Bug98: five years of serotonin syndrome

[Bug98]

I guess I'm supposed to introduce myself here. I was put on drugs starting at age 6 or 7, had the drugs changed once or twice, and now am on venlafaxine extended release 150mg, methylphenidate 36mg, and risperidone (.5mg or 1mg I think) at age 22. I've been on them for years and was on lithium at one point, and at age 17, I got into certain teenage behavior (not drugs) which, I didn't realize at the time, didn't mix well with the drugs I'm on. I've had incredibly large amounts of noradrenaline, dopamine, and serotonin not being reabsorbed the past 5 years. I seem to have reabsorbed a ton, and now, I just seem to have a mild yet problematic amount not being reabsorbed.

 

Edited February 19, 2022 by Bug98
Forgot to add title

[ChessieCat]

Hi Bug98 and welcome to SA

 

Q:  What assistance are you wanting?

 

Please do the drug interactions for ALL drugs you are currently taking and copy and paste the results here in your Introduction topic.  Please use both interaction checkers; they display the interactions in a different format.

 

Drug.com Interactions Checker

Medscape Drug Interaction Checker

 

Q:  What symptoms are you currently experiencing?

 

Please create your drug signature following these instructions:

 

Instructions:  Withdrawal History Signature

 

Once we have more information we will be better able to offer suggestions.

 

This is your own Introduction topic which is the best place to ask questions and journal your progress.  This keeps your history in one place and means you do not have to repeat your story.

[Bug98]

Q:  What assistance are you wanting?

I'm wanting to know what I need to know for tapering off venlafaxine (extended release, 150mg), methylphenidate (concerta, 36mg), and risperidone (1mg or .5 mg I think).

 

I've been on them for 15 years (one was changed from lithium to what it is now).

I'm not sure what the psychiatrist will recommend, though it seems there's an at least decent chance their way of getting me off them won't work.

I'm also not sure how to wean off it safely with no withdrawal symptoms or how to deal with the symptoms that might occur. I'm 22. I want to make progress in life, move out, build capital, date, make friends, and become an entrepreneur. I don't want to have to wait around to recover or make slow progress in life (not to suggest I should try to do like 500 tasks a day).

 

 

Q:  What symptoms are you currently experiencing?

Overpronation, poor mental clarity, irritability and emotional negativity, slight acne, dry eyes, shortness of breath at night, low willpower, fluctuating self-esteem, a feeling of stiffness related to tendons (feels like overpronation but in arms and hands), inflammation around kidney area of abdomen in response to stress, less energy or stress tolerance (going for a 1 mile run greatly worsens health problems, though I can walk around, kick a ball, and do some tasks), emotional blunting, inability to focus/defocus my eyes, derealization, anxiety at times, and more.

 

 

Drug interactions:

Monitor Closely

• risperidone + methylphenidate

  risperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

• venlafaxine + risperidone

  venlafaxine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• venlafaxine + risperidone

  venlafaxine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• risperidone + venlafaxine

  risperidone and venlafaxine both increase QTc interval. Use Caution/Monitor.

 

1. Drug Interactions Checker
2. Search
3. Report

 

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Drug Interaction Report

This report displays the potential drug interactions for the following 3 drugs:

• Effexor XR (venlafaxine)
• Risperdal (risperidone)
• Concerta (methylphenidate)
• Add another drug

• Consumer
• Professional

Major (0)

Moderate (2)

Minor (0)

Food (3)

Therapeutic Duplication (0)

Interactions between your drugs

Moderate

methylphenidate

risperiDONE

Applies to: Concerta (methylphenidate), Risperdal (risperidone)

Before taking methylphenidate, tell your doctor if you also use risperiDONE. This combination may sometimes increase the adverse effects of risperiDONE, including tremor, shuffling of your feet, drooling, a mask-like face, tongue stiffness, muscle spasms or rigidity, and involuntary movements. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment if you take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

risperiDONE

venlafaxine

Applies to: Risperdal (risperidone), Effexor XR (venlafaxine)

Using risperiDONE together with venlafaxine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs. However, this does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

methylphenidate

food

Applies to: Concerta (methylphenidate)

Do not use alcohol or medications that contain alcohol while you are receiving treatment with methylphenidate. This may increase nervous system side effects such as drowsiness, anxiety, depression, and seizures. In addition, with certain long-acting forms of methylphenidate, alcohol can cause too much of the drug to be released at one time. High blood levels of the drug may increase the risk of side effects. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

risperiDONE

food

Applies to: Risperdal (risperidone)

RisperiDONE oral solution should not be mixed with tea or cola. It may be taken with water, coffee, orange juice, or low-fat milk. You should avoid the use of alcohol while being treated with risperiDONE. Alcohol can increase the nervous system side effects of risperiDONE such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

venlafaxine

food

Applies to: Effexor XR (venlafaxine)

Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with venlafaxine. Do not use more than the recommended dose of venlafaxine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

 

 

I'd like to mention that five years ago, when I first had what seems to be serotonin syndrome, I got into masturbation and porn which it seems don't mix well with two of the drugs. That seems to have caused serotonin syndrome and very high dopamine and norepinephrine levels, though I've mostly recovered.

[ChessieCat]

Thank you for answering my questions and posting the interaction reports.

