Serotonin Medications: Why They May Not Work for Everyone

Serotonin-related medications

Doctor, is it true that about one in ten people cannot use serotonin-related medications? I have autonomic nervous system dysfunction along with panic attacks! I experience palpitations, unstable blood pressure, chest pain, shortness of breath, dizziness, and anxiety! I have tried serotonin medications (such as Escitalopram) twice, taking half a tablet, and on the same day, I had a severe panic attack with a heart rate of 128 and elevated blood pressure.
The next morning, I vomited gastric acid and felt uncomfortable in my stomach for a month.
After undergoing an endoscopy, I was diagnosed with mild gastritis and gastroesophageal reflux disease, and then I switched to another medication (such as Sertraline), taking half a tablet for a week.
On the first day, my heart rate was 105; on the second day, I felt fatigued; on the third day, I had racing thoughts; on the fourth day, I felt increased abdominal pressure and chest tightness, and I didn't want to speak at all! On the fifth day, I experienced severe shortness of breath.
Of course, I have these symptoms regularly, but they became more severe during that week of medication! My heart rate sometimes tends to be faster.
After a week, when I returned for a follow-up, the doctor said that I am not suitable for serotonin medication treatment...
I feel confused and desperate! Many of my friends are being treated with serotonin medications, some have recovered, and others have managed to control their conditions! Yet here I am, feeling hopeless and as if there is no medication that can help me...
I am truly desperate!

Anna, 40~49 year old female. Ask Date: 2017/03/07

Dr. Zhang Fangrong reply Psychiatry

Dear Sir/Madam,
Thank you for your inquiry and for your message.
I understand that autonomic nervous system dysregulation combined with panic attacks can be quite uncomfortable for you.
You also mentioned that you have had an adverse experience with secondary serotonin treatment.
Indeed, using serotonin-based therapies is a good option for treating autonomic nervous system dysregulation and panic.
During the treatment process, you might consider using a lower dosage or exploring other classes of medications, including tricyclic antidepressants, monoamine oxidase inhibitors, or anxiolytics, which can also yield positive results.
I recommend discussing this further with your physician, as there may be opportunities to alleviate your discomfort.
Wishing you good mental and physical health.
Sincerely,
Dr.
Fang-Rong Chang
General Psychiatry

Reply Date: 2017/03/07

More Info

It sounds like you are going through a very challenging time, and I want to acknowledge the difficulties you are facing with your mental health. Your experience with serotonin medications, such as SSRIs (Selective Serotonin Reuptake Inhibitors), is not uncommon. While many individuals find relief from their symptoms with these medications, there is a subset of the population that may not respond positively or may experience adverse effects, as you have described.

To address your question, it is estimated that around 10-20% of individuals may not respond adequately to SSRIs or may experience intolerable side effects. This phenomenon can be attributed to various factors, including genetic differences, individual brain chemistry, and the presence of co-occurring medical conditions. In your case, it seems that the medications you tried exacerbated your symptoms rather than alleviating them, which can be incredibly frustrating and disheartening.

The symptoms you experienced—such as increased heart rate, elevated blood pressure, gastrointestinal discomfort, and heightened anxiety—are known side effects of SSRIs. These medications work by increasing serotonin levels in the brain, which can help regulate mood. However, in some individuals, this increase can lead to overstimulation of the nervous system, resulting in heightened anxiety and physical symptoms like palpitations and gastrointestinal distress.

Given your history of panic attacks and autonomic nervous system dysregulation, it is understandable that SSRIs may not be the best fit for you. It is crucial to communicate openly with your healthcare provider about your experiences with these medications. If SSRIs are not suitable, there are alternative treatment options available. These may include other classes of medications, such as SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), benzodiazepines for short-term anxiety relief, or atypical antipsychotics. Additionally, non-pharmacological approaches like cognitive-behavioral therapy (CBT), mindfulness practices, and lifestyle modifications can also be beneficial in managing anxiety and panic symptoms.

It is important to remember that finding the right treatment can be a process of trial and error. What works for one person may not work for another, and it may take time to discover the most effective approach for your specific situation. If you feel comfortable, consider seeking a second opinion or consulting with a psychiatrist who specializes in anxiety disorders. They may offer insights into alternative treatments or adjustments to your current regimen.

Lastly, I encourage you to reach out for support from friends, family, or support groups. Sharing your experiences and feelings with others who understand can provide comfort and help alleviate feelings of isolation and despair. Remember, you are not alone in this journey, and there are people and resources available to help you navigate through these challenges.

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