symptoms can be confusion, feeling irritable, or feeling disoriented. Your heart might beat faster and blood pressure could go up.

With more severe serotonin syndrome, seizures, coma, changes in heartbeat, and even unresponsiveness are possible. The most severe cases can lead to death.

Prevent Serotonin Syndrome

Your best defense against serotonin syndrome is to be very open with all of your doctors and your pharmacist about each medication you take. Ask each of them to carefully evaluate your entire regimen.

Do not change your dose on your own. Increasing your dose without guidance increases your risk of serotonin syndrome.

Adding medications you choose to take on your own can increase risk. Medications that can increase serotonin include those you take for cough, for other mood disorders, for pain, for migraine, for nausea, and for some infections. The list is so long, I encourage you to make sure you always share all of your medicines with all of your healthcare providers.

Note, even herbal medications and illicit medications can increase serotonin.

Please don’t be afraid or stop your antidepressant

The purpose of this blog is to make you aware, not to make you afraid. When taken at appropriate doses, antidepressants have aided in the resolution of depression for many people. Keep in mind; counseling is a key part of depression therapy versus medication alone. Keeping your entire medical team involved in each aspect of your care and how you feel during therapy will help avoid issues such as serotonin syndrome.

I want to remind you to never stop your antidepressant/antianxiety medication all of a sudden. Your healthcare team will guide you through a gradual tapered withdrawal when that is warranted.

For information about depression and anxiety treatment, serotonin syndrome, and drug interactions, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

This might be a loose association, so please stay with me here. I found that people with lingering depression and/or their loved ones seek relief from multiple sources. They sometimes combine prescription medications with herbal therapies with cognitive behavior therapies with religion with any other options for which they find anecdotal evidence. I typically do not hear the full picture at my first visit. It is with time and the building of trust that I get the full story. Sometimes those mixtures of therapies work, and other times they lead to more problems.

I think the same can be true with spiritual growth options. There is a lot of information ‘out there’. You can find speakers, books, videos, churches, ministries, and blogs that will tell you just about anything.

I have mentioned before the rapid growth of para-spiritual businesses that exist to help people feel better. Many of them are quite centered on the person rather than on the One True God.

Discernment is key with so many voices and messages to select. And, wow, this is so much easier to type than to do.

Jesus, Paul, John, Solomon, James, and others throughout the Bible encourage us to be careful. Follow God’s word, follow the leading of the Holy Spirit, and don’t fall for just anything that you hear.

1 John 4:1 ESV

Beloved, do not believe every spirit, but test the spirits to see whether they are from God, for many false prophets have gone out into the world.

I like this passage even better in The Message:

My dear friends, don’t believe everything you hear. Carefully weigh and examine what people tell you. Not everyone who talks about God comes from God. There are a lot of lying preachers loose in the world.

When you’re not sure what you’re hearing is right, take a time out. Go to the Bible. Talk with spiritually mature Christians. Pray for guidance. Hasty decisions can quickly get you into trouble.

James 1:5 ESV

If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him.

You’re smart, but that doesn’t mean you can’t get caught up in false information.

Matthew 24:24 ESV

For false christs and false prophets will arise and perform great signs and wonders, so as to lead astray, if possible, even the elect.

There are so many confusing messages in our World.   Just this past week alone has bombarded you with message of right and wrong and what you should believe.

Romans 12:2 ESV

Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

Don’t beat yourself up if you’re confused. It is a smart thing to question all you hear, read, see, and experience.

1 Timothy 6:3-5 ESV

If anyone teaches a different doctrine and does not agree with the sound words of our Lord Jesus Christ and the teaching that accords with godliness, he is puffed up with conceit and understands nothing. He has an unhealthy craving for controversy and for quarrels about words, which produce envy, dissension, slander, evil suspicions, and constant friction among people who are depraved in mind and deprived of the truth, imagining that godliness is a means of gain.

Jesus tells us to expect this confusion. He also tells us to be wise, discerning, smart, and loving all at the same time. And HE is the one who can help us do that. You can’t do it alone.

Matthew 10:16 ESV

“Behold, I am sending you out as sheep in the midst of wolves, so be wise as serpents and innocent as doves.

