Serotonin syndrome is an iatrogenic disorder induced by pharmacologic treatment with serotonergic agents that increases serotonin activity. In addition, there is a wide variety of clinical disorders associated with serotonin excess. The frequent concurrent use of serotonergic and neuroleptic drugs and similarities between serotonin syndrome and neuroleptic malignant syndrome can present the clinician with a diagnostic challenge. In this article, we review the pathophysiology, diagnosis, and treatment of serotonin syndrome as well as other serotonergic disorders.
A big thank you to Peter Ruppert’s team for their diligent work developing a handy tool to track symptoms of adverse effects to medication and withdrawal.
Adverse Effects, Discontinuation and Withdrawal Symptoms Tracker
BrainZaps! Is a new solution for those who are on and thinking of coming off medication.
Discontinuation Syndrome can have some serious and uncomfortable effects, including Brain Zaps, a sensation of an electrical shock in the brain or throughout the body that can manifest in different ways. These symptoms stop many people each year from successfully weaning off of their medication, especially if they have been taking higher doses throughout the years.
New research questions conventional practices regarding rapid withdrawal from selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, which are sometimes prescribed for migraine, peripheral neuropathy, and other neurologic disorders. Neurologists who prescribe these drugs said the study recommendations fit with their own clinical experience.
Tapering patients off selective serotonin reuptake inhibitors (SSRIs) should be done much more slowly and gradually than currently recommended, over a period of months rather than weeks, in order to avoid withdrawal syndrome, a team of researchers suggested in a paper published online March 5 in Lancet Psychiatry.
Although serotonin and norepinephrine reuptake inhibitors (SNRIs) were not the subject of the paper, studies show they show the same hyperbolic dose-response pattern, said the paper’s first author, Mark Abie Horowitz, PhD, a neurobiologist who is currently a clinical research fellow at University College London and a psychiatry trainee at Prince of Wales Hospital in Sydney, Australia.
“The clinical data also show that withdrawal symptoms from SNRIs last much longer than the one to two weeks ascribed to them by standard texts, much more in the region of months,” Dr. Horowitz told Neurology Today. “Tapering protocols suggested for SSRIs in the paper also apply to SNRIs; they should occur over at least months, down to doses close to one-fortieth of therapeutic doses and titrated to individual tolerability.”
The study authors proposed what they call a “pharmacologically informed method for tapering SSRI treatment.”
For instance, reducing doses of citalopram in steady 5 mg decrements resulted in serotonin transporter inhibition hyperbolically rising from 3 percent when the dose was cut from 20 mg to 15 mg, to 6 percent when the dose was cut from 15 mg to 10 mg, to 13 percent when the dose was cut to 5 mg, and to 58 percent when cut to zero.
“These large reductions in inhibition could account for the paucity of success of previous tapering regimens, and particularly for the difficulties with withdrawal symptoms that patients have towards the end of their taper, at low doses,” the study authors concluded.
Rather than taper by fixed amounts, the study authors recommended that clinicians taper the dose by following a hyperbolic slope. In the case of citalopram, for instance, the dose would be dropped from 20 mg, to 9.1 mg, to 5.4 mg, 3.4 mg, 2.3 mg, 1.5 mg, and then to 0.8 mg, 0.4 mg, and finally to zero.
Neurologists who treat migraine, diabetic neuropathy, and other disorders for which SSRIs and SNRIs are sometimes prescribed said the recommendations fit with their own clinical experience.
“I have seen the withdrawal effect; it can go on for months,” said Richard B. Lipton, MD, FAAN, the Edwin S. Lowe Professor and vice chair of neurology at Albert Einstein College of Medicine, where he is also director of the Montefiore Headache Center. “I definitely agree with the authors of this paper on the need for more gradual tapering in some patients. I’ve certainly had certain patients buy pill cutters to cut an already low dose of an SSRI into quarters and take them daily, then take them every other day, to try to make the taper more comfortable.”
Dr. Lipton said he also agreed with the authors of the paper that current guidelines on tapering SSRIs should be reconsidered, and that randomized, controlled trials would be useful to more rigorously test the effects of a slower, more gradual tapering protocol.
This list was assembled by Richard C. Mohs, Ph.D., former vice chairman of the Department of Psychiatry at the Mount Sinai School of Medicine.
The Top 3 Types of Drugs That Cause Memory Loss
If you are taking any prescription medication, the odds are that it falls into one of these three categories of drugs known to cause memory loss and other cognitive problems:
The “Anti” Drugs
If you take a drug that starts with “anti,” such as antihistamines, antidepressants, antipsychotics, antibiotics, antispasmodics, or antihypertensives, it’s likely that it will affect your acetylcholine levels.
