Posted by Katekite on April 9, 2002, at 20:40:18
Hi -- I am new to this forum and could use insight on puzzling side effects. The neat part is I think maybe my flushing effect is indicative of some little known drug mechanisms at work.....................My psychiatrist appears stumped. (This could get long.) I've taken a bunch of psychotropic meds (prescribed :) over the last 10 years (moody mildly anxious depression). Including (all by themselves): one dose buspar (felt like alien), 4 ssris with typical side effects of sedation, nausea, best was prozac which just didn't do much, trazodone one dose (hypotensive crisis), serzone (nothing until confusion at 300mg/day), xyprexa 3 smallest available doses (confusion and inability to stand up), one high dose remeron (24hrs sleep followed by hypnotic state for 2d), 4 days wellbutrin (suicidal agitation), valium (nice!), Ativan (mild anti-anxiety, mostly just sedating), Klonopin (helps moodiness, also sedating, cognitive effects, ? other side effects see below). Here's where it gets fun! Having started klonopin 1 mg/day last summer then also started neurontin 600mg/day and felt darn good, calm, focussed, goal oriented although more moody than usual for the first 5 weeks. Then ate salmon (don't laugh) and became hot. Hot flush. Flu-like symptoms, neck stiffness, headache, muscle fasciculations similar to nervous tics, mild vertigo, alternating hot and cold symptoms for several days. BP and temp normal but subjectively temp felt hot. Tapered neurontin, went away. Unfortunately did not associate tapering neurontin with resolution and reinstated neurontin, lower dose. While on neurontin and klonopin: tried depakote one dose (24 hrs vertigo and extreme sedation but still anxious), tried one dose lamictal (10 days of nausea), tried one dose gabatril (3 days vertigo). During following month continued to have occasional hot flushes, flu symptoms, etc, worsening with time until was sick and hot continuously. True temp was never high. Finally became pissed off and stopped neurontin and tapered klonopin to 0.5 mg/day. 2 days later completely normal. Still on klonopin: Restarted neurontin several weeks later, became hot/flushed, discontinued. Still on klonopin: Tried moclobemide 5 days, amotivation after 3rd day, hot on 5th day. Retried at lower dose, 5th day amotivation no flushing. Have eaten salmon twice, have become hot after each time but resolves in 24hrs. Decided buspar had not given buspar a fair chance, retried one dose, became hot at 60 minutes lasting 12hrs. Decided Wellbutrin not a fair trial 5 years back, did another 5 days, again extreme agitation but NOT flushed. Ativan and valium do not cause flushing at least in one time doses. Flush responds a bit to high doses of antihistamines, I think, but can't be positive on that..................................... Every flushing episode resolves within 24 hrs of stopping the new drug. Flushing is always accompanied by mild neck stiffness, sense of malaise, and increased anxiety or mild agitation. I may 'feel' flushed, but do not always 'look' flushed, although usually there is at least a transient objective whole body flush when it starts........... sorry this is so long...... the question is what is the mechanism of this...... I'm concerned about a serotonergic mechanism given flush on all but wellbutrin and other benzos, found one reference to a klonopin maoi interaction causing flushing, on medline, but otherwise can not find that klonopin should cause increased tendency to flush. Is this just benign flushing, or is it some sort of mild serotonin syndrome? Is it dangerous? ......................I have now been diagnosed with ADD (only the previous shrink thought I was BP II, no one else, ADD makes sense to me) and will start ritalin in a couple days.... is this wise? Why is my psychiatrist not more concerned about this? He simply shrugs and tries something else, I get hot every time unless they are single dose meds (with the exception of buspar which does it with a single dose). He really would like to try effexor next but given the recent hx I'm pretty sure it would simply make me hot, then I would face withdrawal. Since buspar has such a distinct mechanism and it does it in a single dose of 3.75 mg I have come up with a serotonin hypothesis, but truly don't understand it and would appreciate all comments. How can salmon be involved........salmon is known for histamine problems but not serotonin that I am aware of. What about switching to a less serotonergic benzo? What is the least serotonergic benzo that still has anti-anxiety effects (ie not a pure sleep aid)?...... Is it worth asking to get serotonin metabolites measured or will they laugh? Thankyou in advance for any similar experiences or interpretation of this weird reaction..................... In conclusion, if it is serotonin then neurontin has to have a serotonin modulating effect which I haven't seen reported yet. Interesting, eh? -- Apologies for length of first post, does not bode well for future posts, LOL. -- kate
poster:Katekite
thread:102572
URL: http://www.dr-bob.org/babble/20020408/msgs/102572.html