Woman in distress

Serotonin used to be an esoteric term used by neuroscientists to describe a chemical found in the brain, digestive tract and blood. But thanks to drugs like Paxil,  Prozac and Zoloft, this chemical term has almost become a household word.

Many people now know that medications like fluoxetine, paroxetine and sertraline are SSRIs (selective serotonin reuptake inhibitors). There is also another category of brain drugs called SNRIs (serotonin and norepinephrine reuptake inhibitors). They include duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). These drugs are similar to SSRIs.

Beware Serotonin Syndrome

Not everyone appreciates the potentially disastrous consequences of elevated serotonin levels. The medical term for this is serotonin syndrome. We wish more prescribers were aware of this complication.

One reader told her story:

“I have been on tramadol for pain and Cymbalta for depression. I got depressed due to the constant sciatic nerve pain I was in.

“About ten days ago I felt extremely sick. When I saw a doctor, she immediately said that I have serotonin syndrome and must go to the hospital emergency department. She even called them to say I was coming.

“At the emergency department, they ran IV drips that stopped the uncontrolled twitching. They told me to stop taking tramadol and Cymbalta immediately. Well, that was like sending me straight to hell!

“I have been so ill the last 10 days. Today is the first morning I could get out of bed without walking into something. My symptoms are:

“Severe brain zaps. If I move my eyes, I get brain zaps.

“Really bad flu.

“Hyperthermia. I wake up every night and my pajamas are soaked through. I also have very weird dreams.

“I have had diarrhea now for six days.

“Mood swings: In the last two days I have felt depressed and crying my eyes out one minute and the next I want to punch someone. Please tell me it will stop.”

This unfortunate woman got hit with a one-two punch. First she had serotonin syndrome. Both tramadol (Ultram) and duloxetine (Cymbalta) affect serotonin. Together, they can cause symptoms such as agitation, confusion, rapid heartbeat, elevated blood pressure, uncontrollable muscle twitching and elevated body temperature. Nausea, vomiting, incoordination and even hallucinations can also occur in serotonin syndrome, and severe cases can lead to unconsciousness and sometimes death. It’s no wonder the doctors at the emergency department were concerned.

Stopping Tramadol & Duloxetine Triggers Withdrawal

The doctors in the ER didn’t take into account the discontinuation syndrome. Stopping either of these drugs suddenly could have triggered withdrawal, as many readers have testified. Stopping both medications at once could well intensify the symptoms. Here is a link to more information on tramadol side effects and withdrawal and here is a link to duloxetine side effects and withdrawal syndrome.

Many people report sensations like electric shocks in the brain, often referred to as brain zaps; light-headedness; headaches; anxiety and irritability; tremor and fatigue as part of the discontinuation syndrome from Cymbalta and similar antidepressants. In addition to these, sweating and flu-like symptoms, along with nightmares, vomiting, diarrhea, hallucinations and aggressiveness can occur when stopping tramadol abruptly.

Brain Drug Interactions

We frequently hear about people who are put on several different medications simultaneously. When these pills alter brain biochemistry it can lead to disastrous complications.

Health care professionals should be paying closer attention to the potential for interaction of the drugs they prescribe. But time constraints may keep them from looking things up, and no one can keep all the possible combinations and complications in their heads.

That means it is up to patients to protect themselves by looking up any prescribed medicine and its effects and interactions before starting to take it. Our book, Top Screwups Doctors Make and How to Prevent Them provides the tools you and your loved ones need to do just that.

Our chapter titled “Drug Interactions Can Be Deadly” describes several cases of serotonin syndrome that will make you want to do your homework. You will learn why doctors and pharmacists often ignore computerized warnings about interactions. You will also find our “Top 11 Tips for Preventing Dangerous Drug Interactions.”

We hope you can become engaged and empowered to prevent one of the most common causes of adverse drug experiences: combining incompatible medicines. Arm yourself with strategies to prevent this epidemic of drug disasters so you will not end up like our reader on tramadol and Cymbalta simultaneously.

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  1. Candie
    Reply

    Hi, I went off the straterra because of the headaches. I went to a counselor and they said I was depressed…well yeah I knew that and the doctor decided to try me on a new drug called Viibryd. But I don’t want to take anything for depression the rest of my life and I want to fill like I did when I was on tramadol. I know this sounds like I’m an addictive druggie but when I took tram it made me care about things in life.

