buddha443556 Posted July 30, 2009 Share Posted July 30, 2009 I'm on Invega 3mg QD for psychosis. It works, the hallucinations have just about stopped or at the very least I'm not chasing them around with a 357 magnum. The problem is the Invega is causing serotonin poisoning (syndrome). I've suffered this 3 times before and I know that Vistaril (hydroxyzine) eases the problem after discontinuation. I'm also taking Micardis for the blood pressure. I'm just wondering if I'm playing Russian Roulette by covering up the problem with Vistaril and Marcardis? The solution for serotonin poisoning is to discontinue the medication but I'll have this problem with just about any atypical antipsychotic [Clozapine might be the exception]. I see my pdoc on the 3rd. Not even sure I want to ask him. Invega fixed my hallucinations, it didn't do shit for my paranoia. Link to comment Share on other sites More sharing options...
AirMarshall Posted July 30, 2009 Share Posted July 30, 2009 I'm on Invega 3mg QD for psychosis. It works, the hallucinations have just about stopped or at the very least I'm not chasing them around with a 357 magnum. The problem is the Invega is causing serotonin poisoning (syndrome). I've suffered this 3 times before and I know that Vistaril (hydroxyzine) eases the problem after discontinuation. I'm also taking Micardis for the blood pressure. I'm just wondering if I'm playing Russian Roulette by covering up the problem with Vistaril and Marcardis? The solution for serotonin poisoning is to discontinue the medication but I'll have this problem with just about any atypical antipsychotic [Clozapine might be the exception]. I see my pdoc on the 3rd. Not even sure I want to ask him. Invega fixed my hallucinations, it didn't do shit for my paranoia. hmm, Okay, this is getting into more complicated pharmacology.... However, my best understanding is... -Invega is an antipsychotic and does not cause Serotonin Syndrome. It can cause Neuroleptic Malignant Syndrome. Serotonin Syndrome can be mistaken for Neuroleptic Syndrome. - Vistaril is not used to treat Serotonin Syndrome directly. The primary treatment is to discontinue the offending drug and provide supportive care. The only use I could see for Vistaril is possibly to treat muscle clonus (tightness or spasms). - Neuroleptic Malignant Syndrome is treated by discontinuing the offending drug, treating with dopamine agonists and muscle relaxants. Although I don't see Vistaril listed primarily, it is possible it might be used for muscle rigidity. Serotonin Syndrome, but most especially Neuroleptic Malignant Syndrome can be life threatening incidents requiring emergency care. You should address any questions and concerns with your doctor. Do not think that you can treat them on your own. **I am NOT a medical professional** a.m. Link to comment Share on other sites More sharing options...
buddha443556 Posted August 3, 2009 Author Share Posted August 3, 2009 Doctor said "it's all in my head" and wrote me out a prescription of hydroxyzine. Guess I can stop the Micardis and Hydroxyzine ... IT'S ALL IN MY HEAD!! Hold it why am I taking the Invega!? Fuck that shits all in my head too!! Shit guess I don't need medications. I ALWAYS FEEL SO GOOD AFTER SEEING MY PSYCHIATRIST!! Link to comment Share on other sites More sharing options...
sorrel Posted August 3, 2009 Share Posted August 3, 2009 What symptoms do you have from the Invega that makes you think it's serotonin syndrome? Link to comment Share on other sites More sharing options...
buddha443556 Posted August 4, 2009 Author Share Posted August 4, 2009 Temperature bounces around but is usually around 100F. Tremors, head and hands, hands is rare for me. (Made spaghettis and meatballs fun.) Restless, which is why I started taking the Vistaril. Blood pressure is bouncing around too, High 161/101 90bpm. Onset, about the third day after starting Invega. Vistaril is a serotonin antagonist (not dopamine). Link to comment Share on other sites More sharing options...