I’m praying we each seek the truth through the One who is and was and is to come.

Blessings,

Michelle

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What is a tmedication-sliderhorough medication evaluation? Would you benefit from one? Don’t other people already
evaluate your medications on a regular basis? Do you worry about hurting someone’s feelings if there is a difference of opinion about your medication regimen?

You likely have several different healthcare providers – your primary care doctor, any nurse practitioners or physician assistants in that office, your specialist doctor(s), your local pharmacist, and maybe a chiropractor, physical therapist dietician, and others. Surely between all of them someone is providing you with a very thorough evaluation of your medications?

Do you take anything for a cold? Or a stomachache? Or to help you sleep? Or for pain?

Do you tell your healthcare providers about these things you take only once in awhile?

Do you take vitamins or supplements or herbal therapies that you select for yourself? Do you tell your healthcare providers about these?

Do you always take your medications at the same time every day? What do you do when you forget to take them? Do you take some of them only when you feel like you need them? Have you ever stopped taking a medication without telling your providers?

thorough medication evaluation will cover all of these things. Our research has shown that in 98% of visits there is at least one thing that you didn’t know about your medication that you really should know.

As a clinical pharmacist, I am looking at all of your prescribed medications and other substances you take to assure none of these nine problems exist:

  • Each dose is not too high (You have more side effects than needed or even have toxicity.)
  • Each dose is not too low (You take it but it doesn’t work for you.)
  • All conditions that should be treated with a medication are being treated with the best medication(s) based on current medical studies.
  • Each medication you take is actually necessary. (Sometimes there are medications that have been on your list for a long time but no one remembers why.)
  • No medications interact with each other making your health worse. Also, your diet and supplements don’t interact with your other medications or each other.
  • You are able to obtain and take each prescribed medication. (Sometimes pills are too big, inhalers are hard to use, eye drops are hard to get into the eye, or medications are too expensive or not covered by insurance.)
  • None of your medications for one condition make another condition worse.
  • You are able to safely take all of your medications. Allergies and medication intolerances will be reviewed and clarified for your healthcare team.
  • You are taking each medication at the optimal time in relation to food, other medications, and potential side effects.

Clinical pharmacists have extensive training specific to all aspects of medications and how they work., more than any other health professional. Often, having a clinical pharmacist working with the rest of your providers will further assure that all of your medication use is necessary, safe, and effective.

For more information about a thorough medication assessment, contact www.medsmash.com.

Biblical Application

Just like medication intended for good can sometimes actually cause harm, are there elements of our spiritual lives that can be more harmful than good?

There are many interpretations of the content of the Bible. There are many preachers and teachers and blogs and radio programs and television programs and articles written.

Are they all true and accurate?

How do you determine what to believe and what to implement in your life?

Jesus, Paul, John, and others warned us about false teachers and the importance of discernment. Well, that sounds good, but how do you actually do it?

First, here is what the Bible says.

1 John 4:1 (MSG)

My dear friends, don’t believe everything you hear. Carefully weigh and examine what people tell you. Not everyone who talks about God comes from God. There are a lot of lying preachers loose in the world.

John 7:24 ESV

Do not judge by appearances, but judge with right judgment.

Proverbs 2:1-5 ESV

My son, if you receive my words and treasure up my commandments with you, making your ear attentive to wisdom and inclining your heart to understanding; yes, if you call out for insight and raise your voice for understanding, if you seek it like silver and search for it as for hidden treasures, then you will understand the fear of the Lord and find the knowledge of God.

Discernment might sound difficult or only for those with advanced theological training, but the Bible encourages us to pray about it. When you hear or read something that you’re not sure about, pray and ask God to guide you. Jesus says that the Holy Spirit is with us at all times.

Matthew 28:20 ESV

Teaching them to observe all that I have commanded you. And behold, I am with you always, to the end of the age.

Joshua 1:9 ESV

Have I not commanded you? Be strong and courageous. Do not be frightened, and do not be dismayed, for the Lord your God is with you wherever you go.

(And there are several more such verses throughout the Old and New Testament).

Let God lead you with discernment and love.

Blessings,

Michelle