Q: Hypomania or Serotonin Syndrome
Dr Phelps
Please answer to my question in my email if you can't publish it. It's very
important to me. I was diagnosed with depression and I was prescribed Paxil
20mg.From the 3rd day on it I felt very euphoric, very sleepy (sometimes I
couldn't get up from the bed) and all I wanted to do is lying on the bed. That
kept going on all the time of the day for 10 days and then I stopped it and
this symptoms disappeared. In your opinion what do you think was that: hypomania
or serotonin syndrome?
Thank you.
Dear Spark --
As you seem to have figured out, it could be either. I just checked to see how
common serotonin syndrome is if one is just taking a single antidepressant like
Paxil;
here's an article
that might review the subject if you try to get the whole printout (e.g. your
local hospital librarian, maybe); but suffice to say that there clearly are
such cases, and they appear to be extremely rare.
Meanwhile, I hear all the time about people
who took Paxil (and less often even Prozac, which is generally thought to be
more "activating") and felt "sleepy" on it. One patient called it "my lost
year". These people did not report euphoria. Was this some sort of subtle
"serotonin syndrome"? Or is this sleepiness just what we would otherwise call a
"side effect"? That is a distinction with rather little difference, probably.
And then there's the "euphoria" you report,
and as you've learned, yes, that does sound a bit more like
antidepressant-induced hypomania, especially if as you look back on that episode
you can say that the euphoria was clearly not normal for you compared to
your usual experience. In that case at minimum I'd have you take a Mood
Disorders Questionnaire. If that was "negative", and there was no other reason
to worry about bipolar disorder (e.g. there is no huge history of bipolar
disorder in your family), then you could probably try an antidepressant again in
the future -- a different one, obviously. That would be an issue for discussion
with your doctor.
Dr. Phelps
Published January, 2003
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