# Remeron and 5-HTP



## tooker (May 1, 2006)

Would this be alright to take together? 

I know that combining drugs like 5-HTP and St. Johns Wort with SSRI's can cause Serotonin Syndrome and stuff like that, but what about Remeron? I know Remeron works differently, and I was hoping that combing the two might help my SA more than the Remeron alone. Anyone know? Caedmon?


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## Caedmon (Dec 14, 2003)

:stu Sorry, I don't know.


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## D.B. Cooper (Jul 21, 2006)

Its really impossible to tell since no one can seem to agree on exactly how remeron affects serotonin. Combing remeron with effexor/cymbalta is a popular treatment for "treatment resistant depression". It seems to amplify the effects of the SNRIs (ie 2+2=5) but nothing i've read is particularly sure why.


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## Scrotacles (Nov 13, 2003)

Its probably okay since the evidence for serotonin syndrome even when combiningh SSRIs with 5-HTP are not that great...but given the few studies, there's a small possibility that it might cause problems. Here's a section from a journal article reviewing studies of serotonin syndrome with 5-HTP:

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Pharmacol Ther. 2006 Mar;109(3):325-38

Human data

In humans, serotonin syndrome is characterized by hypertension, hyperthermia, flushing, hyperreflexia, dizziness, disorientation, and myoclonus ( Sternbach, 1991). It is a theoretical possibility with any drug that affects the serotonin system, including SSRIs and tricyclic antidepressants ( Lane & Baldwin, 1997). Cases of serotonin syndrome have been reported in patients taking l -tryptophan and fluoxetine together ( Lane & Baldwin, 1997) and in patients switching from one SSRI to another ( Mills, 1995).

To our knowledge, however, serotonin syndrome has not been reported in humans in association with 5-HTP, either as monotherapy or in combination with other medications. Regarding the combination of 5-HTP with SSRIs, we know of only 1 relevant study ( Meltzer et al., 1997). Single doses of 5-HTP were administered to 16 patients taking (multiple doses of) fluoxetine, none of whom manifested signs or symptoms of serotonin syndrome. In the same study, single doses of 5-HTP were administered to 14 patients taking tricyclic antidepressants (which inhibit serotonin re-uptake to varying degrees). Again, none of these patients showed evidence of serotonin syndrome.

In a multiple-dose study of 26 patients, 5-HTP was used to augment clomipramine, a potent inhibitor of serotonin re-uptake. There were no signs of serotonin syndrome or other serious adverse events ( Nardini et al., 1983). In addition, trials with patients taking 5-HTP together with MAOIs, a class of antidepressants notorious for its many drug interactions, did not indicate any side effects attributable to serotonin syndrome (Alino et al., 1976; Kline & Sacks, 1980; Nicolodi & Sicuteri, 1996 [ Alino et al., 1976, Kline & Sacks, 1980, Nicolodi & Sicuteri, 1996]). Finally, 5-HTP has been given in combination with tryptophan, with no signs of serotonin syndrome ( Quadbeck et al., 1984). Taken together, these safety findings are encouraging; however, in view of the small numbers of patients exposed in these studies, these findings must be regarded as preliminary. According to the Rule of Three ( Hanley & Lippman-Hand, 1983), the observation of zero cases of serotonin syndrome among the ∼ 870 patients exposed to 5-HTP means that the upper end of the 95% confidence interval for the true rate of serotonin syndrome with 5-HTP could still be as high as 3/n = 3/870 = 0.34%.

When serotonin syndrome does develop, symptoms often appear within 2 hr of increasing the dose of a serotonergic drug ( Mills, 1995). Serious complications can rarely occur and, in extreme cases, deaths have been attributed to serotonin syndrome ( Mills, 1995). However, symptoms of serotonin syndrome, even at mild levels, can now be sensitively monitored using the Serotonin Syndrome Scale (SSS; Hegerl et al., 1998), and serotonin syndrome is often a self-limited condition: 70% of cases show complete resolution within 24 hr after discontinuation of serotonergic drugs ( Mills, 1995).


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