Serotonin Syndrome: 7 Things You Need to Know

Serotonin syndrome is a dangerous reaction to antidepressant drugs. Find out what its warning signs are.

By Everyday Health StaffMedically Reviewed by Sanjai Sinha, MD

Reviewed: January 15, 2014

Medically Reviewed

Serotonin Syndrome

Serotonin is a neurotransmitter (a naturally occurring brain chemical) that helps regulate mood and behavior, and increasing serotonin is one way of treating depression.

But if you’re taking antidepressant medication that increases serotonin too much, you could be at risk for a dangerous drug reaction called serotonin syndrome.

“Serotonin syndrome usually happens when a doctor prescribes a drug that increases serotonin to a patient already on an antidepressant,” said Mark Su, MD, assistant professor of emergency medicine at Hofstra University and director of the Toxicology Fellowship at North Shore University Hospital in Manhasset, N. Y.

Drugs for Depression Increase Serotonin

Early reports of serotonin overload occurred in the 1950s with antidepressants called monoamine oxidase inhibitors (MAOIs). When new drugs called selective serotonin reuptake inhibitors (SSRIs) became widely used to fight depression, reports of serotonin syndrome increased.

SSRIs include Prozac and Paxil. Other antidepressant drugs that increase serotonin are called serotonin-norepinephrine reuptake inhibitors (SNRIs), which include Cymbalta and Effexor.

Drugs That Cause Serotonin Overload

“A single antidepressant can cause serotonin syndrome if a patient overdoses on the drug. Another cause is starting a new antidepressant before an old antidepressant has been completely washed out of the body,” said Dr. Su.

“But the most common cause is adding on another type of drug. This can happen if a patient doesn’t let a doctor know they are on an antidepressant or if a doctor is not aware of the danger. ” Some common add-on drugs that could lead to serotonin overload are the pain medication meperidine (better known by the brand name Demerol), the cough medication dextromethorphan, drugs called triptans used for migraine, and the recreational drug ecstasy.

Serotonin Syndrome Symptoms

Serotonin syndrome can cause a wide spectrum of symptoms due to overstimulation. Gastrointestinal symptoms include diarrhea and vomiting. Nervous system symptoms include overactive reflexes and muscle spasms, said Su.

Other serotonin syndrome symptoms include high body temperature, sweating, shivering, clumsiness, tremors, and confusion and other mental changes.

Symptoms of serotonin syndrome can range from mild to life threatening. In extreme cases, body temperature can become very high, muscles may break down, and a person may go into shock.

Serotonin Syndrome Facts

A 2013 review of serotonin syndrome published in the journal AACN Advanced Critical Care noted that the Toxic Exposure Surveillance System identified 26,733 cases of serotonin syndrome in 2002. Of those cases, 7,349 were considered moderate or severe, and 93 resulted in death.

Just two years later, there were 48,204 cases, 8,187 moderate or severe cases, and 103 deaths. The key to successful treatment is early recognition.

Diagnosing Serotonin Syndrome

“The best way to diagnose serotonin syndrome is by taking a history of drug exposure and symptoms of serotonin overload. Lab tests don’t help much, so doctors need to be aware of the signs and symptoms,” said Su.

According to the AACN Advanced Critical Care study, having a history of taking a serotonin-raising drug and having three of the major symptoms or signs of serotonin syndrome are enough to make the diagnosis. Blood tests may be done to look for drugs that raise serotonin levels.

Serotonin Syndrome Treatment

Serotonin syndrome usually requires treatment in a hospital. The first step is to stop any drugs that raise serotonin.

You may need medication to control anxiety and relieve muscles spasms and possibly a drug that blocks serotonin production, cyproheptadine.

“Cyproheptadine is only available in oral form. Sometimes we need to crush it and give it through a nasogastric tube. Cooling baths may be used to bring down body temperature. Fluids, blood pressure, and breathing support may be needed for severe cases. Most patients are better within 48 hours,” said Su.

