Discussion: SSRIs & Injectable opiates

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SSRIs & Injectable opiates​

SSRIs (Selective Serotonin Reuptake Inhibitors) work by specifically targeting and modifying the levels of serotonin, a neurotransmitter in the brain. Serotonin is released by certain neurons in the brain and acts as a chemical messenger that transmits signals between nerve cells. It helps to regulate mood, sleep, appetite, and social behavior.

After serotonin is released into the synapse (the gap between nerve cells), it performs its function by binding to specific receptors on the receiving nerve cell. Once the signaling is complete, the serotonin is reabsorbed by the presynaptic neuron through a process called reuptake.

SSRIs, as the name suggests, selectively inhibit the reuptake of serotonin. They bind to the serotonin transporter proteins on the presynaptic neuron and block their ability to reabsorb serotonin. By doing so, SSRIs increase the concentration of serotonin in the synapse, enhancing its availability for binding to receptors on the postsynaptic neuron.

By increasing serotonin levels in the brain, SSRIs can help regulate mood and emotional states. This is particularly beneficial in treating conditions like depression, anxiety disorders, and certain other mental health conditions.

There are several SSRIs that are commonly prescribed for various mental health disorders. Here are some examples:

• Fluoxetine (Prozac): Used to treat depression, panic disorder, and obsessive-compulsive disorder (OCD).
• Sertraline (Zoloft): Prescribed for depression, social anxiety disorder, panic disorder, and PTSD (post-traumatic stress disorder).
• Paroxetine (Paxil): Used for depression, generalized anxiety disorder (GAD), and social anxiety disorder.
• Escitalopram (Lexapro): Primarily prescribed for depression and generalized anxiety disorder.
• Citalopram (Celexa): Used to treat depression and may be prescribed off-label for other conditions.

Injectable opiates, also known as opioids, work by interacting with specific opioid receptors in the central nervous system to reduce the perception of pain. In the human body, there are several types of opioid receptors, including mu, kappa, and delta receptors. The mu-opioid receptors are primarily responsible for pain relief and are the main target of opioids.

When an injectable opiate, such as morphine or fentanyl, is administered, it enters the bloodstream and crosses the blood-brain barrier, allowing it to reach the central nervous system. Once in the brain, opiates bind to the mu-opioid receptors, which are located in areas that regulate pain perception. By binding to mu-opioid receptors, injectable opiates reduce the transmission of pain signals between nerve cells. This leads to a decreased perception of pain and a sense of analgesia or pain relief. Besides pain relief, injectable opiates can also induce feelings of euphoria, sedation, and relaxation. These effects are a result of the interaction with opioid receptors in other regions of the brain.

Types and Examples of Injectable Opiates: Morphine, Heroin, Fentanyl, Hydromorphone (Dilaudid), Meperidine (Demerol).

SSRIs and injectable opiates both act on the central nervous system and can interact when taken together. The main mechanism of interaction is that SSRIs can inhibit the metabolism of opiates in the liver, leading to higher opiate levels in the bloodstream. Specifically, SSRIs inhibit the CYP450 enzyme system in the liver, which is responsible for metabolizing many drugs including opiates. This causes the opiates to be broken down and eliminated from the body more slowly.

High levels of opiates can lead to increased side effects such as:

1. Respiratory depression - slowed or stopped breathing due to the central nervous system effects of opiates
2. Extreme drowsiness and sedation
3. Nausea and vomiting
4. Constipation
5. Confusion
6. Low blood pressure

The combination also increases the risk of serotonin syndrome, which can be life-threatening. Symptoms of serotonin syndrome include high fever, rapid heartbeat, tremors, confusion, and seizures. Several opioids have been implicated in cases of serotonin toxicity, including meperidine, tramadol, dextromethorphan, propoxyphene, tapentadol, methadone, oxycodone, and fentanyl. Morphine and its analogs, however, which are not serotonin reuptake inhibitors, do not induce serotonin toxicity in some studies. This does not mean that it is safe to combine them with SSRIs for the reasons mentioned above.

All things considered, we recommend avoiding this combination under any conditions.