 

SA's recommended method is to taper only one drug at a time and to reduce by no more than 10% of the current dose (not original/starting dose) and to hold for at least 4 weeks to allow the brain to adapt to not getting as much of the drug.  This method of tapering generally helps to keep withdrawal symptoms to a minimum so you can live you life as normally as possible.  SA recommends not making another reduction until you are at withdrawal normal.  It is generally better to hold for longer than to risk tapering again too soon.

 

I will give you a list of links.  Please work through them and then ask any questions, here in your Introduction topic, that you have.

 

Taking multiple psych drugs? Which drug to taper first?
If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug).

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's WD Symptoms Checklist 

 

Post #1 of the following topics provide information on how to get non standard doses:

 

Please note the list is in NO particular order (ie I am not suggesting the order that you taper the drugs)

 

Tips for tapering off venlafaxine (Effexor)

 

Tips for tapering off risperidone (Risperdal)

 

We do not have a tapering topic for Concerta.  I will ask the other mods who may have more knowledge about how to get non standard doses.

[Altostrata]

Welcome, @Bugs Have you talked about these adverse effects with your doctor?

 

Why was methylphenidate added, and when? Are you taking an extended-release version (Concerta)? Did you ever take immediate-release (Ritalin)?

 

What times o'clock do you take your drugs, with their dosages?

 

When was the last time the dosage was changed for all of your drugs, what was the change?

[Bug98]

I haven't talked about it with my doctor. There's a whole issue with an immature parent I have to deal with first, and it seems likely the doctor's solution won't work.

 

I think the drugs were added because of diagnosis of aspergers and ADD.

 

I don't know about the extended or immediate release statuses of Concerts and Ritalin.

 

Lately, I've taken them various times before 12:00 PM.

 

I don't know what the dosage changes were.

 

I can't access a lot of the information pertaining to the drugs because of issues pertaining to my parent. Her fight-or-flight response goes off easily, especially in response to stuff pertaining to the medicine.

 

Edited February 25, 2022 by ChessieCat
extracted response from quote and added spacing

[Bug98]

On 2/23/2022 at 3:19 PM, ChessieCat said:

Thank you for answering my questions and posting the interaction reports.

 

SA's recommended method is to taper only one drug at a time and to reduce by no more than 10% of the current dose (not original/starting dose) and to hold for at least 4 weeks to allow the brain to adapt to not getting as much of the drug.  This method of tapering generally helps to keep withdrawal symptoms to a minimum so you can live you life as normally as possible.  SA recommends not making another reduction until you are at withdrawal normal.  It is generally better to hold for longer than to risk tapering again too soon.

 

I will give you a list of links.  Please work through them and then ask any questions, here in your Introduction topic, that you have.

 

Taking multiple psych drugs? Which drug to taper first?
If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug).

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's WD Symptoms Checklist 

 

Post #1 of the following topics provide information on how to get non standard doses:

 

Please note the list is in NO particular order (ie I am not suggesting the order that you taper the drugs)

 

Tips for tapering off venlafaxine (Effexor)

 

Tips for tapering off risperidone (Risperdal)

 

We do not have a tapering topic for Concerta.  I will ask the other mods who may have more knowledge about how to get non standard doses.

Thank you SOOOOO much, Chessie!!!

[Altostrata]

On 2/23/2022 at 12:13 PM, Bug98 said:

Overpronation, poor mental clarity, irritability and emotional negativity, slight acne, dry eyes, shortness of breath at night, low willpower, fluctuating self-esteem, a feeling of stiffness related to tendons (feels like overpronation but in arms and hands), inflammation around kidney area of abdomen in response to stress, less energy or stress tolerance (going for a 1 mile run greatly worsens health problems, though I can walk around, kick a ball, and do some tasks), emotional blunting, inability to focus/defocus my eyes, derealization, anxiety at times, and more.

 

Hello, @Bug98 What do you mean by overpronation? Do you have pain in your abdomen? Have you been getting regular blood tests for kidney and liver function? How's your sleep?

 

As you can see from your interactions report, you are taking an unusual combination of drugs that don't play well together.

 

Are you a minor? Is there a  court order assigning your parents the responsibility for your medical decisions?

[Bug98]

20 minutes ago, Altostrata said:

 

Hello, @Bug98 What do you mean by overpronation? Do you have pain in your abdomen? Have you been getting regular blood tests for kidney and liver function? How's your sleep?

 

As you can see from your interactions report, you are taking an unusual combination of drugs that don't play well together.

 

Are you a minor? Is there a  court order assigning your parents the responsibility for your medical decisions?

By overpronation, I mean my ankles turn inward too much. I don't have abdominal pain, and I haven't been getting blood tests for kidney and liver function as far as I'm aware. I don't seem to have sleep problems anymore, though I do have a willpower problem at the end of the day which makes it hard to get to sleep on time.

 

I'm not a minor. As far as I'm aware, there's not a court order for that, though there are legal documents for that in the event I become incapacitated which I'm not. I think taking a sales-like approach would personally be better than a legal approach when it comes to dealing with my mom.

[Altostrata]

Why do you associate this pronation with the drugs you're taking?

33 minutes ago, Bug98 said:

I think taking a sales-like approach would personally be better than a legal approach when it comes to dealing with my mom.