Preventing Serotonin Syndrome

The best way to prevent serotonin syndrome is to let all of your caregivers know about all of your medications before adding any new ones.

If you’re on any drug that increases your serotonin level, check with your doctor before taking even an over-the-counter medication or supplement.

Besides ecstasy, recreational drugs linked to serotonin syndrome include LSD and bath salts.

“Knowing the danger and knowing the symptoms should help you and your caregivers avoid a dangerous serotonin overload,” said Su.

Serotonin Syndrome: Symptoms, Causes, Diagnosis, Treatment

Written by Mary Anne Dunkin

• What Is Serotonin Syndrome?
• Serotonin Syndrome Symptoms
• Serotonin Syndrome Causes and Risk Factors
• Serotonin Syndrome Complications
• Serotonin Syndrome Diagnosis
• Serotonin Syndrome Treatment
• Serotonin Syndrome Prevention
• More

Serotonin syndrome is when your body has too much of a chemical called serotonin, usually because of a medication or combinations of medications.

Your body makes serotonin to help your brain cells and other nervous system cells communicate with each other. Researchers think a lack of serotonin in your brain may play a role in depression. But too much of it can lead to extreme nerve cell activity and dangerous symptoms.

Serotonin syndrome symptoms often begin hours after you take a new medication that affects your serotonin levels or after you raise your dose of a current drug. Symptoms may include:

• Confusion
• Agitation or restlessness
• Dilated pupils
• Headache
• Changes in blood pressure and/or temperature
• Nausea
• Vomiting
• Diarrhea
• Rapid heart rate
• Tremor
• Loss of muscle control or twitching muscles
• Shivering and goosebumps
• Heavy sweating

In severe cases, serotonin syndrome can be life-threatening. Call 911 or go to the emergency room if you have any of these symptoms:

• High fever
• Seizures
• Uneven heartbeat
• Passing out

Medications usually cause serotonin syndrome, especially certain antidepressants. You might be at higher risk if you take two or more drugs and/or supplements that affect your serotonin levels.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressants. They work by raising your serotonin levels. These drugs include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Other prescription and over-the-counter drugs that can raise serotonin levels, either alone or when you take them together, include:

• Serotonin and norepinephrine reuptake inhibitors (SNRIs), a class of antidepressants including desvenlafaxine (Khedezla), desvenlafaxine succinate (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), and venlafaxine (Effexor)
• Monoamine oxidase inhibitors (MAOIs), a class of antidepressants including isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and transdermal selegiline (EMSAM)
• Buspirone (BuSpar), a drug used to treat anxiety disorders
• Trazodone (Desyrel), a drug that treats depression or insomnia
• Migraine treatments such as almotriptan (Axert), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
• Certain pain medications, especially opioids and related medications including fentanyl (Sublimaze, Fentora), fentanyl citrate (Actiq), meperidine (Demerol), pentazocine (Talwin), and tramadol (Ultram)
• Dextromethorphan, a cough suppressant in many over-the-counter and prescription cough medicines or cold medicines
• Certain medications for nausea, such as granisetron (Kytril), metoclopramide (Reglan), and ondansetron (Zofran)
• Antidepressants that affect multiple serotonin receptors, such as vilazodone (Viibryd) and vortioxetine (Trintellix)

Some recreational drugs, such as LSD and cocaine, and dietary supplements, including St. John’s wort and ginseng, can also cause serotonin syndrome when you take them with these antidepressants.

The FDA has asked drugmakers to add warning labels about the risk of serotonin syndrome. If you have questions about a medication, check the label or ask your doctor. Don’t stop taking any medication before talking to your doctor.

Without treatment, serotonin syndrome can cause seizures, kidney failure, trouble breathing, coma, and death.

No single test can tell your doctor that you have serotonin syndrome. Instead, they’ll ask about your medical history — including your use of medications, supplements, and recreational drugs — and do a physical exam. They may order lab tests to rule out other health conditions that can look like serotonin syndrome, such as tetanus, sepsis, encephalitis, or heatstroke.

