Combinations - Adderall & Alcohol -- how much is safe with Lexapro?

[hemalitun]

SWIM has cyclical, sometimes debilitating anxiety comorbid with depression & is on his 5th day of taking 10mg lexapro to treat both. SWIM's doc has advised him to consume no more than 2 drinks/week, which presents a problem as SWIM is in college & usually has anywhere from 5-10 drinks on an average friday/saturday. SWIM has read that the 2 prime dangers resulting from mixing SSRIs & alcohol are a) serotonin syndrome and b) increased resperitory depression; he's concerned less with the greater intoxication than with the possibility of inducing serotonin syndrome. Further, SWIM will occasionally consume between 20-40mg of adderall to aid with studying or for recreational purposes.

SWIM's question is this: how many drinks/mgs of adderall can safely be consumed on a daily regimen of 10mg lexapro? Again, SWIM's primary concern with both is that they could potentially induce serotonin syndrome. Basically, could ~6 drinks or ~30mg of adderall pose any serious danger? If it helps, SWIM just drank a Guinness & felt markedly more affected than usually -- between 2-3 times more than usual -- but this could have something to do with the fact that SWIM has abstained from alcohol completely for close to a month.

Thanks in advance for your input.

[wespawloski]

SWIM almost had serotonin syndrome (syrian rue and St. John's was chill, but Prozac took it to the edge to a scary place for this Swimmer). The combo mentioned above has similarities to your proposition.

If you know how amphetamines and SSRIs work, you can make some initial assumptions :

SSRI blocks reuptake, thus increasing intracellular stimulation
Amphetamine has a mechanism to influx the level of monoamines + inhibit the reuptake = UNKNOWN levels of NTs

in SWIM's case he took street ecstacy during prozac therapy (Including SWIM's few extra for the party) and felt the normal amphetamine craze.

If SWIY was only slightly swayed by prozac (I mean, it wasnt life changing) Then we can assume that direct serotonin stimulation is not a demanding issue. SWIM would recommend passing on your SSRI for the day if SWIY wants to use addy recreationally.

Alcohol is not too much to worry about. SWIM used excessive dosage of SSRI + alcohol on nights and was no better or worse off. But the GABA excitation of alcohol can do crazy shit, coupled with a addy and lexapro combo... Just make sure you know your body.

"If it helps, SWIM just drank a Guinness & felt markedly more affected than usually -- between 2-3 times more than usual -- but this could have something to do with the fact that SWIM has abstained from alcohol completely for close to a month." - Now that scares me, throwing amphetamine into the mix is... unwise without further investigation of the increased drunkenness theory. SWIM recalls off the top of his head that a common side-effect of prozac is increased drunkenness, so check that first.

Do not let anybody give you a dosage. SWIM would recommend study of SWIY's adderall + prozac combination before even going to alcohol. Truthfully, serotonin syndrome is hard to get for the average person as you can see with some kids who pop ecstasy in scary proportions. The increased drunkenness would only REALLY indicate you will get FUCKED, but serotonin syndrom is off the radar IMO.

"debilitating anxiety comorbid with depression" - To SWIM that is of particular importance, as heavy depression could mean either a strong resistance (++) or super-sensitivity, the latter being volatile. One or two drinks wont kill you either way, but it could be in your favor to leave it avoided.

[MadDawg]

ANti-deps don't do shit to amphetamine. They work with each other, speed's got no effect on the serotonin transmitters, only dopamine and noradrenaline. High dose meth use may effect serotonin though....

Drinking fucks with GABA, SSRI's don't fuck with GABA hence why they suck so much ass at anxiety.

Dude, UTFSE next time.

[Jatelka]

^^^ Not true. Lifted the following directly from Medscape:

"Amphetamines/Selective Serotonin Reuptake Inhibitors;

Severity of interaction Moderate

MECHANISM OF ACTION: Amphetamines may affect serotonin release and/or reuptake, depending on their molecular structure. Ring substitution tends to increase amphetamine-induced release of endogenous serotonin. However, the effect on serotonin release may also be dose related and is more likely if the amphetamine is taken in greater than those approved and generally employed in treating Attention-deficit-hyperactivity-disorder, or if abused, especially over long periods of time.(1)

CLINICAL EFFECTS: Concurrent use of amphetamines with agents that affect serotonin may increase the risk of serotonin syndrome. Symptoms of serotonin syndrome include irritability, altered consciousness, double vision, nausea, confusion, anxiety, hyperthermia, increased muscle tone, rigidity, myoclonus, rapid fluctuations in vital signs, and coma. Serotonin syndrome may result in death.

