1636 replies to this topic

[invalidusername]

Wonderful, wonderful!!! I too hope that continues for a while!

[ForLyla]

Yup now just have to make sure I live so that i can enjoy being acid reflux free, at least for a short while!

[ForLyla]

Guys I'm wondering if maybe the antibiotic I was on plus the ppi at the same time could have put me into serotonin syndrome? I keep passing out and feeling like I'm going to die any minute. My blood tests show anemia. I'm so so sick. By far the worst state I've ever been in.

Ppis show to increase ssri's anywhere from 20-50% and antibiotics also have an affect. I dropped both the ppi and antibiotic at the same time just a few days before this living hell hit. It's been 2 weeks since I stopped now. Does serotonin syndrome get better over time? I keep getting worse. I'm scared.

[fishinghat]

Serotonin Syndrome  does get better with time once the drug incompatability is removed. For example if you are taking 2 antidepressants at the same time you can get serotonin syndrome BUT as soon as you remove one of the antidepressants you start to improve. It sounds more like your lack of iron/anemia has lowered your blood's ability to transport oxygen. Do you have a blood O2 app on your cell phone? Also if it is low oxygen than you will not have a fever but if serotonin syndrome you would have a fever.

 

If you are periodically blacking out you need to see the dr soon, very soon . Also check your blood pressure as well.

[ForLyla]

Well whatever it is, I'm 100% this was caused by taking the ppi and antibiotic at the same time. I was also taking an over the counter nasal decongestant. That's when this all started. Why would that make me have blackouts and this sick? Just severe withdrawals? Ppi's and antibiotics both affect serotonin. Could my sibo possibly stop the absorption of the meds?

I'm going to emergency tonight. I really hope I can make it through this. This is the sickest I've ever been.

[fishinghat]

Yes, they both effect the absorption of Cymbalta which effects the serotonin levels BUT it takes a lot of extra serotonin to cause serotonin syndrome. On the other hand iron defeciency/anemia effects the ability of blood to carry oxygen and that would cause black outs and make you feel very bad. 

[ForLyla]

My ferritin level was normal so I imagine my iron isnt that bad.

[fishinghat]

Probably so.

 

by the way, I thought you would get a kick out of this...

 

"When the researchers analyzed the data, they found that respondents who said they used proton pump inhibitor (PPI) medications to treat their heartburn had anywhere from two to nearly four times the risk of testing positive for COVID-19, compared to people not using such medications."

[ForLyla]

I'm so scared. I've never felt this terrible. I need to go to emergency.

[ForLyla]

My doctor checked my spo2 and it ranged around 97%. My blood pressure is a little low but normal considering I'm so skinny now. My ecg was normal. Can this just all be withdrawal? The mix of the ppi and antibiotic killed me. The nasal decongestant spray probably didnt help. I did have a window for pretty much all of last night until I woke up a couple hours after falling asleep. My speech is slurred, my mind is so out of it and fatigued. Head pressure. Blacking out. Heart thumping worse than ever. Extreme agitation, fog and anxiety.

[fishinghat]

Lyla, your situation is so complex with the sibo, anemia, withdrawal, meds, heartburn that I hesitate to even guess. With the symptoms you mentioned it could still be withdrawal but not the black outs. The heartpounding is an almost 100% sign of stress wether it be anxiety or withdrawal. How long you been at your current dose of Cymbalta?

[ForLyla]

Been at current dose for 1.5 years with many ppi setbacks in between. I think the blackouts could possibly be withdrawal.

[ForLyla]

Vasovagal syncope is one of the possible listed side effects. I suspect that ppi's increase the absorption of cymbalta as they do for SSRI's. So I may have had a 20-50% increase in dosage and then sudden drop when I stop them. I'm just surprised that one week of that could cause such devastating and long lasting side effects. Youd think after a week or two youd go back to normal.


"Orthostatic hypotension, falls, and syncope have been reported in patients treated with the recommended Cymbalta dosages. Syncope and orthostatic hypotension tend to occur within the first week of therapy but can occur at any time during Cymbalta treatment, particularly after dose increases."

