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Acacia

Serotonin Syndrome - Opiates(?) + Moclobamide

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Posted (edited)

So I an opiate about 3 hours ago, forgetting I was on an MAOI inhibiting anti depressant (moclobamide). It's quite severe, but I don't think it's bad enough to go to hospital and I want to avoid telling my folks (who I live with).

 

Anyone got any ideas of herbs or other things around the house that may decrease the severity?

Symptoms i'm experiencing:

  • Eyes not focusing correctly (I'm going cross eyed randomly)
  • High body heat (I'm naked in my room with all windows open and its pretty damn cold
  • Visual distortions
  • Nausea
  • Slight dizziness


 

Edited by Acacia

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Just bumping this so it shows on the main page as I posted in another thread... Symptoms still very apparent. Cross eyed thing is the most annoying.

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Sorry bro, I got nothing practical that I can really offer and hope you get through this.  SAB forum is probably the last place to seek urgent medical advice.

 

If you need medical attention, you may have to engage with your parents to get to the hospital.  Tell them you feel sick.  Surely it doesn't require a full confession.

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16 minutes ago, SayN said:

Sorry bro, I got nothing practical that I can really offer and hope you get through this.  SAB forum is probably the last place to seek urgent medical advice.

 

If you need medical attention, you may have to engage with your parents to get to the hospital.  Tell them you feel sick.  Surely it doesn't require a full confession.

 

Yeah I've told them now. They already know I use opiates occasionally, just hate stressing them out. 

 

Your right about seeking urgent medical advice here lol. Bit of a shot in the dark. I thought maybe there is a herb that decreases serotonin that I may have in my garden unknowingly.

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Posted (edited)

Don't freak out. Usually in hospital they just treat it by waiting and observation anyway. Unfortunately there's not a lot you can do. You might just have to ride it out, but you will be ok. The prognosis is good. It will subside in time.

 

Maybe take your temperature?

 

https://en.wikipedia.org/wiki/Serotonin_syndrome#Management

Edited by Cimi

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1 hour ago, Cimi said:

Don't freak out. Usually in hospital they just treat it by waiting and observation anyway. Unfortunately there's not a lot you can do. You might just have to ride it out, but you will be ok. The prognosis is good. It will subside in time.

 

Maybe take your temperature?

 

https://en.wikipedia.org/wiki/Serotonin_syndrome#Management

My temperature seems okay. The ill effects seem to be subsiding now, should be fine.

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11 hours ago, Acacia said:

My temperature seems okay. The ill effects seem to be subsiding now, should be fine.

please update us, we all are worried.

 

I can't give medical advice as all of us, but am very certain that cooling you body with cold water could be a method, in this instance.

that's what hospitals have done as well, I think.

 

let us all research this topic, and get back to the forums a regarding this.

 

and yes forgot to say, you are a bloody idiot (sorry I love you).

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Posted (edited)

 

1 hour ago, withdrawl clinic said:

please update us, we all are worried.

 

I can't give medical advice as all of us, but am very certain that cooling you body with cold water could be a method, in this instance.

that's what hospitals have done as well, I think.

 

let us all research this topic, and get back to the forums a regarding this.

 

and yes forgot to say, you are a bloody idiot (sorry I love you).


I survived without having to attend a GP or hospital, thankfully. Yeah cold water was really helpful. I drank a heap of fluids to try and flush my system and rested on the couch with my folks. Managed not to lose consciousness. Although I almost did a few times.

 

The contraindication episode lasted about four hours. It showed no signs of going away for the first 3, then eventually subsided.

I won't be doing opiates again. Yuck :(

Edited by Acacia
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Yeah careful man. Glad to hear you pulled though. You were in a very dangerous situation there for a while.

 

Fuck opiates. They are life destroyers. Stick with psychedelics and their allies.