You’ll probably need to stay in the hospital so your doctor can treat your symptoms and monitor your recovery.

Removing the drug that caused your serotonin syndrome is crucial. You’ll probably feel better within a day of stopping the medication, although some drugs can take longer to leave your system. You might also need to get fluids through a vein (intravenous, or IV).

In severe cases, you might take a medication called cyproheptadine (Periactin) to keep your body from making serotonin.

Be sure your doctor knows about all the medications and supplements you take and any reactions you have, especially if you get prescriptions from more than one place.

If you use more than one drug that affects your serotonin levels, know the symptoms of serotonin syndrome so you can watch for them.

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Serotonin syndrome – symptoms, signs, examinations, who treats

Serotonin syndrome – symptoms, signs, examinations, who treats

Serotonin syndrome is a serious drug reaction. It is caused by drugs that increase the level of serotonin in the body. Serotonin is a chemical that the body naturally produces. It is necessary for the functioning of nerve cells and the brain. But too much causes symptoms that can range from mild to severe. Severe serotonin syndrome can lead to death if left untreated. Serotonin syndrome can occur when you increase the dose of certain drugs or take a new drug. Most often, it occurs when a combination of products containing serotonin, such as migraine medications and antidepressants. Some illegal drugs and nutritional supplements have been associated with serotonin syndrome. Milder forms of serotonin syndrome may resolve within 1 to 2 days after stopping the medication that causes symptoms, and sometimes even after taking drugs that block serotonin.

Contents

Symptoms of serotonin syndrome

Symptoms of serotonin syndrome usually appear within a few hours after taking a new drug or increasing the dose of an already taken drug. Signs of serotonin syndrome include:

• Excitement or restlessness
• Insomnia
• Palpitations and high blood pressure
• Dilated pupils
• Loss of muscle coordination or muscle twitching
• Muscle stiffness
• Heavy perspiration
• Diarrhea
• Headache
• Trembling
• Goosebumps.

Features include:

• High temperature
• Tremor
• Convulsions
• Irregular heartbeat
• Loss of consciousness.

Which doctor diagnoses and treats serotonin syndrome

If you suspect serotonin syndrome after starting a new drug or increasing your dosage, contact your doctor immediately. If there are severe or rapidly worsening symptoms, seek emergency care immediately.

Causes of serotonin syndrome

Excessive accumulation of serotonin in the body creates the symptoms of serotonin syndrome.

Nerve cells in the brain and spinal cord produce serotonin, which helps regulate attention, behavior and body temperature.

Other nerve cells in the body, primarily in the gut, also produce serotonin. It plays a role in regulating the process of digestion, circulation and respiration.

Although it is possible that taking only one drug that increases serotonin levels can cause serotonin syndrome in some patients, the condition most commonly occurs when certain drugs are combined.

For example, serotonin syndrome can occur when taking antidepressants with a migraine medicine or an opioid pain medicine.

Another cause of serotonin syndrome is a deliberate overdose of antidepressants.

A number of OTC and prescription drugs may be associated with serotonin syndrome, especially antidepressants. Illicit drugs and dietary supplements may also be associated with this condition.

Drugs and supplements that have the potential to cause serotonin syndrome include:

• Selective serotonin reuptake inhibitors, antidepressants such as citalopram, fluoxetine, fluvoxamine, escitalopram, paroxetine and sertraline
• Serotonin and norepinephrine reuptake inhibitors, antidepressants such as desvenlafaxine, levomilnacipran, milnacipran, duloxetine and venlafaxine
• Bupropion, antidepressant and anti-tobacco drug
• Tricyclic antidepressants such as amitriptyline and nortriptyline
• Monoamine oxidase inhibitors, antidepressants such as isocarboxazid and phenelzine
• Anti-migraine drugs such as carbamazepine, valproic acid and triptans, including almotriptan, naratriptan and sumatriptan
• Pain medications such as opioids, including codeine, fentanyl, hydrocodone, meperidine, oxycodone and tramadol
• Lithium – mood stabilizer
• Illicit drugs, including LSD, ecstasy, cocaine and amphetamines
• Herbal supplements, including St. John’s wort, ginseng and nutmeg
• OTC cough and cold preparations containing dextromethorphan
• Anti-nausea drugs such as granisetron, metoclopramide, droperidol and ondansetron
• Linezolid – antibiotic
• Ritonavir, an antiretroviral drug used to treat HIV.

