People’s Pharmacy: Serotonin syndrome

The People's Pharmacy

I take Zoloft (sertraline) for depression, but I had a frightening experience recently. I am in excellent physical health. To relieve a cold, I took one dose of a cold formula that contains dextromethorphan. The box warned about MAOI class antidepressants. It said nothing about Zoloft.

About an hour later, I began to experience chest pain, shortness of breath, shaking and tingling. Paramedics were called and found my EKG and blood pressure were fine, but my heart was racing. I had a textbook panic attack. I’ve never had one before.

When I refilled the Zoloft, I read the fine print the pharmacist supplied. I noticed, buried in a long list of drug names, that dextromethorphan was listed as harmful in combination with Zoloft. With so many Americans taking SSRI antidepressants, shouldn’t there be a warning about this interaction?

You may have suffered serotonin syndrome. When too much of this brain chemical accumulates, symptoms may include agitation, rapid heartbeat, muscle twitching, sweating, shivering, nausea, diarrhea, elevated body temperature, changes in blood pressure and mental confusion.

Dextromethorphan (DM) is found in many cough and cold medicines, including Robitussin DM and NyQuil. Although there is a warning about interactions with monoamine oxidase inhibitors (MAOIs), there is no mention of SSRI antidepressants such as Prozac (fluoxetine) or Zoloft. Nevertheless, serotonin syndrome has been reported when DM is taken with this type of antidepressant (Clinical Toxicology, September 2008).

I graduated from nursing school in 1986. My first job was in long-term care. Unfortunately, we had a few patients with large bedsores. We were told to mix up a batch of sugar and Betadine gel so we could pack the wounds and cover with a sterile dressing. The results were sometimes amazing. When all else fails, some of the old-time remedies do work well.

We first heard about this approach from a reader of this column 25 years ago. After some sleuthing, we found an article in the Journal of the American Medical Assn. (Jan. 8, 1973) describing the use of sugar for hard-to-treat bedsores. The physician described an 80% healing rate over five years of study. He speculated that the granules create local irritation that stimulates tissue formation and wound repair. Sugar is also bactericidal.

Joe Graedon is a pharmacologist, and Teresa Graedon is an expert in medical anthropology and nutrition.