 

Very true. But if you are not a minor, you can tell the doctors what you want to do. Your parents don't have to be in the room. Do you feel confident about that?

 

You could, for example, ask for kidney and liver function tests. These are usually included in any regular check-up. If you've had blood tests for a check up recently, kidney and liver function tests probably were done.

 

You also need to learn more about the drugs you're taking. You can identify them by Googling images of the tablets or capsules. We need to know if you're taking dosage and immediate-release or extended-release forms of each drug. Please check this and let us know exactly what you're taking.

 

In my opinion, you are taking a weird assortment of drugs, none of which are standard treatment for Asperger's. If you had ADD before, it appears your drug-induced state is worse, since you have drug-induced concentration difficulties. As you can see, the combinations can lead to odd symptoms.

 

Among your drugs, risperidone causes the most serious adverse effects. I would be very concerned about movement or muscle symptoms. See the interactions with Concerta.

 

On 2/23/2022 at 12:13 PM, Bug98 said:

This combination may sometimes increase the adverse effects of risperiDONE, including tremor, shuffling of your feet, drooling, a mask-like face, tongue stiffness, muscle spasms or rigidity, and involuntary movements.

 

Risperidone is also probably causing you to be foggy, tired, and demotivated. 

 

On 2/25/2022 at 12:53 AM, Bug98 said:

Lately, I've taken them various times before 12:00 PM.

 

It's very, very important that you take your psychiatric drugs on a consistent schedule. Taking them inconsistently may be causing some of your odd symptoms.

 

It doesn't make any sense to take Concerta, a stimulant in the nighttime. Taking all your drugs together confuses your symptom pattern. We like to separate the drugs to see what each one is doing. May I suggest you take venlafaxine at 9 a.m., Concerta at noon, and Risperdal at 10 p.m.?

 

It's possible you're getting surges of "anxiety" after you take Effexor or Concerta because that's an adverse effect of the drugs. If we can see what's causing what, we can better figure out what should be tapered first.

 

Please let us know what you decide for your drug schedule.

 

 

[Bug98]

On 2/26/2022 at 3:40 PM, Altostrata said:

Why do you associate this pronation with the drugs you're taking?

I could be wrong. It seems as though it's related to serotonin levels. Something with a tendon near my ankle. The amount the tendon is used seems to change in relation to serotonin levels. I've noticed the same feeling in my arms and fingers at times too and would feel it in my back at one point, though it can be seen and heard with my feet and the way I walk.

On 2/26/2022 at 3:40 PM, Altostrata said:

 

Very true. But if you are not a minor, you can tell the doctors what you want to do. Your parents don't have to be in the room. Do you feel confident about that?

Yes. I'll have to use sales tactics, though.

On 2/26/2022 at 3:40 PM, Altostrata said:

 

You could, for example, ask for kidney and liver function tests. These are usually included in any regular check-up. If you've had blood tests for a check up recently, kidney and liver function tests probably were done.

On 2/26/2022 at 3:40 PM, Altostrata said:

 

You also need to learn more about the drugs you're taking. You can identify them by Googling images of the tablets or capsules. We need to know if you're taking dosage and immediate-release or extended-release forms of each drug. Please check this and let us know exactly what you're taking.

Got it!

On 2/26/2022 at 3:40 PM, Altostrata said:

In my opinion, you are taking a weird assortment of drugs, none of which are standard treatment for Asperger's. If you had ADD before, it appears your drug-induced state is worse, since you have drug-induced concentration difficulties. As you can see, the combinations can lead to odd symptoms.

The drugs caused a bunch of problems for me. Serotonin syndrome was from a mix of one or more of the drugs and PMO. It never crossed my mind it wouldn't mix well with the drugs.

On 2/26/2022 at 3:40 PM, Altostrata said:

 

Among your drugs, risperidone causes the most serious adverse effects. I would be very concerned about movement or muscle symptoms. See the interactions with Concerta.

 

 

Risperidone is also probably causing you to be foggy, tired, and demotivated. 

I did notice brain fog before serotonin syndrome actually. The symptoms I had pre-PMO were blurred vision, allergic rhinitis, brain fog, emotional blunting, reduced affect display, a delay in the mobilization of my brain and body for action, depersonalization or derealization, constipation, maybe foggy mental imagery, bruxism, occasionally hearing a whistle-like sound (not sure if everyone experiences that at times), possibly changes in dietary needs, deviated septum, possibly something with my attention span, and possibly tics (long story, but could've been related to false conclusions I had about what caused the side effects I didn't realize were from the drugs when I was a kid).

 

The symptoms I've had post-PMO (which have now significantly reduced or disappeared, including the severe/dangerous ones) are or were brain fog, dry eyes, dry nose, poor impulse control or low willpower, extreme task-switching or cognitive shifting, low energy, overpronation, weight loss, insomnia, acne and oily hair and skin, sexual dysfunction, poor attention, anxiety, depression, high blood pressure, emotional blunting, dry bowels, blunted pain, oversensitivity, bruxism, low body temperature at times, irritability, tachycardia, shivering, tremors, "hyperness" (like a person on cocaine), cynicism or negativity, inflammation near my kidneys and genitalia, dry mouth, sensitive teeth, sensitivity to light, distorted perception (not hallucinations but distorted in the same way a sleep-deprived person's perception is distorted), low self-esteem, low stress tolerance, altered wakefulness, eye bags I think, poor memory, dilated pupils, poor posture, goosebumps, low motivation, and "talkativeness".