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Posted (edited)

Phew. Thanks for letting us know. Serotonin syndrome can certainly go on for a while but is rarely fatal. Of course it depends on what has been taken and yeah taking MAOIs certainly rules out a lot of recreational substances unfortunately.

 

EDIT: Including most psychedelics which would have also probably triggered serotonin syndrome in this situation. 

Edited by Cimi
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AFAIK there are no psychedelics that will trigger serotonin syndrome, with or without an MAOI. In fact it's an excellent combination in moderation.

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^ Many consider MDxx a psychedelic (as well as a stimulant).

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Posted (edited)

Who knows what was in your heroin, but from what I understand the risk of serotonin syndrome from MAOI + opioid combination isn’t from morphine analogues. I read there is some risk with phenylpiperidine series opioids, and even greater risk with MDMA and analogues + MAOI as SayN has said. 

 

The fact that DMT is commonly combined with MAOI to make changa or xxxhuasca just confuses things, especially when drugs are mislabelled, used in combinations and/or understood  in general categories. It is some complicated shit and really highlights the huge silenced discourse on illicit drug health - why is there no public health initiative that connects this information with the people on the ground? Erowid, forums like this and everyday people are doing a lot more heavy lifting than they should, but even they struggle to clearly explain contraindications around selective and reversible MAOIs.

Where the fuck is real drug education?! 

Edited by Wile E. Peyote
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^This :huh:

 

Sometimes ya just gotta do it yourself aye? It's coming bruz :wink:

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Remember pharma MAOIs are not the same as RIMAs.

 

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Posted (edited)
4 hours ago, Northerner said:

AFAIK there are no psychedelics that will trigger serotonin syndrome, with or without an MAOI. In fact it's an excellent combination in moderation.

 They are pretty much all serotonin agonists, even moreso than opiate substances. To be clear, I'm talking primarily about hallucinogens  - LSD, psilocybin, mescaline and MDMA I guess. They all act primarily on serotonin receptors. LSD can definitely cause SS. Actually a lot of things can cause it. Being on a regular MAOI certainly increases sensitivity. It's unpredictable. I'm sure some people would be ok but it doesn't mean its advisable.

Edited by Cimi

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2 hours ago, Glaukus said:

Remember pharma MAOIs are not the same as RIMAs.

 

RIMAs are a type of MAOI. Moclobemide is technically a RIMA, and mescaline, MDMA & opioids appear on the list of "unsafe" combinations with RIMAs including moclobemide here:

 

https://psychonautwiki.org/wiki/RIMA

 

What point are you trying to make? Are you saying Moclobemide isn't "technically" an MAOI, or are you saying that other MAOIs are safe to use with psychedelics, or are you saying that psychedelics are safe with moclobemide?

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Posted (edited)

I've not read a single case report of LSD causing serotonin syndrome. Psilocybin mimics serotonin and binds to the receptors, it definitely cannot cause SS, just like DMT cannot. Look to amphetamines, cocaine, MDMA and other serotonin agonists for case studies of actual SS.

If you read the unsafe guidelines they will even mention strong cheese, beer, wine and preserved meats as contraindicated. Lab possibilities do not add up to real world outcomes though.

 

I'd not considered mescaline before, I wouldn't mix that. I should be careful about making blanket statements.

 

I'm super glad Acacia is alright though. This sort of interaction is one of my nightmare scenarios.

Edited by Northerner
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I feel that it must be more complicated than MAOI + opioid = always hazardous. I would like to know which opioid and MAOI combinations have significant risk of serotonin syndrome, and which do not. Surely selectivity/reversibility plays some role? I wonder if there are some opioids that do not interact so much with the serotonin system. The literature seems a bit conflicted over this from my brief searching.