Risk factors

Some patients are more prone to exposure to drugs and supplements that cause serotonin syndrome than others, but anyone can experience the condition.

The risk of developing serotonin syndrome is increased if:

• Recently started or increased a drug known to increase serotonin levels
• Take more than 1 serotonin-increasing drug
• Take herbal supplements that increase serotonin levels
• Use illegal drugs that increase serotonin levels.

Severe serotonin syndrome can lead to unconsciousness and death.

Diagnosis of serotonin syndrome

No study can confirm the diagnosis of serotonin syndrome. The doctor will ask about your symptoms, medical history, any medications you are taking, and do a physical exam. To make sure your symptoms are due to serotonin syndrome and not something else, your doctor may do tests to:

• Measure the dosage of medications taken
• Check for signs of infection
• Check bodily functions that may be affected by serotonin syndrome.

A number of diseases can cause symptoms similar to those of serotonin syndrome. Minor symptoms can be caused by several diseases. Moderate to severe serotonin syndrome-like symptoms can be caused by:

• Serious reaction to certain drugs, such as anesthetics, antipsychotics and other drugs that cause such severe reactions
• Overdose of illicit drugs, antidepressants or other drugs that increase serotonin levels
• Damage related to illegal drug use
• Severe alcohol withdrawal.

Your doctor may order additional tests to rule out other causes of your symptoms. The survey includes:

• Blood and urine tests
• Chest x-ray
• Computed tomography
• Spinal tap.

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References:

1. Danilov, D.S. Antidepressants selective serotonin reuptake inhibitors: a 40-year history / D.S. Danilov // Neurology, neuropsychiatry, psychosomatics. – 2015. – V. 7, No. 1. – S. 6674.
2. Blood serum serotonin in patients with adaptation disorders with a predominance of depressive reactions / L.A. Levchuk, S.A. Ivanova, E.V.
3. Bokhan N. A., Ivanova S. A., Levchuk L. A. Serotonin system in the modulation of depressive and additive behavior // N. A. Bokhan, S. A. Ivanova, L. A. Levchuk. Tomsk: Ivan Fedorov Publishing House, 2013. 102 p.
4. Amon M. Prospects in the study of the pathogenesis and therapy of affective disorders: the role of serotonin and melatonin//Journal of Neurology and Psychiatry. S.S.Korsakov. 2007. – No. 11. – S. 77-83.
5. Gromova E. A. Serotonin and its role in the body / E.A. Gromova. M.: Medicine, 1966. – 183 p.

2021-02-19
2021-02-29

British scientists: depression is not associated with low levels of the “happy hormone” – serotonin

• Rachel Schraer
• Health and disinformation reporter

August 27, 2022

90 002 Subscribe to our newsletter “Context”: it will help you understand the events.

Image copyright, Getty Images

A new study by British scientists that found no connection between low levels of the “happiness hormone” serotonin and depression has become one of the most resonant in recent times.

The authors of this scientific paper have come to conclusions that call into question the treatment of depression as a mental disorder.

When Sarah was in her early 20s, she suffered the first major mental illness of her life. The doctors who prescribed her the medicine said it was like “insulin for diabetics”. The pills were meant to correct a chemical imbalance in her brain, and they took them for the rest of her life.

Sarah’s mother had type 1 diabetes, so she took the doctor’s orders seriously.