Acetylcholine is the primary neurotransmitter involved with memory and learning. Low acetycholine can lead to symptoms that resemble dementia including mental confusion, delirium, blurred vision, memory loss, and hallucinations.
Prescription sleeping pills are notorious for causing memory loss.
The popular drug Ambien has been coined by some as “the amnesia drug.” Some users experience night terrors, sleep walking, sleep driving, and hallucinations.
Prescription sleeping pills have been found to put you in a state similar to being passed out drunk or in a coma while bypassing the restorative sleep your brain needs. There are much better ways to get to sleep!
These reports indicate that many doctors are unaware of the potential harms of antidepressants- Oliver Letwin MP
ALL PARTY PARLIAMENTARY GROUP FOR PRESCRIBED DRUG DEPENDENCE
8 October 2018
For immediate release
Many doctors may be failing to warn patients about the risks of antidepressants, new research suggests
The All Party Parliamentary Group for Prescribed Drug Dependence today publishes two new pieces of research which indicate that many doctors and psychiatrists may be failing to warn patients about the potential risks of antidepressants, and subsequently fail to recognise withdrawal symptoms. Furthermore, sources of NHS support for patients, such as NHS 111, were found to be unhelpful.
The first report, ‘Antidepressant Withdrawal: A Survey of Patients’ Experience’, was authored by researchers at the University of Roehampton on behalf of the APPG, and is based on the results of a survey of 319 UK patients affected by antidepressant withdrawal.
64% of patients surveyed claim not to have received any information from their doctors on the risks or side effects of antidepressants, while only 2.5% of patients found NHS 111 to be a helpful source of support during withdrawal. In addition, responses to the survey make clear that the impact of antidepressant withdrawal can be devastating for some individuals with severe withdrawal reactions, with 30% of respondents reporting being off work indefinitely due to the severity of their symptoms.
The second report, ‘Voice of the Patient: Petition Analysis Report’, identifies failure points in the health care system based on the testimony of 158 individuals impacted by prescribed drug withdrawal who responded to two petitions lodged with parliamentary Petitions Committees in Scotland (1) and Wales (2) in 2017. The report concludes that the failures encountered by the respondents will require systemic change. Both reports will be submitted to Public Health England as part of its review into prescribed drug dependency and withdrawal, due for publication in spring 2019.
Dr James Davies, of the University of Roehampton, commented: “The majority of the people we surveyed and who responded to the petitions indicated that they were never properly informed about the risks associated with antidepressants, including withdrawal. This undermines the principle of informed consent, which is essential if patients are to make a proper assessment of the harms and benefits. This is very concerning, particularly as the survey shows that severe antidepressant withdrawal can have a devastating effect on patients’ lives, including long-term disability. Furthermore, the research suggests that patients who suffer from withdrawal mostly find existing sources of NHS support, such as 111, unhelpful.’
Sir Oliver Letwin MP, chair of the APPG, said: ‘These reports indicate that many doctors are unaware of the potential harms of antidepressants, and fail to communicate the risks to their patients. This highlights the need for additional guidance and training in this area, and we hope that Public Health England will consider this as part of their current review into prescribed drug dependence. Furthermore, it suggests that existing NHS sources of support are inadequate, and new dedicated services, including a 24 hour national prescribed drug withdrawal helpline, are therefore urgently needed.’
This five minutes could be the most important for your health & honest statement spoken about the medical “industry”.
The full two hours debate here
Super session in the 2-hour European Parliament meeting on Thursday – so many issues raised by Dr. Aseem Malhotra, MEP Nathan Gill, Sir Richard Thomson, Professor Hanno Pijl and Sarah Macklin. Now edited with HD footage and clear sound. Let’s get the message out – MEP Nathan Gill and Aseem reckon a million views would be a great goal – only if it gets shared like hell !
To allow doctors to be honest and give best advice for our health, the medical and pharmaceutical industry needs transparency and movement away from profit orientated business and poor medicine.
Antidepressant Withdrawal – What we Know and Don’t Know
My Doctor/Psychiatrist told me that I have to take an antidepressant to correct a chemical imbalance in my brain, is this true?
No, it is a myth, we cannot test or measure the state of neurotransmitters in your brain, the
American Psychiatric Association disavowed this myth in 2011(1). It is a pharmaceutical
company invention (2).
How many people experience withdrawal effects?
It varies according to which drug is used, at what dosage, and for how long. Recent
studies (3) are showing the number affected to be greater than 50% of those taking the
drugs. The UK Royal College of Psychiatrists did their own survey (4) (now removed) which
showed that 63% reported withdrawal effects.
Why does my doctor/psychiatrist keep saying ‘discontinuation syndrome’ when I mention withdrawal?
