Posted on 03/03/2007 8:37:14 PM PST by neverdem
The death of Libby Zion, an 18-year-old college student, in a New York hospital on March 5, 1984, led to a highly publicized court battle and created a cause célèbre over the lack of supervision of inexperienced and overworked young doctors. But only much later did experts zero in on the preventable disorder that apparently led to Ms. Zion’s death: a form of drug poisoning called serotonin syndrome.
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In its classic form, serotonin syndrome involves three categories of symptoms:
¶Cognitive-behavioral symptoms like confusion, disorientation, agitation, irritability, unresponsiveness and anxiety.
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Perhaps adding to the diagnostic challenge is the fact that a huge number of drugs — prescription, over the counter, recreational and herbal — can trigger the syndrome. In addition to selective serotonin reuptake inhibitors like Zoloft, Prozac and Paxil and serotonin/norepinephrine reuptake inhibitors like Effexor, the list includes tricyclic antidepressants and MAOIs (for monoamine oxidase inhibitors); narcotic painkillers like fentanyl and tramadol; over-the-counter cough and cold remedies containing dextromethorphan; the anticonvulsant valproate; triptans like Imitrex used to treat and prevent migraines; the antibiotic Zyvox (linezolide); antinausea drugs; the anti-Parkinson’s drug L-dopa; the weight-loss drug Meridia (sibutramine); lithium; the dietary supplements tryptophan, St. John’s wort and ginseng; and several drugs of abuse, including ecstasy, LSD, amphetamines, the hallucinogens foxy methoxy and Syrian rue.
Although serotonin poisoning can be caused by an antidepressant overdose, it more often results from a combination of an S.S.R.I. or MAOI with another serotonin-raising substance. Patients at particular risk, some experts say, are those taking combinations of antidepressant and antipsychotic drugs sometimes prescribed to...
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Most important to preventing the syndrome is for patients to give each of their doctors a complete list of drugs they regularly take — including prescriptions, over-the-counter medication, dietary supplements and recreational drugs — before a doctor prescribes something new.
(Excerpt) Read more at nytimes.com ...
It all comes out in the wash.
"Libby's father had the power of the press behind him and that's the only reason it became a huge story. He did not want to face the fact his daughter was not the perfect little girl he thought she was. And that's the truth."
As I understand this story, the cause of death seems to be complications of an interaction between Libby Zion's legally prescribed antidepressant Nardil and the narcotic painkiller Demerol that was given to her at the hospital. I see no mention of the ingestion of any other drugs. If she was asked, I don't know why this young woman did not tell the doctor at the hospital that she was taking Nardil. Maybe she wasn't thinking straight due to her illness and fever, or maybe she was taking more than the prescribed dosage and didn't want to admit it. The thrust of the article seems to be that doctors need to be made more aware of the manifestations of this syndrome. Of course, if they are conscious and cognizant, the patient has to do his part by being honest with the doctor.
Sorry, but I am sick of allowing people to "excuse" criminal behavior just because they were taking a certain medication at the time of the crime.
The kid that is on Riddlin may be a miscreant, but he/she still knows the difference between right and wrong. When decisions reach criminal perportions, he/she should be held accountable. I don't care how badly the brain nuerons are misfiring, there is still a comprehension of choices and consequenses.
If you really want to know what happened, here it is. An older Doc once told me, "We have checks in place in medicine and bad things can't happen without multiple mistakes being made. Even so it happens and when it does it isn't 'One persons fault' but multiple failures." In this case the intern told the nurse over the phone to give the agitated patient more Demerol to calm her down. There are at least two mistakes here. 1) the intern should have known better than to give the oder 2) the nurse should have known better than to give the medicine to the patient. The intern probably should have gone to evaluate the patient. The ER probably should have insisted on a patient that was that ill go to a Unit bed instead of the floor and the ER doc should have known better than to start this mess by giving Demerol for agitation. The upper level resident should have been keeping a closer eye on an intern that was this clueless. The charge nurse should have been keeping a closer eye on a nurse that was his clueless. I could just go on and on here but I think you get the point.
I don't disagree with that view.
alcohol should be on the list- the interaction of alcohol with many other medications (prescriobed or not) can be lethal.