[fishinghat]

Well, I learned something today. Wasn't aware of that. 

 

Vasovagal syncope is a sudden drop in blood pressure due to a response to something (like a change in medication levels). Can you feel it comin on? 

 

1.5 years at the same dose. That is terrible. Deep thinking time.

[ForLyla]

I would be fine if it weren't for the ppi's. I learned my lesson that no matter how bad things get, never take any ppi's or any other acid reducers. I never get a chance to recover from cymbalta withdrawal because of them. I feel like I'm permanently damaged now. No coming back from this one.

[fishinghat]

I am beginning to agree with you on the ppis. Recently, as you know, they discovered that ppis makes you more vulnerable to Covid-19. I will also be posting some info on the fact that ppis cause major changes in digestive bacteria populations as well. The good news just keeps coming.  lol

[ForLyla]

Can this cause irreversible damage? I'm worried I might not go back to normal again.

[fishinghat]

Not that I am aware of. Unluckily you are in a catch 22 situation. The ppis have effected your Cymbalta ansorption as well as the bacteria in your gut which makes your sibo worse. The additional symptoms from the change in Cymbalta absorption will fade with time after you stop using the ppi BUT the change in gut bacterial population will remain bad unless you use probiotics, antibiotics ot other sibo medications. when you do take something to treat the sibo it effects the gut bacteria which will release endotoxins which upsets the gastric system until the good bacteria come back into balance BUT the change from bad bacteria to good will also effect the Cymbalta absorption and cause more withdrawal symptoms until the bacterial population settles down.

 

So, bottom line. Stay away from the ppi as it complicates things. Either wean off the Cymbalta and deal with the withdrawal symptoms the best you can and then address the sibo OR address the sibo first then deal with the Cymbalta wean. Either way you will be suffering for a while. Sibo is hard to cure so I would be tempted to "endure" the Cymbalta withdrawal first then deal with the sibo. Finishing your Cymbalta withdrawal may take a few months and then another few months to even begin to feel better. This is of course an educated guess.

[fishinghat]

I thought you might find this interesting...

 

PPIs

 

For example, proton pump inhibitors (e.g. omeprazole), widely used to treat acid reflux, reduce diversity and affect 20% of species, creating an unhealthy gut microbiota that may predispose to gastrointestinal infection. Indeed, PPIs may negatively impact the gut bacteria population even more so than do antibiotics.

 

https://pubmed.ncbi....h.gov/32514445/

Bacterial cultures from the stomach were obtained from 103 patients, and duodenal samples were also cultured from 49 of them, for a total of 53 patients with PPI use and 50 patients without. Positive gastric cultures were found in 42 of 53 patients with PPI use and in 13 of 50 without (P < 0.0001). Duodenal cultures were positive in 20 of 24 with PPI and 8 of 25 without (P < 0.0001). The most commonly identified bacterial species were oral strains of Streptococcus, followed by Neisseria and Haemophilus influenzae. Bacterial growth in the stomach and duodenum is more common in patients with PPI treatment. 

 

https://pubmed.ncbi....h.gov/31990420/

Twelve observational study cohorts with 708 PPI users and 11 interventional cohorts with 180 PPI users were included in the review. In most studies, PPI treatment did not affect microbiological richness and diversity, but was associated with distinct taxonomic alterations: In the upper gastrointestinal tract, PPI users showed overgrowth of orally derived bacteria, mostly Streptococcaceae (findings based on six independent cohorts with 126 PPI users). In faecal samples, PPIs increased multiple taxa from the orders Bacillales (eg, Staphylococcaceae), Lactobacillales (eg, Enterococcaceae, Lactobacillaceae, Streptococcaceae) and Actinomycetales (eg, Actinomycetaceae, Micrococcaceae), the families Pasteurellaceae and Enterobacteriaceae and the genus Veillonella. Taxa decreased by PPIs include Bifidobacteriaceae, Ruminococcaceae, Lachnospiraceae and Mollicutes (findings in faecal samples based on 19 independent cohorts with 790 PPI users). 

[ForLyla]

Thanks for sharing FH. I think what happened was a double whammy of antibiotics and the ppi at the same time. Both affect serotonin. Also I was taking a nasal decongestant and surely that didn't help.