Discontinuation syndrome is an invented term (5) which minimises the role of the drug in the
harm caused and steers users away from addiction terminology. While dependence and
withdrawal have some features in common with addiction, they are not accurately
described using just this approach. What you are experiencing is an effect of withdrawing
from a drug, not of discontinuing treatment.
Why does my doctor insist that ‘once the drug is out of my system’ I will be fine?
Because not all doctors understand the effects of antidepressant drugs on the brain (6). A
heavy drinker or smoker may suddenly stop drinking/smoking, but the effects on their brain
and nervous system continue to be felt long after they have quit. Antidepressant drugs
change the brain in ways we don’t currently understand. These adaptations (7) to the drug
are responsible for withdrawal effects.
What does withdrawal feel like?
It’s a highly variable experience ranging from mild symptoms which pass quickly, to
profound symptoms that sometimes persist for many years. In a 2017 survey (8), 46% of
those reporting withdrawal symptoms described them as ‘severe’. Most common reported
symptoms (9) are insomnia, dizziness, fatigue, digestive problems, anxiety, panic,
depression, agitation. Withdrawal symptoms can sometimes mimic depressive or anxious states but should not be confused with relapse (10).
I am worried about dependence, what should I do?
The most important thing is never stop your drugs suddenly, this can be dangerous. Talk to
your doctor but be prepared as many doctors do not have the information to be able to
help. Withdrawal is a unique experience, with no fixed rules.
There are some excellent and
reliable online sources for help including:
www.jfmoore.co.uk August, 2018
Antidepressant Withdrawal – What we Know and Don’t Know
Commonly prescribed drugs called fluoroquinolones cause rare, disabling side effects. Researchers are struggling to work out why.
(For help & support on this issue – http://www.quintoxsupport.co.uk)
In 2014, Miriam van Staveren went on holiday to the Canary Islands and caught an infection. Her ear and sinuses throbbed, so she went to see the resort doctor, who prescribed a six-day course of the popular antibiotic levofloxacin. Three weeks later, after she had returned home to Amsterdam, her Achilles tendons started to hurt, then her knees and shoulders. She developed shooting pains in her legs and feet, as well as fatigue and depression. “I got sicker and sicker,” she says. “I was in pain all day.” Previously an active tennis player and hiker, the 61-year-old physician could barely walk, and had to climb the stairs on all fours.
Since then, she has seen a variety of medical specialists. Some dismissed her symptoms as psychosomatic. Others suggested diagnoses of fibromyalgia or chronic fatigue syndrome. Van Staveren is in no doubt, however. She’s convinced that the antibiotic poisoned her.
She’s not alone. Levofloxacin is one of a class of drugs called fluoroquinolones, some of the world’s most commonly prescribed antibiotics. In the United States in 2015,doctors doled out 32 million prescriptions for the drugs, making them the country’s fourth-most popular class of antibiotic. But for a small percentage of people, fluoroquinolones have developed a bad reputation. On websites and Facebook groups with names such asFloxie HopeandMy Quin Story,thousands of people who have fallen ill after fluoroquinolone treatment gather to share experiences. Many of them describe a devastating and progressive condition, encompassing symptoms ranging from psychiatric and sensory disturbances to problems with muscles, tendons and nerves that continue after people have stopped taking the drugs. They call it being ‘floxed’.
For decades, regulatory agencies and the medical profession were sceptical that a brief course of antibiotics could have such a devastating, long-term impact. But after persistent campaigning by patient groups, attitudes began to change in 2008, when the US Food and Drug Administration (FDA) announced the first of what would be a series of strong alerts about the side effects of fluoroquinolone drugs, including tendon rupture and irreversible nerve damage. In 2016, the agency accepted the existence of apotentially permanent syndrome that it calls fluoroquinolone-associated disability (FQAD), and recommended that the drugs be reserved for serious infections. That move has triggered other regulatory agencies to reassess the antibiotics: Health Canada warned doctors of rare cases of persistent or disabling side effects in January 2017, and the European Medicines Agency (EMA) isexpected to publish the results of a safety review this year, after a public hearing planned for June.
Fluoroquinolones are valuable antibiotics, and safe for most people. Yet they are so widely prescribed that their side effects might have harmed hundreds of thousands of people in the United States alone, say scientists who are working with patients to unpick FQAD’s causes. Fluoroquinolone toxicity, they say, provides a compelling example of an emerging understanding that antibiotics don’t just harm microbes — they can severely damage human cells, too. Until recently, investigations into the side effects of antibiotics have focused on how the drugs disrupt the human microbiome, says James Collins, a medical engineer at the Massachusetts Institute of Technology in Cambridge. “Antibiotics are also disrupting our cells, and in pretty hefty ways,” he says.