TEEN SUICIDE INCREASE - ANTIDEPRESSANT ALARMIST CASUALTIES
http://abcnews.go.com/Health/Depression/story?id=2850783&page=1
(see my post 24) It is truly a tragedy that teens are deciding in greater numbers to take their own lives. But I can't be overly sympathetic about the reduction in availabilty of antidepressants being to blame. I am a strong believer in personal responsibility. Isn't it possible that the increased suicide rate is due to a culture that fails to imbue respect for human life. Rap songs, movies, video games etc. embrace the concepts of murder, torture, abuse. Self sacrifice has been replaced by the overly hyped necessity - "healthy self esteem". The current culture wants kids to acheive good self esteem thru osmosis or by decree from our education systems, as if it can be poured into them. Our parents taught us to be responsible adults and they did it the old fashioned way, by example. They worked hard and made sacrifices to benefit others. Many kids today just assume that they will all of a sudden be grown up, self satisfied, well rounded individuals. After all, they have been taught that everything is "Fair" and nothing unfair should ever happen to them.
BTTT
Let's just say that story has been rewritten for history sake. However, Sid Zion did change the hours doctors had to stay on duty, and that was a fantastic thing.
Sid Zion was a broken man after his beloved daughter died.
That was my statement, not Calvin Locke's.
As per the Times' article: "In its classic form, serotonin syndrome involves three categories of symptoms:"
¶Cognitive-behavioral symptoms like confusion, disorientation, agitation, irritability, unresponsiveness and anxiety.
¶Neuromuscular symptoms like muscle spasms, exaggerated reflexes, muscular rigidity, tremors, loss of coordination and shivering.
¶Autonomic nervous system symptoms like fever, profuse sweating, rapid heart rate, raised blood pressure and dilated pupils.
Sorry, but I am sick of allowing people to "excuse" criminal behavior just because they were taking a certain medication at the time of the crime.
Sorry, but if you don't want to accept the symptoms as described by the NY Times' writer, then enter (SSRI or serotonin syndrome) and (aggression or violence) into the query box at PubMed.
If you don't understand that drugs called selective serotonin reuptake inhibitors, SSRIs, e.g. Prozac, Zoloft, etc., can make people lose their minds, then why do you think the FDA recently demanded Black Box Warnings on them?
Look at the stories linked in comment# 1. You'll find that many of these kids were just started on a SSRI, or that their dose was recently increased.
I just hate to see beneficial drugs be maligned and/or taken off the market because the wrong people got them.
They are still on the market, but with the Black Box Warnings. IMHO, folks started on these meds need to be tested for genetic variations alluded to in comment# 6.
I personally treated a person who became so hemodynamically unstable, i.e. a seriously abnormal blood pressure and heart rate, on multiple psychiatric drugs that she was admitted to the ICU. I stopped the meds. Then I spoke to her shrink who insisted that she needed all of them.
One of the reasons I posted the article was because it stated that 85% of docs are ignorant of serotonin syndrome.
Thanks for the link. If I was a kid today, I'd be suicidal.
I am not familiar with that syndrome. However, if this does exist the SSRIs would be helpfull. The mechanism of Serotonin Specific Reuptake Inhifitors SSRIs is to decrease the amount of serotonin that is taken back out of the synapse into the neuron. It does not change the total amount of serotonin in the body but keeps more in the synapse thus in effect increasing the amount of the neurotransmitter that is available to carry the signal across the synapse. The neurotransmitters in the synapse are constantly taken up into the neuron and recycled as needed into the synapse. This is how an electrical signal in the neuron "jumps" the gap between them. The serotonin will go from one neuron to the next neuron and this will cause an electrical signal to go down the second neuron.
Yes we do know the majority of the combinations. However, when a new drug comes out and is given to the public we will almost always find some new side effect that was not discovered in the initial clinical trials. In my opinion the use of multiple SSRIs is not warranted. The normal procedure is to try one and if it does not work, stop that one and start the patient on a different SSRI. The anti depressants are very patient specific and it is not unusual to try several until the best one for a particular patient is found.
However, it is not uncommon for a patient to be on two different anti depressants at the same time and this is perfectly rational. The SSRIs can affect sleep and make it difficult. It is very common to give an SSRI in the morning and a non specific re uptake inhibitor at bedtime. The non specific ones will have a sedative side effect and make sleep much easier and also have good anti depressant activity.
Where I work (a teaching hospital) I have had residents call the pharmacy and ask the most basic of questions or something really stupid. These Residents are very smart and knowledgeable people. They just did not have enough sleep and could no longer think straight. Fortunately they are now on reasonable schedules and this is now a rare occurrence.
Oh, what a scary set of events! I can't see how there is any way to protect yourself from something like this happening to you or a loved one. In situations like this we tend to put our complete faith in the medical professionals. The family of this young girl are probably constantly tortured by the "what ifs". If any one of the factors that you mentioned had been done differently, this person might still be alive. Tragic.
"Sid Zion was a broken man after his beloved daughter died."
Poor man, any parent, or for that matter anyone, can empathize with his loss.
Yes. My father knew him.
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