 

On 2/26/2022 at 3:40 PM, Altostrata said:

 

 

It's very, very important that you take your psychiatric drugs on a consistent schedule. Taking them inconsistently may be causing some of your odd symptoms.

I have been taking them an hour or three off at times lately. I'm not an expert on the drugs. I don't think it's to blame for the incredibly high serotonin levels, though.

On 2/26/2022 at 3:40 PM, Altostrata said:

 

It doesn't make any sense to take Concerta, a stimulant in the nighttime. Taking all your drugs together confuses your symptom pattern. We like to separate the drugs to see what each one is doing. May I suggest you take venlafaxine at 9 a.m., Concerta at noon, and Risperdal at 10 p.m.?

I take all three in the morning. I'm not sure why, though.

On 2/26/2022 at 3:40 PM, Altostrata said:

It's possible you're getting surges of "anxiety" after you take Effexor or Concerta because that's an adverse effect of the drugs. If we can see what's causing what, we can better figure out what should be tapered first.

I don't think I had anxiety before I got into PMO other than anxiety from low self-esteem which may be related to the drugs, my family, and/or lack of therapy at the time.

On 2/26/2022 at 3:40 PM, Altostrata said:

 

Please let us know what you decide for your drug schedule.

 

 

Got it!

[Bug98]

On 3/4/2022 at 10:21 PM, Bug98 said:

I could be wrong. It seems as though it's related to serotonin levels. Something with a tendon near my ankle. The amount the tendon is used seems to change in relation to serotonin levels. I've noticed the same feeling in my arms and fingers at times too and would feel it in my back at one point, though it can be seen and heard with my feet and the way I walk.

Yes. I'll have to use sales tactics, though.

Got it!

The drugs caused a bunch of problems for me. Serotonin syndrome was from a mix of one or more of the drugs and PMO. It never crossed my mind it wouldn't mix well with the drugs.

I did notice brain fog before serotonin syndrome actually. The symptoms I had pre-PMO were blurred vision, allergic rhinitis, brain fog, emotional blunting, reduced affect display, a delay in the mobilization of my brain and body for action, depersonalization or derealization, constipation, maybe foggy mental imagery, bruxism, occasionally hearing a whistle-like sound (not sure if everyone experiences that at times), possibly changes in dietary needs, deviated septum, possibly something with my attention span, and possibly tics (long story, but could've been related to false conclusions I had about what caused the side effects I didn't realize were from the drugs when I was a kid).

 

The symptoms I've had post-PMO (which have now significantly reduced or disappeared, including the severe/dangerous ones) are or were brain fog, dry eyes, dry nose, poor impulse control or low willpower, extreme task-switching or cognitive shifting, low energy, overpronation, weight loss, insomnia, acne and oily hair and skin, sexual dysfunction, poor attention, anxiety, depression, high blood pressure, emotional blunting, dry bowels, blunted pain, oversensitivity, bruxism, low body temperature at times, irritability, tachycardia, shivering, tremors, "hyperness" (like a person on cocaine), cynicism or negativity, inflammation near my kidneys and genitalia, dry mouth, sensitive teeth, sensitivity to light, distorted perception (not hallucinations but distorted in the same way a sleep-deprived person's perception is distorted), low self-esteem, low stress tolerance, altered wakefulness, eye bags I think, poor memory, dilated pupils, poor posture, goosebumps, low motivation, and "talkativeness".

 

I have been taking them an hour or three off at times lately. I'm not an expert on the drugs. I don't think it's to blame for the incredibly high serotonin levels, though.

I take all three in the morning. I'm not sure why, though.

I don't think I had anxiety before I got into PMO other than anxiety from low self-esteem which may be related to the drugs, my family, and/or lack of therapy at the time.

Got it!

Sorry the response took so long.

I want to say first that I feel like it might be possible that my serotonin syndrome is being attributed to the drug combination or schedule rather than PMO while on the drugs. I could be wrong. There's a lot of strong evidence that points to the cause being from getting into PMO while on the drugs, though. I would guess it's related to PMO and the venlafaxine.

That being said, I remember there was some reason why the drug combination was used and why I take them in the morning. I think it was due to misinformation my parent gave to my doctor. She would give her very subjective report about how I'd respond to the drugs to the doctor, sometimes to get the prescription changes she wanted, sometimes because she biasedly considered aspects of me and my behavior as "bad". For example, she treats argumentation as absolutely bad. There's no gray area to her.

It seems the idea of making changes to the drug combination, amounts, etc. started scaring or angering her at some point. I guess she doesn't want any new changes.

If I were to guess why, it's because of how my brother responded to when he did stuff with the drugs he's on and personal stuff he was going through. Also because of how I behaved during a time when I was younger.

Maybe my behavior could be partially attributed to the drug combination and amounts I was on at the time. I don't think it was due to that, though. I was going through self-esteem issues at the time.

The drugs I'm on are methylphenidate ER 36mg, risperidone 1mg, and venlafaxine ER 150mg. I take them usually some time after 9:00 AM, before 11:00 AM.