Say my serotonin levels were increased by about 50% for a week and then dropped back down to normal levels. Would that not possibly create a serotonin syndrome? Any guess as to when I might stabilize? I have seen a little improvement since I first crashed on July 2nd. My heart pounding isnt quite as bad and I'm able to think more clearly but the faint feeling, fatigue, head pressure and dizziness haven't really let up. Maybe slightly better but still scary. It's been2 weeks now since I've been off all that stuff. I just am mostly scared that it left some kind of permanent damage to my brain or something, as silly as that might sound.

[fishinghat]

"Say my serotonin levels were increased by about 50% for a week"

 

My thought is that number should be around 10 to 2% at most but still I would expect around 4 to 8 weeks to stabilize (educated guess).

 

Each of those can effect different neurotransmitters and each other (antibiotics, ppi and a nasal decongestant). Recovery will probably be slow but sure. Sorry for the hard times. I wish I could make it better.

[invalidusername]

My poor dear Lyla...

 

Just catching up as I never forget your ongoing situation here, and I am sure at times that Hat and yourself were meant to find each other - you keep each other distracted well. Unfortunately, I cannot say anything that will benefit your situation outside that already written by brother Hat, but I can for sure vouch for the antibiotics situation. 

 

On two occasions I have taken antibiotics with snri's and on both occasions had severe set backs, so what you have here is no surprise to me.

 

Also, not that you would, don't take antibiotics just after having a tattoo!!! The agony!!! Didn't sleep, wanted to itch 24/7 but couldn't, anger through the roof... you name it!

[ForLyla]

Ya I learned my lesson. I cut out everything except for digestive enzymes. I have become extremely sensitive to any sugar again. I had a bit of honey last night and boy am I feeling it this morning. Same a few days ago when I had a handful of blueberries. I have to cut out all sugar or I get the crazy withdrawal syndrome symptoms.

My heart pounding is much better. The fainting feeling has also diminished a fair amount. Just waiting for my vision, fatigue and brain fog to improve a bit before I'm really functional again.

[invalidusername]

That is so good to hear. Really good. High time you had some thing turn in your favour. 

 

Steady does it and it will come, brave girl.

[ForLyla]

Yup I'll need to dig my way out of this one. At least I know to never touch a ppi again. Just need to figure out a way to beat these digestive problems once and for all. I'm working on biofilm destruction right now.

[invalidusername]

The mrs has just found relief with a ppi for her digestive issues, but now the doc wants her on Sertraline. Bit worried how the two will fair together... I'd rather her not take an SSRI at all, but if she doesn't try another AD, they have no reason to keep treating her. UK health service sucks.

[invalidusername]

https://www.ncbi.nlm...les/PMC4297217/

 

You see... one study shows a significant change in the serum count of SSRI's used in conjunction with PPIs. Whilst there is less of an effect between the two that the wife is taking, it still should have been noted by the doctor, because this is ONE study and ONE control group. 

 

The concentrations levels of acid will vary greatly between individuals and thus the confidence interval between subjects can be quite broad for that very reason. And THIS is why I am going to be treading carefully with her taking these. Ideally she should have a good couple of months on one or the other rather than taking them so close together.

 

In fact. Sod it.

 

I think she should wait for her system to get used to the PPI before starting the Zoloft.

 

What do you think Lyla.. Hat??

[ForLyla]

IUN ppi's are usually short term gain for long term pain. Its just treating the symptoms but not the root of the problem and the lack of acid makes us vulnerable to bacterial overgrowth and viruses.

I wouldnt recommend taking both at the same time as they will cause wild fluctuations in serotonin. I'd take the ppi as intended for 4 or 5 weeks, wean off after another couple weeks and then start the ssri if needed.

[fishinghat]

I agree with Lyla. One thing at a time.

[invalidusername]

Thank you both.

 

Lyla - this is exactly what I said to the wife. They are not a long-term solution and the root of the problem needs to be identified. 

 

Glad you both feel that this is the way to go. Need to have another word with idiot doctor.

 

Damn they are useless.