Anyone here have patients not tolerating SSRIs or SNRIs

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whopper

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I've known 5 people so far that can either not tolerate SSRIs (I'm talking being put on almost everyone and SNRIs) at all or at extremely low dosages without getting something such as feeling naseous, weak, and dizzy. After the 4th, I noticed they all had a commonality.

These patients all had some type of immunological problem. Three
had Epstein Barr virus that led to infectious mononucleosis, and they later developed chronic fatigue syndrome, another has Sjogren's syndrome, another had Guillian Barre syndrome as a child.

I did further investigation into this and noticed several forums where people with chronic fatigue syndrome also mentioning they could not tolerate medications except at the lowest dosages, where unfortunately these medications had barely any effect.

In one of those cases, the guy had an anxiety disorder so bad, and was on benzos for years (and he wanted off of them because he felt drunk 24/7 and he did not like it), a highly acclaimed institution in the area hosptalized him (at my request...because I knew the docs there would actually give a damn and not just discharge him 48 hours later) and had to monitor his vital signs frequently while he was put on a minimal dosage of Citalopram. His BP went to very high levels (diastolic over 110), and he developed herpetic like lesions around his mouth, finally after about 5 days he stopped having these side effects with the medications.

I developed a theory that perhaps their inability to tolerate the medication is immunologically based, but despite several patients talking about this phenomenon over the internet in various chronic fatigue syndrome support forums, I've never seen any documentation on this in any medical journals and have not found much in literature searches.

Anyone experience something similar? I was thinking if a tally of patients could be pooled, this could lead to an article being published.
 
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I've had several patients with CF, fibromyalgia, multiple chemical sensitivity who weren't able to tolerate SSRI's, but I've never seen measurable physiologic changes such as BP changes. My usual experience is that they have a lot of anxiety and what Barsky calls somatosensory amplification, making them very sensitive to all physiologic sensations. My usual success is actually a combination of the tried and true (start low, go slow), combined with behavioral interventions such as hypnosis and other therapy. 2.5-5mg celexa for 2-4 weeks, for example. Teach and actively guide through relaxation exercises, then have them practice it alot.

The PNI literature might lend some support to your theory, but an alternative explanation would just that they are in a high anxiety/stress state, which is known to be possible triggers for high blood pressure and for herpes and zoster outbreaks. Immunological changes most assuredly are involved, but chicken or the egg?

Some people I've also seen have extreme sensitivity to multiple medications, after they received chemotherapy earlier in life. There's likely many subtleties to pharmacokinetics and dynamics we're just scratching the surface on.
 
Yeah, agree.

I totally think I'm only scratching the surface and may find that my theory is off on a few things but at this point I'm noticing a lot of people, the 5 I mentioned, but lots of people in patient forums having a problem with medication sensitivity.

I did a bunch of lit searches because in those patients I've hit a major roadblock in treating them and all of them had serious symptoms. Yes, I did recommend psychotherapy, but in all cases, it only led to marginal improvement and the patient still needed much more.

I think I may start asking several rheumatologists about this and see if they've seen similar. I might also go into those forums and ask all the people mentioning they have medical sensitivity about possibly being interviewed.

The idea is one of those things I'm not actively pursuing now other than the planning stage because I'm in the middle of several things going on in my life, so if anyone wants to take my idea and run with it, fine with me. Just please include me in any study you do plan on doing. It's after all more about the advancement of the knowledge but I do want to contribute if possible.
 
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