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Dr. Bob is Robert Hsiung, MD,
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Posted by ed on November 8, 1999, at 18:12:04
Has anybody heard of Periactin (cyproheptadine) causing a serotonin-syndrome type reaction when combined with an MAOI? Recently, while on 60mg of Marplan daily, I tried relatively high doses of cyproheptadine (up to 16 mg) as an antidote for anorgasmia (to no great effect, I should tell you). The following day, I started experiencing an enhanced startle response (like receiving a slight electrical shock or shot of adrenaline through the body when even slightly startled). This concerned me, since I had experienced exactly the same thing a year ago, after being on Nardil 75mg/day. That time neither I nor my pdoc knew what to make of the startle response, so we did nothing. After a few days of this, I finally had a worse reaction--severe dizziness, strange and painful zaps going through my head, hyperreflexia, tremors in my legs, etc. I ended up in the emergency room. Nardil was immediately discontinued, and my symptoms rapidly decreased over the next 24 hours. I never went back to the Nardil, but now, as I said, was trying Marplan. As soon as I felt the startle response and after talking to my pdoc, I rapidly decreased the dose (I'm now at 30/day), and the symptom disappeared within a day or so. Was this just a typical side effect to these MAOIs? Sounds to me almost like a serotonin syndrome. Ironically, cyproheptadine (for its antiserotonergic action) is recommended as an antidote to the syndrome, although I did find a reference that high doses of the stuff can actually contribute to it. Does my experience make any sense to anyone or ring any bells?
ed
Posted by Judy on November 8, 1999, at 20:00:02
In reply to Reaction to Periactin and MAOIs(?), posted by ed on November 8, 1999, at 18:12:04
>I started experiencing an enhanced startle response (like receiving a slight electrical shock or shot of adrenaline through the body when even slightly startled
ed,
I know *exactly* what you mean by 'electric shocks' when startled and - my case - when moving my eyes or head quickly to the side. I have had them many times BUT always when I was withdrawing from Nardil and Marplan. When I told my Pdoc about these shocks the first time I experienced them, he was skeptical; however, shortly afterward I received a note from him in the mail which read "You are not alone!" It was attached to a photocopy of an article from one of his psych journals regarding other MAOI users reporting the same phenomenon.
If you hadn't described your first experience with Nardil, I would have jumped all over your Marplan episode and reasoned that the antiserotonergic action of the cyproheptadine somehow suggested to your Brain/CNS that you were withdrawing rapidly from Marplan. However, that doesn't explain your reaction to Nardil. Had you recently increased it to 75 mg or changed another medication when the problems started?
I can also tell you that MAOI's are known to cause myoclonus. I had it mildly while taking Nardil, but on Marplan, the jerking was so severe and so constant (at 60 mg/day) that I weaned off it and will never take it again! I have taken Nardil four times over the past 15 years, but never more than 30 mg/day, so your 75 mg sounds like a huge dose to me. Is it possible that MAOI's at higher doses are affecting some unknown part of your Brain/CNS causing unwanted effects? My Pdoc likens MAOI's to SCUD Missiles - you shoot them in and hope they "hit" something that helps. Unfortunately, they "hit" other things too.
Sorry, ed, no big psychopharmological 'bullseye' here, but maybe a couple of things to think about. And know "you are not alone."
Judy
Posted by ed on November 8, 1999, at 21:50:50
In reply to Re: Reaction to Periactin and MAOIs(?), posted by Judy on November 8, 1999, at 20:00:02
> I know *exactly* what you mean by 'electric shocks' when startled and - my case - when moving my eyes or head quickly to the side. I have had them many times BUT always when I was withdrawing from Nardil and Marplan. When I told my Pdoc about these shocks the first time I experienced them, he was skeptical; however, shortly afterward I received a note from him in the mail which read "You are not alone!" It was attached to a photocopy of an article from one of his psych journals regarding other MAOI users reporting the same phenomenon.Judy,
Thanks for sharing your experience. Actually, I forgot to specify that I had also been adding cyproheptadine to the Nardil I was taking when I developed the same startle response symptoms. I had been on 75mg for at least four months without developing this specific side effect, until I started the cyproheptadine. It might just be coincidence. Or, the MAOI/cyproheptadine combination was doing something funky to my system. Perhaps the MAOI doses were simply too high. Thanks for your comment.
ed
This is the end of the thread.
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