PREDISPOSING FACTORS: High doses or long-term abuse of amphetamines may increase the risk of this interaction.

PATIENT MANAGEMENT: The concurrent use of amphetamines with agents that affect serotonin should be approached with caution.(1) Patients receiving concurrent therapy should be instructed to report any signs or symptoms of serotonin syndrome immediately.

DISCUSSION: In a case report, a 13 year-old female experienced tachycardia when amphetamine was added to her sertraline regimen.(2)

Increased side effects have also been reported in patients maintained on fluoxetine who ingested illicit amphetamines.(3)

In another report, a patient experienced jitteriness, stomach cramps, dry eyes, palpitations, and tremors after taking one dose of phentermine eight days after discontinuing fluoxetine.(4)

In a case report, a 32 year-old male developed agitation, anxiety, shivering, tremors, and diaphoresis two weeks after adding venlafaxine to his dexamphetamine.(5)

There have also been reports of safe and effective use of amphetamines with fluoxetine,(6) dextroamphetamine and sertraline,(6) and dextroamphetamine with fluoxetine.(7)

REFERENCES:
1.Anonymous. Personal communication: Adderall XR and SSRI's. Shire US Inc. August 11, 2004.
2.Gracious BL. Atrioventricular nodal re-entrant tachycardia associated with stimulant treatment. J Child Adolesc Psychopharmacol 1999;9(2):125-8.
3.Barrett J, Meehan O, Fahy T. SSRI and sympathominetic interaction. Br J Psychiatry 1996 Feb;168(2):253.
4.Bostwick JM, Brown TM. A toxic reaction from combining fluoxetine and phentermine. J Clin Psychopharmacol 1996 Apr;16(2):189-90.
5.Prior FH, Isbister GK, Dawson AH, Whyte IM. Serotonin toxicity with therapeutic doses of dexamphetamine and venlafaxine. Med J Aust 2002 Mar 4;176(5):240-1.
6.Findling RL. Open-label treatment of comorbid depression and attentional disorders with co-administration of serotonin reuptake inhibitors and psychostimulants in children, adolescents, and adults: a case series. J Child Adolesc Psychopharmacol 1996 Fall;6(3):165-75. 7.Linet LS. Treatment of a refractory depression with a combination of fluoxetine and d-amphetamine. Am J Psychiatry 1989 Jun;146(6):803-4."

[MadDawg]

Yes, we can all throw about medical lit, but in the scheme of things, Amphetamines and SSRI's are generally safe to use concurrently.

Not unless I'm suffering from an undiagnosed case of Serotonin Syndrome?

[Jatelka]

"throwing around medical lit" is extremely useful from a harm reduction point of view.

Generally safe does not mean Completely safe, and the medical lit thrown about puts doubt on your bold assertion that aphetamines do not affect serotonin.

I'm just in the information providing business, and I'm glad the combination your monkey is on works for her, without SE's. This may not be the case for other monkeys, who deserve the opportunity to read as much about potential for harm as possible: So they can make an informed decision

[MadDawg]

Sorry if I came across as an asshole :/

You're absolutely right. Just because it doesn't happen regularly, doesn't mean that a kid on SSRI's who decides to pop a few of his friends' Adderall's or decides to take a hit of cut, street speed gets a case of serotonin syndrome and dies.

Sorry for being a dickwad Jatelka, as Bluelight always used to throw around medical literature and that was there only response, no responses based purely on experience.

I can say that D-amphetamine, escitalopram combination doesn't cause Serotonin Syndrome, but if I were to chuck in a few pseudoephedrine cold tablets in the mix, I'd be concerned for my health, as demonstrated recently when my pharmacist declined cold tablets when I asked for them.

Amphetamines might not seem dangerous or damaging because of their 'upper' effects, but they're a strong drug and can affect you and your health.