[Altostrata]

@Bug98, what is PMO?

 

Please stop interpreting your symptoms as related to noradrenaline, dopamine, and serotonin. Whatever theory you're employing regarding your noradrenaline, dopamine, and serotonin levels, it is wrong. You have no way of measuring your noradrenaline, dopamine, and serotonin levels. The "chemical imbalance" theory is a myth.

 

While taking too many serotonergic drugs together can cause serotonin toxicity or serotonin syndrome, you have not reported symptoms of these. You have reported symptoms that may be from other drug-drug interactions or from individual drugs.

 

On 2/26/2022 at 1:40 PM, Altostrata said:

It's very, very important that you take your psychiatric drugs on a consistent schedule. Taking them inconsistently may be causing some of your odd symptoms.

 

If I said it's very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very important that you take your psychiatric drugs on a consistent schedule, would that make it clear that it's important you do this?

 

On 2/26/2022 at 1:40 PM, Altostrata said:

May I suggest you take venlafaxine at 9 a.m., Concerta at noon, and Risperdal at 10 p.m.?

 

The reasons I suggest you take your drugs separately on a regular schedule is because 1) this may lessen any drug-drug interactions that you may be getting by taking them all at once; 2) if you separate your drugs, we may be able to see how each affects you, which we cannot do now.

 

On 2/26/2022 at 1:40 PM, Altostrata said:

It's possible you're getting surges of "anxiety" after you take Effexor or Concerta because that's an adverse effect of the drugs. If we can see what's causing what, we can better figure out what should be tapered first.

 

This is the point.

 

Please let us know when you are taking your drugs on a regular schedule. This is required before we can provide peer support for a tapering plan.

[Bug98]

11 minutes ago, Altostrata said:

@Bug98, what is PMO?

 

Please stop interpreting your symptoms as related to noradrenaline, dopamine, and serotonin. Whatever theory you're employing regarding your noradrenaline, dopamine, and serotonin levels, it is wrong. You have no way of measuring your noradrenaline, dopamine, and serotonin levels. The "chemical imbalance" theory is a myth.

 

While taking too many serotonergic drugs together can cause serotonin toxicity or serotonin syndrome, you have not reported symptoms of these. You have reported symptoms that may be from other drug-drug interactions or from individual drugs.

 

 

If I said it's very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very important that you take your psychiatric drugs on a consistent schedule, would that make it clear that it's important you do this?

 

 

The reasons I suggest you take your drugs separately on a regular schedule is because 1) this may lessen any drug-drug interactions that you may be getting by taking them all at once; 2) if you separate your drugs, we may be able to see how each affects you, which we cannot do now.

 

 

This is the point.

 

Please let us know when you are taking your drugs on a regular schedule. This is required before we can provide peer support for a tapering plan.

PMO is an abbreviation or acronym for porn, masturbation, orgasm.

 

I don't have a way to measure my "levels", and I've heard the concept of a chemical imbalance is a myth. I've concluded based on repeated personal observations of my mind, body, and behavior and online research while checking for biases in myself that I have serotonin syndrome, though.

 

For me, "levels" is just an oversimplified shorthand way of describing or explaining things.🙂

 

It's very important I take the drugs on a consistent schedule. Given my situation, it'll be very difficult to take them at separately at different times on a regular, though. It may be doable, though I'm not sure how many times I can get her to do things and not have a massive negative response to things. It might be best if I do it after I complete some tasks I need to complete which will take awhile.

[Altostrata]

To go off drugs with peer support, you must have control over your drugs. If you don't have control over your drugs, we're not going to be able to help you.

 

I understand a difficult relationship with your parents interferes with this. I'm very sorry, we're not going to be able to help you at this time. Please let us know when you get control over your drug dosing.

 

For your information, Tips for tapering off venlafaxine (Effexor)

 

Tips for tapering off risperidone (Risperdal)

 

We don't have a specific topic for tapering methylphenidate (Ritalin). The general principles are the same:

 

Why taper by 10% of my dosage?

How to make a liquid from tablets or capsules
 
Using an oral syringe and other tapering techniques 

[Bug98]

22 hours ago, Altostrata said:

To go off drugs with peer support, you must have control over your drugs. If you don't have control over your drugs, we're not going to be able to help you.

 

I understand a difficult relationship with your parents interferes with this. I'm very sorry, we're not going to be able to help you at this time. Please let us know when you get control over your drug dosing.

 

For your information, Tips for tapering off venlafaxine (Effexor)

 

Tips for tapering off risperidone (Risperdal)

 

We don't have a specific topic for tapering methylphenidate (Ritalin). The general principles are the same:

 

Why taper by 10% of my dosage?

How to make a liquid from tablets or capsules
 
Using an oral syringe and other tapering techniques 

Thanks, Altostrata.

[Bug98]

How should I go about tapering?

 

I'm on venlafaxine extended release, methylphenidate extended release, and risperidone. 150mg, 36mg, and 1mg respectively.

 

I've been taking them at 9:30 AM. I've heard they're normally taken at different times. However, assuming I recall correctly, my parent told the doctor some false information, because she wanted them to be taken at the same time. She's a very immature parent.

