Nightmares Both Real and Imagined

    I started school at the small private school again in September and continued making up for the lost time spent in hospitals. I returned to see my sleep specialist with the complaint that although my sleep quality has improved somewhat I am still waking up so late (12-2pm) that I missed half of summer camp. Not to mention it's hard to make any plans when you start school at 2 pm and end at 7. He put me on a new medication called Tryptophan which is a naturally produced chemical like Melatonin. I didn't find it particularly effective and so we kept raising the dosage. Eventually something did happen but it was far different than what we were hoping for. I started having very strange nightmares, far more visceral than anything i'd experienced before. The one I remember is me being in a basement at the bottom of a staircase. I felt the urgent need to get up the stairs; perhaps something was chasing me. I tried to begin ascending the staircase but when I tried to move it felt like the force of gravity had increased one-hundred fold, pushing me towards the ground. My vision took on a dark green hue and was shaking as if there was an earthquake. As all this happened there was a high pitched ringing in my ears and when I tried to crawl up the stairs I woke up drenched in sweat. It was then I remembered I had an exam later that day.

   The nightmare was pretty disturbing and left me feeling tired but I had enough physical problems to deal with to let emotional ones stop me from going to school and taking my exam. As I prepared to begin writing it I started feeling quite ill. My stomach was hurting and I had a feeling of malaise and feverishness. I was still able to think clearly and knew the material quite well ( I had worked my ass off studying the past week) and so began writing as if nothing was wrong. Over time my stomach continued to worsen, cramping awfully. I began to sweat but forced myself to keep writing. I suddenly urgently needed to go to the bathroom and so stopped writing to do so. It was horrible, and had by this point developed into the worst stomach ache of my entire life, diarrhea galore. I almost couldn't breath because of the cramping but went back to continue writing. Then I had to run to the bathroom again and this cycle of writing a page then running back and forth repeated many times. I was obviously very embarrassed especially when the staff had to come and ask if I was O.K. Eventually though, I finished the exam and rushed home right away. I think I asked a parent to pick me up because I was at that point extremely concerned.

     With my stomach temporarily cleared I was able to go to out for dinner with the family but this is when I began feeling irritable, which caused me confusion. Sure I had been irritable before like anyone else but it was always for a clear specific reason. I thought of anything else that was out of the ordinary which could be related and remembered the new medications along with my nightmare. I googled my symptoms along with my new and old medications and lo and behold, many results for something called Serotonin Syndrome appeared. This syndrome had occurred as a consequence of my Mirtazapine medication interacting with the tryptophan.  I had never heard of it before but quickly learned:"Serotonin Syndrome is a potential Symptom of any number of life-threatening drug interactions which may follow therapeutic drug use, combination, or overdose of particular drugs."
Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma
 Autonomic Effects: shivering, sweating, hyperthermia, vasoconstriction, tachycardia, nausea, diarrhea. Somatic Effects: Myoclonus (muscle twitching) hyperreflexia (manifested by clonus), tremor." The progression of this typically starts with a feeling of illness followed by a severe stomach ache and then mental changes like agitation. At this point people mentally deteriorate very quickly, causing victims to essentially go mad until they potentially die. Thankfully I only got to the point where I started feeling irritability. To top it all off I found many people who went through their own episode of Serotonin Syndrome mention their own strange nightmares. The life threatening part was more than a little concerning so I got in contact with my sleep doctor who confirmed my suspicions as correct and of course advised to discontinue both medications immediately. I went back on Mirtazapine later but didn't touch Tryptophan ever again. Googling your own symptoms on the internet will end badly the vast majority of the time but this time thinking to do it may very well have saved my own life. At least it turned out with me getting 90-something on an exam I did while suffering a life threatening drug reaction. It just goes to show how awful I would have to feel to give up on something. If I ran away every time I felt like shit I wouldn't get anything done. Unfortunately it appears once in a while such perseverance can be dangerous...