Dear Dr. Roach: After being on Paxil for about 15 years, it wasn鈥檛 working anymore. My doctor decreased my dose, and I slowly started Viibryd. The first week I felt great. When I increased the dose of Viibryd, I began feeling sick. I had a bad headache, felt anxious and couldn鈥檛 sleep, and my muscles began jerking involuntarily.
My doctor had me stop immediately, prescribed Deplin for seven days, and said I鈥檇 had serotonin syndrome. Please elaborate on this syndrome.
When I looked it up, I found it can be fatal if the SSRI is not stopped. I was off all SSRIs for about 10 days but started feeling unconfident and fragile, so I began taking 25 mg of Paxil CR. My doctor is concerned the serotonin syndrome could return, and advised me to take Deplin along with the Paxil.
How common is this syndrome? Am I likely to get it again once I have had it? I am weaning myself off the Paxil, but what if I need an antidepressant? M.M.
Serotonin syndrome is more common than often is suspected. It is an abnormality of brain chemistry caused most often by medications, especially selective serotonin reuptake inhibitors (SSRIs), like paroxetine (Paxil) and vilazodone (Viibryd).
You had many symptoms of serotonin syndrome. Serotonin syndrome may consist of mood changes such as anxiety and restlessness, but a person may develop confusion and disorientation. Abnormalities of the muscles, such as rigidity and the uncontrollable jerking you mention, are very common. Finally, sweating, high body temperature, vomiting and diarrhea also may be part of the syndrome.
Treatment is stopping the medication that caused the symptoms. Many experienced practitioners will use the same or similar medications that caused the serotonin syndrome at a lower dose if it is the only effective treatment, but this requires expertise and careful monitoring.
Deplin, a brand of methylfolate, is a B-type vitamin that can make SSRIs work better. It鈥檚 not associated with serotonin syndrome, as far as I have been able to find.
听
Dear Dr. Roach: In my late teens and early 20s, I suffered bad acne that resulted in scarring that is still visible now, even though I am in my 40s. I assume it will be visible for the rest of my life. My acne was cured when I took Accutane.
Now I also suffer from ulcerative colitis. Even though I can鈥檛 make a direct connection as a side effect of Accutane, the symptoms of UC first showed shortly after I completed my treatments for acne.
Now that my children are entering their teen years, is it possible for them to avoid my fate? Are acne problems like mine hereditary, or can they avoid the problems I experienced with proper hygiene? B.B.
Acne, familiar to almost all teenagers, is caused mostly by the bacteria P. acnes, but also by hormonal changes that affect the skin oils and cells, predisposing the skin to bacterial growth. Hygiene has a limited effect on acne, with overwashing and oily cosmetics causing the most problems.
Acne tends to run in families, so your children are more likely to have worse acne than usual.
The association of ulcerative colitis, a type of inflammatory bowel disease, with isotretinoin (Accutane) is intensely debated, with the most recent data and the opinion of professional groups generally that isotretinoin probably does not cause IBD. While I can understand why you might wish to avoid it, it remains the most effective treatment, and is still worth considering if other options are not successful.
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Dear Dr. Roach: I had an abnormal blood sugar reading of 111, where the normal range is 65-99. My primary care doctor has been monitoring it and doesn鈥檛 think it鈥檚 a concern. What can I do to bring the number down? I take folic acid daily with other vitamin and mineral supplements. I鈥檝e had cinnamon recommended by friends who have had success. Is this something you鈥檇 suggest I try? J.M.
We in North America are in an epidemic of diabetes, and many people with diabetes aren鈥檛 yet aware of it. As doctors do more screening, we find people with abnormal blood sugar but who aren鈥檛 diabetic.
First of all, 111 is a very abnormal blood sugar level if you had been fasting, but it鈥檚 a normal blood sugar level two hours after eating. Both fasting and nonfasting levels can be used when looking for diabetes, but the ranges of normal are different. The normal range you gave was for fasting.
Second, the two most important factors that decide whether a person with a predisposition for diabetes will actually get it are diet and exercise, and these are where I would most recommend making changes. The big problem with dietary choices is sugar 鈥� simple sugars especially, but even complex sugars like starches predispose one to diabetes if taken in excess. Natural sugars, such as what鈥檚 found in whole fruit, are less of a problem than fruit juices, sodas or sweetened processed foods.
Exercise is a powerful way to reduce blood sugar and diabetes risk. It doesn鈥檛 have to be extreme exercise 鈥� even a half-hour walk per day can begin to reduce blood sugar, especially when taken after eating.
Cinnamon does have the ability to lower blood sugar in people with type II diabetes. As little as 1/4 teaspoon twice daily reduced blood sugar about 20 per-cent. However, I still recommend healthy exercise and low sugar for almost everybody.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column when possible. Readers may email questions to [email protected].
