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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by jzin on December 10, 2000, at 1:29:43
Hello, this site has been very beneficial. I am starting serzone after being on so many others such as prozac, zoloft, buspar and not to mention xanex. I have myasthenia gravis for about 3 years now and started having the panic attacks with depression. I was just wondering if others suffer from this ?
Thanks for any suggestions...
Posted by mars on December 31, 2000, at 11:04:59
In reply to serzone-Myasthenia Gravis ??, posted by jzin on December 10, 2000, at 1:29:43
hiya ~
About 3 years ago I started having a problem when walking ~ my legs, usually my left leg first, would become numb and I would eventually stop being able to walk. Quite frightening. I am a long-time, hard-core depressive, have been on almost every prescription antidepressant, anti-convulsant, augmentative, etc. available in the U.S. At the time I was on a very strong dose of Parnate and a fair amount of lithium. My pdoc dismissed the idea it was my meds, and a neurologist eventually diagnosed me with MG. While I was waiting (and waiting) to have the tensilon test I read as much about MG as I could and subscribed to several lists (one of them was out of Australia and was quite good). Preparing myself for the worst and hoping for the best, as they say. I would recommend checking out the sources on the 'net. I remember that lots of the folks on the Aussie list had a lot of knowledge about AD's and were really supportive.
When I finally had the tensilon test I failed it! The neuro didn't know what was going on with me, and my pdoc (who is a cranky, cantankerous lady but who is great with meds) eventually reconsidered her dismissal and thought that the anticholinergic effects of Parnate might have something to do with it. I'm on a hefty dose of Effexor right now, and haven't had the MG symptoms for awhile, although I still have a lot of fatigue and weakness at times.
Good luck. If you have trouble finding the MG lists post again and I'll help you find what's out there right now.
mars
Posted by SLS on January 3, 2001, at 9:17:56
In reply to Re: serzone-Myasthenia Gravis ??, posted by mars on December 31, 2000, at 11:04:59
Hiya Mars.
It may have been a manifestation of a serotonin syndrome. Lithium has been known to induce serotonin syndrome when it is combined with a drug that has pro-serotoninergic properties. These would include:
Prozac - fluoxetine
Zoloft - sertraline
Luvox - fluvoxamine
Paxil - paroxetine
Celexa - citalopram
Serzone - nefazodone
Desyrel - trazodone
Anafranil - clomipramine
Nardil - phenelzine
Parnate - tranylcypromineIn addition, using any two of the drugs listed here has the potential to produce serotonin syndrome.
The leg thing is very reminiscent of something I experienced when I was taking a very powerful MAOI and using trazodone for sleep. I think it is likely that Parnate + lithium may have produced in you a mild serotonin syndrome that caused asthenia and/or changes in muscle tension making it difficult to walk.
Your doctors may have been wrong. While the Parnate + lithium combination may have been the culprit, it is generally a great combination when treating difficult cases. Perhaps you only needed 300mg-600mg.
- Scott> hiya ~
>
> About 3 years ago I started having a problem when walking ~ my legs, usually my left leg first, would become numb and I would eventually stop being able to walk. Quite frightening. I am a long-time, hard-core depressive, have been on almost every prescription antidepressant, anti-convulsant, augmentative, etc. available in the U.S. At the time I was on a very strong dose of Parnate and a fair amount of lithium. My pdoc dismissed the idea it was my meds, and a neurologist eventually diagnosed me with MG. While I was waiting (and waiting) to have the tensilon test I read as much about MG as I could and subscribed to several lists (one of them was out of Australia and was quite good). Preparing myself for the worst and hoping for the best, as they say. I would recommend checking out the sources on the 'net. I remember that lots of the folks on the Aussie list had a lot of knowledge about AD's and were really supportive.
>
> When I finally had the tensilon test I failed it! The neuro didn't know what was going on with me, and my pdoc (who is a cranky, cantankerous lady but who is great with meds) eventually reconsidered her dismissal and thought that the anticholinergic effects of Parnate might have something to do with it. I'm on a hefty dose of Effexor right now, and haven't had the MG symptoms for awhile, although I still have a lot of fatigue and weakness at times.
>
> Good luck. If you have trouble finding the MG lists post again and I'll help you find what's out there right now.
>
> mars
Posted by mars on January 7, 2001, at 15:06:27
In reply to Re: serzone-Myasthenia Gravis ?? » mars, posted by SLS on January 3, 2001, at 9:17:56
Hiya Scott ~
Thank you for your lucid response. I'll forward it on (w/o your name) to my pdoc. I don't think the info about serotonin syndrome was around in '97 when I first had the problem - do you know?
As far as doctors being wrong, well, I'm afraid I'm used to that ;-) I was misdiagnosed at 14 and had such horrible experiences with the helping professions that I avoided them for the next ten years. When I finally did start doing meds again in '89 I was quite active in learning about what was out there (my dad's a PhD in pharmacology and would give me textbooks to read). Unfortunately, I let that go the past years, in part because I finally ended up in the care of a pdoc who was able to diagnose me as Bipolar II (she's an Akiskal follower) and came to rely on her perhaps a bit too much. That's why I'm here now, trying to be more, um, proactive again.
