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About The Siuslaw news. (Florence, Lane County, Or.) 1960-current | View Entire Issue (April 8, 2017)
4 B SIUSLAW NEWS | SATURDAY, APRIL 8, 2017 TO YOUR GOOD HEALTH Serotonin Syndrome Affects Mood, Muscles DEAR DR. ROACH: After being on Paxil for about 15 years, it wasn’t working anymore. My doc- tor decreased my dose, and I slowly started Viibryd. The fi rst week I felt great. When I increased the dose of Viibryd, I began feeling sick. I had a bad headache, anxiety and couldn’t sleep, and my muscles began jerking. I went to the doctor, and she had me stop immediately, prescribed Deplin for seven days, and said that I’d had serotonin syn- drome. 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 unconfi dent and fragile, so I began taking 25 mg of Paxil CR. My doctor seemed con- cerned that the serotonin syndrome could return, and advised me to take Deplin along with the Paxil. How common is this syndrome? I am SALOME’S STARS ARIES (March 21 to April 19) Th e Lamb loves to be surrounded by fl ocks of admirers. But be careful that some- one doesn’t take his or her admiration too far. Use your persuasive skills to let him or her down easily. TAURUS (April 20 to May 20) Th is is a good time to begin setting far-reaching goals and connecting with new contacts. Aspects also favor strengthening old relationships -- per- sonal and/or professional. GEMINI (May 21 to June 20) A personal disappointment should be viewed as a valuable learning experi- ence. Go over what went wrong and see where a change in tactics might have led to a more positive outcome. CANCER (June 21 to July 22) Don’t leave projects unfi nished or personal weaning myself off the Paxil, but what if I need an antidepressant? -- M.M. ANSWER: Serotonin syndrome is more common than often is suspected. It is an abnormality of brain chemistry caused most often by medications, especially selec- tive serotonin reuptake inhibitors (SSRIs), like paroxetine (Paxil) and vilazodone (Viibryd). You had many symptoms of serotonin syndrome. Serotonin syn- drome 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 medi- cation 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’s not associ- ated with serotonin syndrome, as far as I have been able to fi nd. DEAR DR. ROACH: A diagnosis of “Cameron erosions of the esopha- gus” was made after my gastrosco- py. I was not able to fi nd that term at nlm.nih.gov/medlineplus. Have you ever heard of this? -- A.M. ANSWER: To be honest, no. However, I did look it up, and found that Cameron erosions are found only in people with a hiatal hernia. A hiatal hernia isn’t like an umbili- cal or groin hernia; in a hiatal her- nia, the stomach goes upward into the chest through the diaphragm, the sheet of muscle that separates your chest from your abdomen. It is our primary muscle for breathing. There normally is a hole in the dia- phragm (the hiatus), but in a hiatal hernia, the structures that hold the stomach in place weaken and allow it to go into the chest. The part of the stomach inside the chest is prone to bleeding, and the areas that bleed can be seen by the endoscope and are called Cameron erosions, or ulcers. Small hiatal hernias usually can be managed with medication as nec- essary. However, large hernias and those with a history of bleeding may require surgical repair. An expert is needed to decide whether surgery is required. obligations unresolved, or you might fi nd yourself tripping over all those loose ends later on. A relative has important news. LEO (July 23 to August 22) Expect a challenge to the usual way you do things. Although you might prefer the tried-and-true, once you take a good look at this new idea, you might feel more receptive to it. VIRGO (August 23 to September 22) Much work has yet to be done to polish a still-rough idea into some- thing with signifi cant potential. Expect to encounter some initial rejection, but stay with it nonetheless. LIBRA (September 23 to October 22) Th ere still might be some commu- nication problems in the workplace, but they should be resolved soon. Meanwhile, that “tip” from a friend should be checked out. SCORPIO (October 23 to November 21) A new relationship appears to need more from you than you might be willing to give right now. Best advice: Resist making promises you might not be able to keep. SAGITTARIUS (November 22 to December 21) Th at restless feeling encourages you to gallop off into a new venture. But remember to keep hold of the reins so you can switch paths when necessary. CAPRICORN (December 22 to January 19) A demanding work sched- ule keeps the high-spirited Goat from kicking up his or her heels. But play- time beckons by the week’s end. Have fun. You earned it. AQUARIUS (January 20 to February 18) You’re beginning to come out from under those heavy responsibilities you took on. Use this freed-up time to enjoy some much- deserved fun with people close to you. PISCES (February 19 to March 20) Before you get swept away by a tidal wave of confl icting priorities, take time to come up for air, and reassess the situation. You might be surprised by what you’ll fi nd. 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