Aurochs Posted August 4, 2009 Share Posted August 4, 2009 Vistaril is a serotonin antagonist (not dopamine). I cannot find any evidence that hydroxyzine is a serotonin receptor antagonist, or that it has anything at all to do with serotonin. Maybe I'm missing something here? Link to comment Share on other sites More sharing options...
buddha443556 Posted August 4, 2009 Author Share Posted August 4, 2009 Hydroxyzine is one of the least anticholinergic first-generation antihistamines at about 8-10 per cent of the antimuscarinic power of atropine. It is also, along with its relatives cyclizine, buclizine, meclizine, and others as well as phenindamine (Thephorin, Nolahist) and cyproheptadine (Periactin) (the prototype of the piperidine chemical class of first-generation antihistamines), and the phenothiazines, part of a small number of antihistamines to have clinically significant antiserotonergic effects as well. Hate to quote Wikipedia but easiest reference to find. Second reference: http://www.drugs.com/mmx/hydroxyzine-hydrochloride.html Link to comment Share on other sites More sharing options...
sorrel Posted August 4, 2009 Share Posted August 4, 2009 Your symptoms are not really classic for serotonin syndrome, nor is Invega typical for causing it (although there are reports of antipsychotics in combination with antidepressants causing it.) It could be something else going on. Why do you say you'll have this problem with any atypical antipsychotic? Link to comment Share on other sites More sharing options...
null0trooper Posted August 4, 2009 Share Posted August 4, 2009 Hate to quote Wikipedia but easiest reference to find. Easy to find, but the paragraph that lumps the "first-generation antihistamines" together as having the same effect on serotonin does not have a reference included with the article. Second reference: http://www.drugs.com/mmx/hydroxyzine-hydrochloride.html The second reference is an archived general treatment of systemic antihistamines, labeled by drugs.com itself as "Content may be obsolete" Even so, the serotonin antagonist discussed on that page is cyproheptadine NOT hydroxyzine. Link to comment Share on other sites More sharing options...
buddha443556 Posted August 4, 2009 Author Share Posted August 4, 2009 I should have said "probably" but I've had these same symptoms with Paxil, Zoloft, Effexor/Seroquel. Last time they called it Neuroleptic Malignant Syndrome and took me off the Effexor, it didn't improve and I quit the Seroquel on my own and took lots of hydroxyzine. Twitched pretty bad for about a week but lived. Link to comment Share on other sites More sharing options...
AirMarshall Posted August 4, 2009 Share Posted August 4, 2009 Thanks for the point to Wikipedia about Vistaril being a clinically significant antiserotonergic. Unfortunately, I can't find any other reference to that action in my regular sources. Pub Med has only one tangential reference which isn't applicable. Coming back full circle, you aren't taking any drugs that normally cause Serotonin Syndrome. I think you need to readdress your symptoms and concerns with your doctor. It is not clear to me that the two of you have directly discussed this and what your doctors explanation is. Perhaps a second opinion may be appropriate. Regards, a.m. Link to comment Share on other sites More sharing options...
null0trooper Posted August 4, 2009 Share Posted August 4, 2009 Last time they called it Neuroleptic Malignant Syndrome and took me off the Effexor, it didn't improve and I quit the Seroquel on my own and took lots of hydroxyzine. Twitched pretty bad for about a week but lived. If the diagnosis was Neuroleptic Malignant Syndrome and they left you on the antipsychotic medication, I think a second opinion may very well be in order. I can understand some of the reasoning ... but not all of it. BTW, anticholinergics are used in relieving extrapyramidal symptoms (e.g., diphenydramine (RxList)), but not because of a direct effect on serotonin receptors. Link to comment Share on other sites More sharing options...
buddha443556 Posted August 4, 2009 Author Share Posted August 4, 2009 I think you need to readdress your symptoms and concerns with your doctor. It is not clear to me that the two of you have directly discussed this and what your doctors explanation is. Perhaps a second opinion may be appropriate. I don't have the option to piss off this doctor. However, I did speak to another doctor the one that prescribed the Hydroxyzine. I told her I was having trouble with the Invega and that the hydroxyzine helped. She gave me the prescription. I feel ok, as long as I take the hydroxyzine and Micardis ... it's bearable. Link to comment Share on other sites More sharing options...
buddha443556 Posted August 7, 2009 Author Share Posted August 7, 2009 Some more notes ... best place for me to keep them is on the Internet ... just ignore. Antipsychotics: Hydroxyzine may antagonize the therapeutic effects of antipsychotics http://www.umm.edu/altmed/drugs/hydroxyzine-065900.htm Benadryl to take the edge off antipsychotics. http://www.4therapy.com/consumer/medications/item.php?uniqueid=87&categoryid=69 "absence seizures" - that's what they're called. Link to comment Share on other sites More sharing options...
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