Dextromethorphan (DXM) & SSRIs
Dextromethorphan (DXM) is a medication that primarily works as a cough suppressant. But for recreational purposes, it is used due to its dissociating effect. The exact mechanism of DXM's action is not completely understood, but it is believed to involve multiple mechanisms within the body.
One of the primary ways DXM works is by acting as an antagonist at the NMDA (N-Methyl-D-Aspartate) receptors in the brain. NMDA receptors are involved in the transmission of pain signals and cough reflexes. By blocking these receptors, DXM helps to reduce the cough reflex, leading to cough suppression.
By obstructing NMDA receptors, DXM interferes with excitatory signaling within the central nervous system. This mode of action is comparable to that of Кetamine. Rather than directly antagonizing NMDA receptors itself, dextromethorphan functions as a prodrug, converting into its more potent metabolite, dextrorphan, which actually mediates the dissociative effects.
Additionally, DXM can also affect other receptors in the brain, such as sigma-1 receptors, alpha-3 beta-4 nicotinic receptors, and serotonin receptors. In the case of the latter, the DXM functions as a nonselective serotonin reuptake inhibitor.
Furthermore, DXM raises the levels of adrenocorticotropic hormone (ACTH) and corticosterone in the blood plasma. Despite being derived from morphine, DXM does not function as a potent μ-opioid agonist like for example codeine.
SSRIs (Selective Serotonin Reuptake Inhibitors) are a class of medications commonly used to treat conditions like depression, anxiety disorders, and certain other mental health conditions. SSRIs work by affecting the levels of serotonin in the brain.
Serotonin is released by one nerve cell and travels to another, where it binds to specific receptors, transmitting signals between nerve cells. After transmitting the signal, serotonin is reabsorbed by the first nerve cell through a process called reuptake.
SSRIs work by blocking the reuptake of serotonin, which increases the amount of serotonin available in the spaces between nerve cells (synaptic clefts). This allows for enhanced serotonin signaling and communication between nerve cells.
By increasing serotonin levels, SSRIs help to regulate mood and alleviate symptoms associated with depression and anxiety disorders. It may take several weeks of consistent SSRI use to experience the full therapeutic benefits. Examples of SSRIs include:
- Fluoxetine (Prozac): It is used to treat major depressive disorder, obsessive-compulsive disorder (OCD), panic disorder, and bulimia nervosa.
- Sertraline (Zoloft): It is used to treat major depressive disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD).
- Escitalopram (Lexapro): It is used to treat major depressive disorder and generalized anxiety disorder.
- Paroxetine (Paxil): It is used to treat major depressive disorder, panic disorder, generalized anxiety disorder, and social anxiety disorder.
The interaction between DXM and SSRIs occurs primarily due to their effects on serotonin levels. Both substances increase serotonin levels and this allows us to expect increased development risks for a dangerous condition called serotonin syndrome. This occurs when there is an excessive accumulation of serotonin in the body, leading to symptoms such as:
- Confusion
- Agitation or restlessness
- Increased heart rate
- High blood pressure
- Dilated pupils
- Loss of muscle coordination or twitching
- Muscle rigidity
- Heavy sweating
- Diarrhea
- Headache
- Shivering
- Goosebumps
- In severe cases, serotonin syndrome can be life-threatening and may cause complications such as seizures, irregular heartbeat, and unconsciousness
Given the complex and not fully studied effects of both components of this combination, other side effects can be expected.
If you are taking SSRIs as indicated by doctors in the form of a course of treatment, it is worth completing the course and waiting for a pause of 2-3 weeks before paying attention to the recreational use of DXM.
All things considered, we recommend avoiding this combination under any conditions.
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