I'd been doing the parnate/lithium thing since '95, which had barely kept me able to work, and we'd negotiated dosages starting low and working up. But by the time the leg problem occurred it was clear that parnate wasn't cutting it for me anyway ~ the divorce, increase in job stress, and the myasthenia episode didn't help either, ha ha. In between then and now I've tried a number of drugs. Effexor isn't great but I haven't really been functional the past year and a half anyway, and at least I'm not thinking about suicide all the time. A major piece of the puzzle has been added lately ~ I've been diagnosed with fetal alcohol effects. Not sure how to handle that yet, been a bit overwhelming.
I'd love to get the advice of you and the other great folks on babble, but my medical history is so long I'm not sure how to start. I guess this is it. :)
Thanks again,
mary
> Hiya Mars.
>
> It may have been a manifestation of a serotonin syndrome. Lithium has been known to induce serotonin syndrome when it is combined with a drug that has pro-serotoninergic properties. These would include:
>
> Prozac - fluoxetine
> Zoloft - sertraline
> Luvox - fluvoxamine
> Paxil - paroxetine
> Celexa - citalopram
> Serzone - nefazodone
> Desyrel - trazodone
> Anafranil - clomipramine
> Nardil - phenelzine
> Parnate - tranylcypromine
>
> In addition, using any two of the drugs listed here has the potential to produce serotonin syndrome.
>
> The leg thing is very reminiscent of something I experienced when I was taking a very powerful MAOI and using trazodone for sleep. I think it is likely that Parnate + lithium may have produced in you a mild serotonin syndrome that caused asthenia and/or changes in muscle tension making it difficult to walk.
>
> Your doctors may have been wrong. While the Parnate + lithium combination may have been the culprit, it is generally a great combination when treating difficult cases. Perhaps you only needed 300mg-600mg.
>
>
> - Scott
Posted by mars on January 12, 2001, at 22:49:04
In reply to Re: serzone-Myasthenia Gravis ?? » SLS, posted by mars on January 7, 2001, at 15:06:27
Hiya Scott -
Just posting a followup - my pdoc thinks you are almost certainly correct. Turns out she knows about serotonin syndrome, but is overwhelmed by work (I think she has half the treatment-resistant depressives in Seattle under her care), and she has been sick as well, so she hasn't been going back and revisiting situations that have been resolved.
Thanks so much for your info, and my pdoc thanks you as well.
best regards,
mary
> Hiya Scott ~
>
> Thank you for your lucid response. I'll forward it on (w/o your name) to my pdoc. I don't think the info about serotonin syndrome was around in '97 when I first had the problem - do you know?
>
> As far as doctors being wrong, well, I'm afraid I'm used to that ;-) I was misdiagnosed at 14 and had such horrible experiences with the helping professions that I avoided them for the next ten years. When I finally did start doing meds again in '89 I was quite active in learning about what was out there (my dad's a PhD in pharmacology and would give me textbooks to read). Unfortunately, I let that go the past years, in part because I finally ended up in the care of a pdoc who was able to diagnose me as Bipolar II (she's an Akiskal follower) and came to rely on her perhaps a bit too much. That's why I'm here now, trying to be more, um, proactive again.
>
> I'd been doing the parnate/lithium thing since '95, which had barely kept me able to work, and we'd negotiated dosages starting low and working up. But by the time the leg problem occurred it was clear that parnate wasn't cutting it for me anyway ~ the divorce, increase in job stress, and the myasthenia episode didn't help either, ha ha. In between then and now I've tried a number of drugs. Effexor isn't great but I haven't really been functional the past year and a half anyway, and at least I'm not thinking about suicide all the time. A major piece of the puzzle has been added lately ~ I've been diagnosed with fetal alcohol effects. Not sure how to handle that yet, been a bit overwhelming.
>
> I'd love to get the advice of you and the other great folks on babble, but my medical history is so long I'm not sure how to start. I guess this is it. :)
>
> Thanks again,
>
> mary
>
> > Hiya Mars.
> >
> > It may have been a manifestation of a serotonin syndrome. Lithium has been known to induce serotonin syndrome when it is combined with a drug that has pro-serotoninergic properties. These would include:
> >
> > Prozac - fluoxetine
> > Zoloft - sertraline
> > Luvox - fluvoxamine
> > Paxil - paroxetine
> > Celexa - citalopram
> > Serzone - nefazodone
> > Desyrel - trazodone
> > Anafranil - clomipramine
> > Nardil - phenelzine
> > Parnate - tranylcypromine
> >
> > In addition, using any two of the drugs listed here has the potential to produce serotonin syndrome.
> >
> > The leg thing is very reminiscent of something I experienced when I was taking a very powerful MAOI and using trazodone for sleep. I think it is likely that Parnate + lithium may have produced in you a mild serotonin syndrome that caused asthenia and/or changes in muscle tension making it difficult to walk.
> >
> > Your doctors may have been wrong. While the Parnate + lithium combination may have been the culprit, it is generally a great combination when treating difficult cases. Perhaps you only needed 300mg-600mg.
> >
> >
> > - Scott
Posted by mars on January 12, 2001, at 23:26:17
In reply to Re: serzone-Myasthenia Gravis ?? » mars, posted by SLS on January 3, 2001, at 9:17:56
oops, that previous message was for Scott.
Scott, thanks again...it's a relief to know what was happening.
mary
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