How Can I Be Sure I Won't Get Serotonin Syndrome?

QUESTION:

I have read many medical journal articles on how taking Fluoxetine (Prozac) and Buspirone (BuSpar) together may cause Serotonin Syndrome. How can you ensure this not to happen since you regularly recommend the two to be taken together for GAD, Fractured Enjoyment and BPD patients?

DR. HELLER'S ANSWER:

I can't. There are rare cases of problems with every medication. You can get serotonin syndrome from Sudafed, bright lights, St. John's wort, lithium, trazodone, electric shock therapy and many foods. This complication is extraordinarily rare. The FDA approved package insert for Prozac (fluoxetine) does not include a warning about combining it with BuSpar (buspirone).

Most cases of serotonin syndrome with SSRI medications like Prozac (fluoxetine) occur when it's combined with tricyclic antidepressants and MAO inhibitors. The tricyclic antidepressant Elavil (amitryptilline) is frequently added to SSRI antidepressants for migraines. This has a much greater risk of serotonin syndrome than combining BuSpar (buspirone) and Prozac (fluoxetine).

I have a lot of patients on this combination and have never seen the serotonin syndrome. I had one patient attempt suicide by taking 250mg 15mg BuSpar tablets with 350 Prozac pulvules. She did fine, although she was very shaky for a few weeks.

There's no guarantee on anything in life. Approximately 10 people per year are killed by vending machines falling down on them. You can be killed or maimed every time you drive a car. The computer you're using can explode. Bad weather, earthquakes, lightning and terrorists can kill. The electricity in your home can cause a fatal fire in your house. Your car can explode. You can be killed by lightning hitting your telephone line.

Being depressed increases the risk of a heart attack by 600%. There are more suicides per year than the combination of homicide and automobile accidents combined. Anxiety dramatically increases the risk of immune system disease, cancer, heart attacks, strokes, high blood pressure and others.

There is no absolute prevention of risk. What we do with everything in life is make an attempt to balance the risks versus the benefits.
I would not be concerned if any of my loved ones took BuSpar (buspirone) and Prozac (fluoxetine) together, in fact some do.

next: What About Trileptal? ~ back to: Borderline Personality Disorder FAQs Table of Contents