This article claims morphine analogues + MAOI do not precipitate serotonin syndrome and there is some risk of serotonin syndrome with phenylpiperidine series opioids + MAOI https://academic.oup.com/bja/article/95/4/434/302715

This article claims morphine analogues oxycodone and codeine + MAOI precipitate serotonin syndrome https://link.springer.com/article/10.1007/s00482-015-1512-0

This article suggests the main contraindication concern with heroin + MAOI is CNS and respiratory depression but there have been no case reports of this https://erowid.org/psychoactives/health/health_article1.pdf

Maybe a Bluelight question lol 

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Posted (edited)
1 hour ago, Northerner said:

I've not read a single case report of LSD causing serotonin syndrome. Psilocybin mimics serotonin and binds to the receptors, it definitely cannot cause SS

 

This table includes LSD as a drug which can cause SS: https://en.wikipedia.org/wiki/Serotonin_syndrome#Cause

 

Attached is the full-text article cited.

Link: http://www.njmonline.nl/getpdf.php?id=245

It goes into the different ways SS can be triggered. The other cited resource is a textbook.

 

Yes, that's what Psilocybin does. Mimicking serotonin is also what mescaline (and LSD) does too, so why mescaline but not psilocybin (or LSD - which is incorrect as shown above)? Anything that stimulates the serotonin receptors can increase the likelihood of SS.

 

Quote

 

I'd not considered mescaline before, I wouldn't mix that. I should be careful about making blanket statements.

 

I'm super glad Acacia is alright though. This sort of interaction is one of my nightmare scenarios.

 

SS article.pdf

Edited by Cimi

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Once again that's scientific articles, not case studies. Ive never read a single case where anyone has experienced SS from psychedelic and maoi combinations. Scientists claim all sorts of shit, particularly about illegal drugs, but much of it is speculation, potential possibilities. Just like people can potentially die from allergic reaction to MDMA. Sure it's happened before. I know of 2 cases, one in Australia and one in the UK. But how many tonnes of MDMA gets consumed annually globally do you reckon? I reckon it's  lot. Scientists will warn about sudden death from MDMA use now, write all sorts of stuff about it. More chance of dying suddenly from peanuts though. Significantly more.

 

The only reason I'd be cautious about mixing mescaline is alkaloids do not occur alone. I've had an experience mixing it with LSD and alcohol where I seriously thought I was physically in trouble. Weak heart rate, faintness, low blood pressure, bad mojo. Knowing how MAOIs  can also affect the heart gives me reason to stop and think about this combo. It's not the risk of SS that would make me stop and think.

 

 I duked this one out years ago with other people, when I still believed the scientific literature on the topic. But experience and complete lack of evidence shows that these musings by so called academics are speculation rather than evidence based assertions.

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Posted (edited)

Most of the time when people get SS they don't actually die from it, so it's quite possible for it to be commonly caused by drugs without high death rates. It usually occurs in the presence of an MAOI or an SSRI, and another serotonergic drug(s). So if you don't want those feelings it wouldn't be advisable to trip on a serotonergic halluncinogen while regularly taking an MAOI, especially if it's already happened to you before on said MAOI. DMT is a bit different obviously.

 

Well according to the article SS has indeed been described with LSD. I agree it's not really a huge concern and rarely dangerous but people can definitely get it from combining different serotonergic drugs, and particularly when an MAOI or SSRI is present.

 

SS is poorly understood. It's just a collection of clinical signs. Really any serotonergic drug could be implicated in causing it in some drug combinations for some individuals, especially when MAOIs or SSRIs are involved..

Edited by Cimi

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Posted (edited)

Cimi, you placed psilocybin in your 'seretonergic hallucinogenic' category. Are you suggesting there is risk of seretonin syndrome from an MAOI + psilocybin combination? This would surprise me considering psilocybin is pharmacologically very similar to DMT, which is commonly combined with MAOIs. I have read a lot of discussion on MAOI + psilocybin combinations for synergistic effects, too. If there is seretonin syndrome risk in this combination I am surprised I have not read discussion on it before.


I think the risk for seretonin syndrome is primarily with seretonergics +  irreversible and non-selective MAOI, not harmalas etc.