 

I've been on drugs since I was 6 or 7, though one or more changes were made since then. I think I was on lithium at one point. Drug doses may have changed at times. Now, I'm 23.

 

I'm planning on using hostage negotiation tactics (tactical empathy) with the psychiatrist. She's not a bad person. Psychiatrists often don't seem to know how to taper properly, though, and I could see a lot of psychiatrists being afraid to do certain things for legal or administrative reasons.

 

Also, I'm planning on moving to another state and becoming independent. Not sure what to do about the paperwork, insurance, or provider. The schools of medicine and the therapies I believe in (traditional medicine and functional medicine mainly, not homeopathy or anti-vax stuff) aren't covered by insurance in the US. However, they can be covered by an HSA.

 

I've been recovering from serotonin syndrome the past several months (long story), and I'm almost fully recovered from it. Masturbation and venlafaxine apparently don't mix well.

 

Edited July 16, 2022 by ChessieCat
added Intro topic title before merging with intro topic and added spacing

[ChessieCat]

On 3/29/2022 at 11:59 AM, Altostrata said:

To go off drugs with peer support, you must have control over your drugs. If you don't have control over your drugs, we're not going to be able to help you.

 

Q:  Do you now have control over your drugs?

[ChessieCat]

Please put all the drugs you are currently taking into these drug interaction checkers and copy and paste the results in a post.  Please do both.  I suggest you post them as two separate posts, one for the drug.com checker and one for the medscape checker because it will be easier to see them.

 

Drug.com Interactions Checker

Medscape Drug Interaction Checker

 

Edited July 16, 2022 by ChessieCat

[Bug98]

2 hours ago, ChessieCat said:

 

Q:  Do you now have control over your drugs?

If you mean I can choose when to take them, yes.

[Bug98]

2 hours ago, ChessieCat said:

Please put all the drugs you are currently taking into these drug interaction checkers and copy and paste the results in a post.  Please do both.  I suggest you post them as two separate posts, one for the drug.com checker and one for the medscape checker because it will be easier to see them.

 

Drug.com Interactions Checker

Medscape Drug Interaction Checker

 

I really don't think my instance of serotonin syndrome is from a mix of drugs. I'll do it, though.

• risperidone + methylphenidate

  risperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

• venlafaxine + risperidone

  venlafaxine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• venlafaxine + risperidone

  venlafaxine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• risperidone + venlafaxine

  risperidone and venlafaxine both increase QTc interval. Use Caution/Monitor.

 

I know masturbation causes a huge release of serotonin, and my symptoms would get very noticeably worse every time I did. Unless I'm missing something (I don't think I am but could be), it's how I got serotonin syndrome in the first place. Also, SNRIs, including venlafaxine, are known to be related to serotonin syndrome while, from what I could find, risperidone and methylphenidate aren't. SNRIs also inhibit the reuptake of serotonin, and I had a huge list of symptoms of "high" serotonin or serotonin syndrome.

 

Regardless, I might have had symptoms from drugs interacting prior to serotonin syndrome. Although, nothing that was an emergency, and I don't see why drugs interacting would all of a sudden cause serotonin syndrome without some other factor.

[Bug98]

Interactions between your drugs

Moderate

methylphenidate

risperiDONE

Applies to: methylphenidate, risperidone

Before taking methylphenidate, tell your doctor if you also use risperiDONE. This combination may sometimes increase the adverse effects of risperiDONE, including tremor, shuffling of your feet, drooling, a mask-like face, tongue stiffness, muscle spasms or rigidity, and involuntary movements. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment if you take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

risperiDONE

venlafaxine

Applies to: risperidone, venlafaxine

Using risperiDONE together with venlafaxine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs. However, this does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

methylphenidate

food

Applies to: methylphenidate

Do not use alcohol or medications that contain alcohol while you are receiving treatment with methylphenidate. This may increase nervous system side effects such as drowsiness, anxiety, depression, and seizures. In addition, with certain long-acting forms of methylphenidate, alcohol can cause too much of the drug to be released at one time. High blood levels of the drug may increase the risk of side effects. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

risperiDONE

food

Applies to: risperidone

RisperiDONE oral solution should not be mixed with tea or cola. It may be taken with water, coffee, orange juice, or low-fat milk. You should avoid the use of alcohol while being treated with risperiDONE. Alcohol can increase the nervous system side effects of risperiDONE such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

venlafaxine

food

Applies to: venlafaxine

Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with venlafaxine. Do not use more than the recommended dose of venlafaxine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

[ChessieCat]

52 minutes ago, Bug98 said:

really don't think my instance of serotonin syndrome is from a mix of drugs. I'll do it, though.

 

I asked for the drug interaction reports because you are taking more than 1 psychiatric drug, which we ask all members to do this.  It was nothing to do with your previous serotonin syndrome.

[ChessieCat]

It is important to understand that you will need to taper your drugs carefully so as not to cause bad withdrawal symptoms, otherwise you may end up in hospital and taking higher doses, adding/changing drugs.  You will also need to learn to control behaviour that might get institutionalised.

 

Please read through this topic:

 

Before you begin tapering what you need to know

 

SA's tapering rate is no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

And it is recommended to only taper one drug at a time, otherwise if you get withdrawal symptoms you will not know which drug you reduced caused it.