• British doctors are advised to prescribe antidepressants instead of painkillers for chronic pain
• How to improve your brain function? Eight Simple Tips

Sarah continued to take the pills even though they only made her worse, eventually hearing voices telling her to kill herself, after which she was given electroconvulsive therapy (ECT).

The doctors’ assertion that Sarah needed medicine, like a diabetic needed insulin, had no scientific basis. However, the conclusion that Sarah received from the doctors about a “chemical imbalance” in Sarah’s brain was not unusual.

“You feel betrayed by people you trusted,” she says.

Image caption,

Sarah and her mother

Many psychiatrists have long known that low serotonin levels do not play a major role in depression – this latest study is nothing new to them. However, the public outcry caused by the results of this scientific work tells us that for many it was a discovery.

True, some interpreted the results of the study in their own way and radically, deciding that antidepressants do not work in principle. Doctors fear that confused patients will abruptly stop taking their medications, in return for a withdrawal syndrome, or abstinence.

The UK’s National Institute for Health and Care Excellence (NICE) states that antidepressants should not be stopped abruptly unless there is a medical emergency. Slow dose reduction may minimize withdrawal symptoms.

Image caption,

Sarah has problems with mobility and speech after undergoing electroconvulsive therapy (ECT).

What did the results of the study show?

The authors reviewed 17 studies and found that serotonin levels in people with depression did not differ from those in people who did not suffer from this mental disorder.

These results suggest that antidepressants cannot cure depression by replenishing serotonin deficiency.

“Many people know that paracetamol helps with headaches,” says Michael Bloomfield. “But hardly anyone seriously thinks that headaches can be caused by a lack of this medicine.”

Do antidepressants work?

According to the results, the benefits of taking antidepressants are only slightly greater than those of placebo pills. Scientists debate how big this difference is.

Some patients report that taking antidepressants helps them manage their mental health problems and helps them manage their symptoms of depression on a daily basis.

Royal College of Psychiatrist professor Linda Gask says antidepressants are “something that makes a lot of people feel better quickly,” especially when it comes to crisis situations.

However, one of the paper’s authors, Professor Joanna Moncrieff, points out that most drug company studies are short-term – little is known about how taking psychotropic drugs affects people’s well-being in the long term.

Image copyright, Getty Images

Image caption,

British scientists have found that antidepressants are only marginally more beneficial than placebo pills.

In addition to the fact that antidepressants may not cure mental illness, some people experience serious side effects from taking antidepressants, including suicidal ideation, sexual dysfunction, emotional devastation, and insomnia, according to the National Institute for Health and Care Improvement.

The authors of the study say that these risks should be more clearly stated. Since last year, British doctors have advised patients to try psychological therapy before prescribing medication. mindfulness practices and meditation.

Image copyright, Getty Images

Image caption,

Doctors in the UK advise patients to exercise, try meditation or psychological therapy before resorting to psychotropic medications

What was the reaction to the study?

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Since the publication of this study, there has been a lot of talk about antidepressant treatment being “on a myth” and that it was all a conspiracy by the drug companies. In fact, the authors of this work did not study the effects of psychotropic drugs.

Serotonin plays a role in our mood, so adjusting its levels can help people feel happier, at least for a while, even if the level of this neurotransmitter was not abnormally low to begin with. Increasing the amount of serotonin can also contribute to the emergence of new neural connections.

Some believe that this study tells us that depression is not a mental illness, but a reaction to our environment.

“Of course, we are talking about both, – says one of the authors of the work, Dr. Mark Horowitz. – Your genetics affects the level of your resistance to stress.”

Zoya, who suffers from severe depression and psychosis, believes that simply renaming depression into “stress” that can be dealt with by solving all her social problems is an overly simplistic approach that overlooks people with really serious problems.

Psychoses in Zoya’s family are not uncommon, they are mainly associated with stressful situations, for example, lack of time before exams. According to Zoya, she managed to find drugs (including antidepressants) that changed her life. She believes that the risk of drug-induced side effects is worth avoiding the truly dire situations.