I am wondering if any of you have ever experienced Serotonin Syndrome as a result of combining triptans and antidepressants. I was warned by the pharmacist a few years ago about taking the SSRI celexa and using zomig because of the potential, albeit unlikely according to stats, to cause this syndrome.
Anyways, I did end up developing it once a few years ago, requiring me to go to the ED, but it was otherwise inconsequential.
I used zomig tonight for the first time in a year and felt a little serotonin-ish, if that makes sense              ( spacey, constricted throat).
Do you all risk it, or am I in the miniroty using both classes of drugs?

Kika-

There are others on this forum that can speak to this better than me.  I have only used Relpax (pill form of triptan) and I take Paxil as well.  I did experience the side effects you mentioned, but my family members that take Imitrex say that is a side effect from the Triptan alone.  Some of them are on an SSRI and some aren't but they all have those side effects and have been taking them for years!  Hope that helps.

Joni   :)

Hi Joni

Thanks for your reply. I should have been more specific: the symptoms I had tonight aren't worrisome to me, nor do I think they were clearly SS.

In the past, I was totally out of it and my legs were twitching constantly, my heart rate was about 130 etc... It is a medical emergency, because blood pressure can be super high, you can develop hyperthermia and get kidney failure if not treated.

kika wrote on Sep 16^th, 2009 at 5:52am:

Hi Joni Thanks for your reply. I should have been more specific: the symptoms I had tonight aren't worrisome to me, nor do I think they were clearly SS. In the past, I was totally out of it and my legs were twitching constantly, my heart rate was about 130 etc... It is a medical emergency, because blood pressure can be super high, you can develop hyperthermia and get kidney failure if not treated.

Oh wow, I've never heard of that!  Glad you are okay!

Joni

My doc's won't prescribe me any triptan due to my Celexa.

If you don't have heart issues, you might want to ask your doctors about D.H.E / Dihydroergotamine. I use it as an abortive, when 02 doesn't work, I'm about to have a procedure, or need some pain free time. (I don't have to use it often, mind you.)

Also if you don't have oxygen, I do recommend you get that, and use it as your first line abortive. It has no side effects. You're not gonna have to worry about serotonin syndrome with it.

Thanks for the DHE tip!  I will check it out and keep it in mind.  Currently, I am happy with Verapamil and Zyprexa but I do have Imitex injections and Relpax pills on hand in case of emergency.  I THINK my 8 weeks are over but I hate even saying that because I realize things could change.  Good luck to you!

Joni   :)

Hmm though for D.H.E you need to get to hospital and stay there? Or there are portable DHE injections, that you can shot yourself? Though I doubt it since it is intravenous?

Wish I was M.D then I would like Dr House have any medication available without these Neurologists telling me no for no apparent bulls$#t

Haha (about Dr. House, don't you love him)!  I didn't realize that about the DHE.  Oh wee, I'm okay for the moment.

Joni

MattyAA wrote on Sep 19^th, 2009 at 1:17pm:

Hmm though for D.H.E you need to get to hospital and stay there? Or there are portable DHE injections, that you can shot yourself? Though I doubt it since it is intravenous?

DHE is a component of Migranal nasal spray, and can work quite well for many people. It's an older drug with powerful vaso-constricting properties and it predates the Triptan group of drugs. Triptans were developed with the idea of more selectively targeting certain blood vessels in the head.

If a CH patient becomes totally intractable, DHE administered in a slow IV drip in a hospital setting, can work wonders for many, many people. Several of us have been down this road to temporarily stop a CH crisis.

There are several potentially dangerous with DHE, but it can be a Godsend for many.

I've read of it being used as an injection, but have no experience with that.

As a side note: My ex-Neurologist told me that if he had to choose the single most effective severe headache drug, it would be DHE.

Marc

I used DHE for a few years and it WAS wonderful at aborting the attcks. However, injecting myself in the thigh, or having my teeanger inject me in the arm every day got to be a real drag. I am told there is a nasal spray version, but not so in Canada it seems.

For anyone considering it, you absolutely cannot use both DHE and any triptan, as they are both very potent vasoconstrictors.

Pixie-elf wrote on Sep 19^th, 2009 at 1:00am:

My doc's won't prescribe me any triptan due to my Celexa. If you don't have heart issues, you might want to ask your doctors about D.H.E / Dihydroergotamine. I use it as an abortive, when 02 doesn't work, I'm about to have a procedure, or need some pain free time. (I don't have to use it often, mind you.) Also if you don't have oxygen, I do recommend you get that, and use it as your first line abortive. It has no side effects. You're not gonna have to worry about serotonin syndrome with it.

Have you considered another anti dep like amitriptyline?

I take the D.H.E injections. It can be sub q, IM, or IV. My doctor told me to try it out sub q, see how it worked, and if I felt like it did a good enough job, stick with it.

I wound up eventually going with IM. She had me take it for 3 days straight around the clock, in hopes it would break my cycle. It didn't, and I'm still chronic, but it's saved me from trips to the ER a few times. Like Marc said, there are some major side effects to be considered. And as has been stated, you can't take ANY triptans within 24 hours of a dose. It can kill you.

It also comes with the side effect of nausea, but I've been able to manage that with either Phenergan, or Zofran.


kika wrote on Sep 19^th, 2009 at 6:48pm:

Pixie-elf wrote on Sep 19th, 2009 at 1:00am: My doc's won't prescribe me any triptan due to my Celexa. If you don't have heart issues, you might want to ask your doctors about D.H.E / Dihydroergotamine. I use it as an abortive, when 02 doesn't work, I'm about to have a procedure, or need some pain free time. (I don't have to use it often, mind you.) Also if you don't have oxygen, I do recommend you get that, and use it as your first line abortive. It has no side effects. You're not gonna have to worry about serotonin syndrome with it. Have you considered another anti dep like amitriptyline?

Yeah, unfortunately nothing has worked for me like the Celexa has. I've been on amitryptaline, as a preventative for the CH, and currently am on nortryptaline. Neither seems to help my depression/ptsd/ocd.

In the end I felt like my mental health wasn't worth risking for the relief of the triptans. I tried cutting my dose of Celexa, but even doing that was too much for me. With oxygen in my arsenal though, I don't feel like I'm missing out on much. :)