 

Q:  Do you know for a fact that one of your drugs is causing bad side effects?  If you have always taken them at the same time then it might be difficult to work out.  I will ask the other staff whether they think that separating the times that you take your drugs might be helpful.

 

If you know that one of your drugs is causing bad side effects then it would generally be better to reduce that drug first.  If you don't, then it is suggested to look up the possible side effects of each of your drugs; I have added what I found on drugs.com in this post (note that I have only given the COMMON side effects and these are just side effects, not interactions).

 

Taking multiple psych drugs? Which drug to taper first?
If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug).  Click on the title to see further information.

 

There is no taper topic for methylphenidate (sold under brand names Concerta and Ritalin) but you could do a search for that names to find other members tapering that drug.

 

When doing the search for the side effects I found this information and I have bolded what might be relevant to your situation which you might not be aware of:

 

Methylphenidate side effects

 

Get emergency medical help if you have signs of an allergic reaction to methylphenidate: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

 

Call your doctor at once if you have:

• signs of heart problems - chest pain, trouble breathing, feeling like you might pass out;
• signs of psychosis - hallucinations (seeing or hearing things that are not real), new behavior problems, aggression, hostility, paranoia;
• signs of circulation problems - numbness, pain, cold feeling, unexplained wounds, or skin color changes (pale, red, or blue appearance) in your fingers or toes; or
• penis erection that is painful or lasts 4 hours or longer.

 

Common methylphenidate side effects may include:

• sweating, increased blood pressure;

• mood changes, anxiety, feeling nervous or irritable, trouble sleeping;

• fast heart rate, pounding heartbeats or fluttering in your chest;

• loss of appetite, weight loss;

• dry mouth, nausea, vomiting, stomach pain, indigestion; or

• headache, dizziness.

 

Post #1 of these topics provide information on ways to get non standards doses to taper:

 

Tips for tapering off venlafaxine (Effexor)

 

Common side effects of venlafaxine may include:

• headache, dizziness, drowsiness, tiredness;
• feeling anxious, nervous, or jittery;
• sleep problems, unusual dreams;
• tremors;
• fast heartbeats;
• blurred vision;
• nausea, vomiting, diarrhea, constipation;
• changes in weight or appetite;
• dry mouth, yawning;
• increased sweating; or
• sexual problems.

 

Tips for tapering off risperidone (Risperdal)

 

Common risperidone side effects may include:

• headache;
• dizziness, drowsiness, feeling tired;
• tremors, twitching or uncontrollable muscle movements;
• agitation, anxiety, restless feeling;
• depressed mood;
• dry mouth, upset stomach, diarrhea, constipation;
• weight gain; or
• cold symptoms such as stuffy nose, sneezing, sore throat.

 

 

[ChessieCat]

You might find it helpful to connect with other members who were put on psychiatric drugs as children:

 

for-people-who-were-drugged-as-children

 

[Bug98]

14 hours ago, ChessieCat said:

 

I asked for the drug interaction reports because you are taking more than 1 psychiatric drug, which we ask all members to do this.  It was nothing to do with your previous serotonin syndrome.

 

14 hours ago, ChessieCat said:

It is important to understand that you will need to taper your drugs carefully so as not to cause bad withdrawal symptoms, otherwise you may end up in hospital and taking higher doses, adding/changing drugs.  You will also need to learn to control behaviour that might get institutionalised.

 

Please read through this topic:

 

Before you begin tapering what you need to know

 

SA's tapering rate is no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

And it is recommended to only taper one drug at a time, otherwise if you get withdrawal symptoms you will not know which drug you reduced caused it.

 

Q:  Do you know for a fact that one of your drugs is causing bad side effects?  If you have always taken them at the same time then it might be difficult to work out.  I will ask the other staff whether they think that separating the times that you take your drugs might be helpful.

 

If you know that one of your drugs is causing bad side effects then it would generally be better to reduce that drug first.  If you don't, then it is suggested to look up the possible side effects of each of your drugs; I have added what I found on drugs.com in this post (note that I have only given the COMMON side effects and these are just side effects, not interactions).

 

Taking multiple psych drugs? Which drug to taper first?
If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug).  Click on the title to see further information.

 

There is no taper topic for methylphenidate (sold under brand names Concerta and Ritalin) but you could do a search for that names to find other members tapering that drug.

 

When doing the search for the side effects I found this information and I have bolded what might be relevant to your situation which you might not be aware of:

 

Methylphenidate side effects

 

Get emergency medical help if you have signs of an allergic reaction to methylphenidate: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

 

Call your doctor at once if you have:

• signs of heart problems - chest pain, trouble breathing, feeling like you might pass out;
• signs of psychosis - hallucinations (seeing or hearing things that are not real), new behavior problems, aggression, hostility, paranoia;
• signs of circulation problems - numbness, pain, cold feeling, unexplained wounds, or skin color changes (pale, red, or blue appearance) in your fingers or toes; or
• penis erection that is painful or lasts 4 hours or longer.

 

Common methylphenidate side effects may include:

• sweating, increased blood pressure;

• mood changes, anxiety, feeling nervous or irritable, trouble sleeping;

• fast heart rate, pounding heartbeats or fluttering in your chest;

• loss of appetite, weight loss;

• dry mouth, nausea, vomiting, stomach pain, indigestion; or

• headache, dizziness.