Edited by Wile E. Peyote

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Posted (edited)
4 hours ago, Wile E. Peyote said:

Cimi, you placed psilocybin in your 'seretonergic hallucinogenic' category. Are you suggesting there is risk of seretonin syndrome from an MAOI + psilocybin combination? This would surprise me considering psilocybin is pharmacologically very similar to DMT, which is commonly combined with MAOIs. I have read a lot of discussion on MAOI + psilocybin combinations for synergistic effects, too. If there is seretonin syndrome risk in this combination I am surprised I have not read discussion on it before.


I think the risk for seretonin syndrome is primarily with seretonergics +  irreversible and non-selective MAOI, not harmalas etc.

 

Yes I did think that psilocybin with an MAOI would carry that possibility for some people to some extent, but that's true about its similarity to DMT so maybe that one doesn't belong there.

 

When MAOIs are combined with DMT they do produce a myriad of unpleasant effects which include symptoms / sensations which could be indicative of some level of SS (eg., sweats / chills; fear / paranoia / confusion). I don't know if a mild form of SS may comprise part of the experience for some people. As I've said, mild-moderate SS is not really dangerous and I kind of just assume that some level of it is probably quite a common experience while tripping. I know I have experienced some of the signs while on hallucinogens and just considered it part of the experience. I don't think it's a big deal. I thought all that's really needed for SS is high levels of serotonergic activity which most hallucinogens produce in high doses or especially in combination with other agents. I'm not really thinking of it as a "risk" unless it's an insane quantity or heaps of different substances at once. It's not completely predictable.


This Erowid page on Ayahuasca states that there are dietary and drug concerns while using rue, but it could be out of date:

 

https://www.erowid.org/chemicals/ayahuasca/ayahuasca_effects.shtml

"There are health concerns about some foods and drugs consumed in combination with the monoamine oxidase inhibiting harmala alkaloids"

 

Yes, RIMAs are a lot safer than irreversible MAOIs. I just agree that it was weird that Acacia got SS of all things with this combo and maybe there's some susceptibility there in conjunction with that prescription medication.

Edited by Cimi
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Right, when I was thinking of seretonin syndrome I was just thinking of extreme cases. I guess this just reinforces what I said about drug education deficits.

 

I still wanna learn more about seretonergic contraindications! I wish there were more detailed MAOI harm reduction resources. We did a tiny bit for the conseracacian.com DMT project and we didn't include any food contraindication info. Torsten understands this stuff better than me and this is an excerpt from him about this;

 

"MAOIa affects serotonergics and tyramine. MAOIb affects stimulants and tyramine. eg it is perfectly safe to take speed after MAOIa, but it could be fatal to take MDMA. Similarly it is safe to take many antidepressants while on MAOIb, but any stimulant could kill.

 

Tyramine is metabolised by both, which is why it is completely safe to inhibit one or the other, but not both. Most of the food restrictions are BS. They are based on someone copying the non-selective (ie both A and B inhibitor) medication pamphlet. Worse even, most of those aren't even that dangerous as long as the inhibition is reversible. MAOIs bind to MAO. If they let go after a certain period of time then that means they are reversible. If they don't let go then they are non-reversible. The latter means the body can't deal with whatever problem has arisen until new MAO is made which can take a couple of days. And that's scary. Selegeline is one of those medications that scare doctors and most of the dietary warnings are copied from this and hence totally irrelevant.

 

Harmalas are reversible. They let go after about 4-5 hours, which is why aya trips end so abruptly. They are also selective for MAO A. A number of experiments have shown that it is impossible to get into a tyramine crisis while on harmalas, but people like to blame this for the crap that goes on in their heads.

 

If you do take MDMA while on harmalas and you survive the first 3 hours then you're fine. But that 3 hours will be quite difficult for the ER physician. For moclobemide it might be a little longer. In any case, the food dangers are completely exaggerated, which obscures the real dangers."

 

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