    My kids, my house, my family, I look around my house and I used to care what it looks like but now even on the viibryd there is not much there. I had the go get it done so I go see the doctor
    tomorrow and explain it to him, but I feel like he is going to give me another depression med.

  2. Candie
    North Carolina
    Reply

    Was on tramadol for joint issues for 12 yr, and my body became used to it and was taking more than prescribed (BIGGEST MISTAKE ) so now doctor has weened me of if it and that was April 2016, now 8 months later I’ve went into this depression no concentration uncontrollably crying no energy to get up and was miserable.

    After 3 months of misery, he put me in Straterra think I might me ADHD, well I tried that Med and it was giving me horrible headaches, so he decided to take me off that and try a anti-depression medication viibryd now on my 2nd week 20 mil I still fill the same except my emotion are numb I really fill like my body is having seratonia issues not getting enough and now I’ve been tested for ADHD still thinking it’s something with the seratonia does this sound even possible and what do I do cause I know he want give me back my tramadol.

  3. Cindy M. Black
    Reply

    For a little less than a year I had to take 2 medications after being dx’ed with atrial fibrillation, which is thankfully now resolved due to a cardiac ablation. The meds were Warfarin, a blood thinner, and Sotolol, a beta blocker. At the start of that year, my eyes were perfect except for needing slight vision correction. About 6 months in, I started noticing poorer visual acuity and then was told I had developed cataracts in both eyes!! I couldn’t believe it and still, to this day, I blame those meds! Avie, above, talks about developing cataracts because of meds; and I’m here to say that yes, that’s entirely possible and the condition is probably not blamed on meds near as often as it should be.

  4. Avie
    Reply

    I just did.

  5. Avie
    Reply

    My arthritis dr. started me on Cymbalta for Fibromyalgia flare-ups. At the same time my GP started me on Lipitor as a preventive measure, 3 pills a week and encouraged me to try the Cymbalta, which I didn’t want to take, but did.

    After several months my vision became blurred and I was seeing double along with excess sweating, itching and most all the side effects listed on the pharmacy information that came with the meds. My eye dr. took me off the Cymbalta. Things did improved. Under Dr. supervision, I weaned off of the in only 1 week. Big mistake, but I didn’t know it should be more like a month to get off the med. The Dr. should have known. As it wore off, the Lipitor side effects kicked in and the person declaring it was Hell coming off the Cymbalta, is so right.

    Shortly after taking the Cymbalta, my cataracts in only 4 months, developed from a 1 in, Dec. to a 3 in April. I had been told that my cataracts were developing so slow, that I should not ever need surgery, but in April, they advised me not to wait. Now I have read they are thinking that the statin, Crestor may be causing the accelerated development of cataracts. I have a nurse friend, who experienced the same experience shortly after starting Lipitor.

    The Drs. are quick to prescribe medications and fail to tell you the side effect. We need to ask more questions, which I plan to do from now on. I know the side effects don’t bother everyone, but anyone with Fibro pain doesn’t need more muscle pain or drugs that cause fatigue and other Fibro symptoms. I am not taking a statin at the present time and if at all possible, don’t plan to. I just wanted to pass this along, so others will be cautious. We think Drs. know everything, but they don’t. We need to take our healthcare into our own hand, get educated so we can look out for ourselves.

  6. Pat
    Reply

    I had been on minimum dose cymbalta for several years. I had a fall, resulting in pelvic fractures and the doctor prescribed tamadol for pain=again the minimum dose. I had no idea of the possibility of drug interaction. If I had any interaction, I guess I just thought it was a reaction to the fall. I’m considering trying to get off cymbalta since I’ve read of the problems of getting off the drug. I didn’t take the tramadol very long. I don’t like taking drugs.

  7. O.G.
    Reply

    As I’ve said before in this forum, my experiences with Tramadol (negative, and unhelpful for pain anyway) and Cymbalta (flat-out dangerous, and also useless as an analgesic) left me with the greatest sympathy for others victimized by their effects.

    Not only do doctors need to pay attention to drug interactions, they need to give much closer attention to the effects of each drug in itself.

    And trusting patients (I was one of them, once upon a time) need to understand that not only their well-being, but their lives, may be at risk unless THEY pay closer attention to the possible problems –and their own experiences — with the drugs prescribed for them.

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