The dark side of fluoroquinolones
Quinolone antibiotics, first developed in the 1960s, kill bacteria by blocking enzymes called class II topoisomerases, which normally untangle DNA during cell replication. These enzymes usually cut DNA’s double helix, pass another part of the strand through the gap, and then mend the cut. But quinolones bind to the enzymes, preventing them from mending their cuts. In the 1980s, researchers added fluorine atoms to the quinolones’ structures. This allowed the antibiotics to penetrate tissues throughout the body, including the central nervous system, and boosted their effectiveness against a broad range of bacterial infections.
Some FDA-approved fluoroquinolones were swiftly withdrawn from the market after severe adverse reactions and several deaths — trovafloxacin, withdrawn in 1999, damaged livers, for instance. But others became the drug of choice both for serious infections and for routine complaints, despite rare side effects. “These are heavily used drugs because they are very effective,” says Joe Deweese, a biochemist who studies topoisomerases at Lipscomb University College of Pharmacy in Nashville, Tennessee. In the 1990s, ciprofloxacin (cipro) was given to US troops serving in the Persian Gulf as prophylaxis in case of exposure to anthrax spores. And in 2001, sales of cipro surged after a series of terrorist attacks involving anthrax; the US Centers for Disease Control and Prevention (CDC) recommended a 60-day course for anyone at risk of being exposed.
Having worked with older and disabled people over the last 13 years in the third sector, my experience of clients knowledge and understanding of their prescribed medication can sometimes be astounding.
I essentially help people get their homes adapted, maintained and made safe so that they are able to live independently. This can also involve general advice and assisting with benefit and disability allowances applications.
Many of my clients are aged over 70 and come from an era where whatever their professional, whether it be a doctor, nurse or specialist say or prescribes, that is what they believe is right. They feel that it is disrespectful to challenge or refuse the medication. Very few will stand up and say they don’t agree.
Even if the medication they are taking makes them feel worse, very few will go against the advice of their GP.
I do not confess to be a medical expert but in my experience with older and vulnerable people, I can identify particular health problems and noted side effects. Long term pain killer use as well as being addictive also can cause memory loss. Many people don’t know that and worry that Dementia is setting in. Majority of people are on gastro pump inhibitors to prevent or heal ulcers and stomach problems. Usually originally caused by other medication. These should only be used short term as they in turn can cause other more serious health problems and coming off them can also experience extreme versions of what the medication was for.
When asking many of my clients which medication they are taking, the usual answer is “lots” or I’m rattling. If asked what each is for, many don’t actually know. They may have been told many years ago but can’t remember. When asked do they read the information leaflet, if they were interested at all some say it’s in too small print or they get the dosette box with no leaflet. This is probably not the case but as they get older it is taken for granted that their health is going to suffer, medication may make some things more bearable and so best not to know the effects or if it might be addictive. Even when medication is reviewed, many don’t like to admit to any problems. I find much of this out when applying for mobility allowances such as Attendance Allowance. This is possibly the only time they will be completely honest about all their health problems.
Even when medication is reviewed, many don’t like to admit to any problems. I find much of this out when applying for mobility allowances such as Attendance Allowance. This is possibly the only time they will be completely honest about all their health problems.
Why when in hospital are patients woken up to be given sleeping tablets?
Just because someone is getting older, their health problems should be diagnosed by listening to the problems not just throwing medication at it.
We know that we can learn about controlling some health issues by diet, exercise or relaxation therapies, why aren’t older people being offered more of this instead of them having to take 4 or more, some up to 15 different medications in one day.
How many of those medications are addictive or have extreme side effects or will be fatal if forgotten to be taken.
I always believed that we are told to understand our own bodies first then ask advice, but it seems if many people have the audacity to make their own opinion of their medication of diagnosis this will be frowned upon.
I have had occasions where I have had to leave homes of clients because their spouse has become irate even verbally abusive. The explanation is that it is the medication causing it or that I shouldn’t visit before a certain time in order to give the medication time to kick in. Again not being a medical expert I cannot say that these are true effects or if they are used as an excuse for behaviour. But if more education to the medication available and being prescribed was available and in simple terms and people were given more choices instead of told?
Many older people when they start suffering with physical health problems start to suffer with depression and anxiety or are diagnosed bi polar. I can see the downward spiral to many of these peoples lives when given medication rather than alternative therapies or counselling about lifestyle or even just changes to their daily routine. When asked about their health issues, they start with the mental health rather than the obvious physical problems. They feel powerless and give up. Those not taking up the medication can often combat this and mange to regain the control of their life, regain their social life and try and help others.
When asked about their health issues, they start with the mental health rather than the obvious physical problems. They feel powerless and give up. Those not taking up the medication can often combat this and mange to regain the control of their life, regain their social life and try and help others.