 

Post #1 of these topics provide information on ways to get non standards doses to taper:

 

Tips for tapering off venlafaxine (Effexor)

 

Common side effects of venlafaxine may include:

• headache, dizziness, drowsiness, tiredness;
• feeling anxious, nervous, or jittery;
• sleep problems, unusual dreams;
• tremors;
• fast heartbeats;
• blurred vision;
• nausea, vomiting, diarrhea, constipation;
• changes in weight or appetite;
• dry mouth, yawning;
• increased sweating; or
• sexual problems.

 

Tips for tapering off risperidone (Risperdal)

 

Common risperidone side effects may include:

• headache;
• dizziness, drowsiness, feeling tired;
• tremors, twitching or uncontrollable muscle movements;
• agitation, anxiety, restless feeling;
• depressed mood;
• dry mouth, upset stomach, diarrhea, constipation;
• weight gain; or
• cold symptoms such as stuffy nose, sneezing, sore throat.

 

 

Thank you SO much!

[Altostrata]

Typically, serotonin syndrome is caused by drug overload -- taking multiple drugs.

 

What times o'clock do you take each of your drugs, with their dosages?

[Estman]

On 7/17/2022 at 4:55 AM, Bug98 said:

I really don't think my instance of serotonin syndrome is from a mix of drugs. I'll do it, though.

• risperidone + methylphenidate

  risperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

• venlafaxine + risperidone

  venlafaxine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• venlafaxine + risperidone

  venlafaxine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• risperidone + venlafaxine

  risperidone and venlafaxine both increase QTc interval. Use Caution/Monitor.

 

I know masturbation causes a huge release of serotonin, and my symptoms would get very noticeably worse every time I did. Unless I'm missing something (I don't think I am but could be), it's how I got serotonin syndrome in the first place. Also, SNRIs, including venlafaxine, are known to be related to serotonin syndrome while, from what I could find, risperidone and methylphenidate aren't. SNRIs also inhibit the reuptake of serotonin, and I had a huge list of symptoms of "high" serotonin or serotonin syndrome.

 

Regardless, I might have had symptoms from drugs interacting prior to serotonin syndrome. Although, nothing that was an emergency, and I don't see why drugs interacting would all of a sudden cause serotonin syndrome without some other factor.

Does masturbation cause withdrawal symptoms?
Even if it's one-off and infrequent?

[Ariel]

@Bug98 @Estman

 

On 7/18/2022 at 4:03 AM, Altostrata said:

Typically, serotonin syndrome is caused by drug overload -- taking multiple drugs.

 

On 7/17/2022 at 3:55 AM, Bug98 said:

I know masturbation causes a huge release of serotonin, and my symptoms would get very noticeably worse every time I did. Unless I'm missing something (I don't think I am but could be), it's how I got serotonin syndrome in the first place.

 

It stretches the limits of my imagination to think that one might get serotonin syndrome from masturbation/sex/orgasm. 

If it were possible or probable I don't know how our species would have become so populous or even have survived at all. 

 

7 hours ago, Estman said:

Does masturbation cause withdrawal symptoms?
Even if it's one-off and infrequent?

 

Something that masturbation and withdrawal syndrome/symptoms have in common is that they are subjectively experienced.

TLDR: Trust yourself. Listen to your body. 

 

The nervous system is involved in sexual arousal in a variety of complex ways. 

It is not inconceivable that a WD-dysautonomic body might encounter certain more or less subtle physiological effects of masturbation and react paradoxically.

In other words, one might wonder whether it could be possible for a WD-hypersensitized, dysregulated nervous system to consider masturbation an imposition akin to an external stressor. 

It doesn't seem impossible that dynamic aspects such as changes to blood flow, blood pressure, muscle tension, breathing pattern, heart rate, signaling activity, and numerous other contributing factors, could be interpreted or processed by our healing, preoccupied brains in unexpected ways with unusual consequences. 

After all, and for example, we know that vigorous exercise triggers cortisol, and in WD we seem to be sensitized to cortisol.

Perhaps it's feasible that particularly spirited self-pleasuring could result in a robust cortisol response, which might in turn provoke an unpredictable WD-related reaction. 

(If that's the case, the same should hold true for partnered sex. I haven't heard reports of partnered sex exacerbating WD symptoms, but that doesn't mean it doesn't happen.)

It seems that cortisol is released in proportion to the intensity of activity.

If we posit that (sensitivity to) cortisol spikes might be at play in a possible WD reaction to sexual activity (solo or not), one might try to steer clear of engaging in overly strenuous practices. 

Just as SA generally advocates going for a walk over a run, one might experiment with the onanistic equivalent of a mindful stroll rather than a furious sprint. 

 

Bottom line: Go gently.

Pay attention -- if something feels good, go with that; if it doesn't feel good, stop. 

Be kind to yourself, treat yourself with tender loving care, and don't worry.

It gets better. 

 

In solidarity and support,

A. 

[ChessieCat]

54 minutes ago, Ariel said:

(If that's the case, the same should hold true for partnered sex. I haven't heard reports of partnered sex exacerbating WD symptoms, but that doesn't mean it doesn't happen.)

 

Yes, some members have mentioned that when they have sex (partnered) that their symptoms increase.