Serotonin syndrome

Description

Serotonin syndrome is a severe drug reaction. It is caused by drugs that accumulate high levels of serotonin in the body.

Serotonin is a chemical that the body produces naturally. It is necessary for nerve cells and brain to function. But too much serotonin causes symptoms and signs that can vary from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can be fatal if not treated.

Serotonin acquiredome may occur when the dose is increased to certain medications or start taking a new medication. It is most often caused by the combination of medications that contain serotonin, such as a migraine headache medication and an antidepressant. Some illicit drugs and dietary supplements are associated with serotonin syndrome.

Milder forms of the serotonin syndrome may go away within a day or two of stopping medications that cause symptoms and, sometimes, after taking drugs that block serotonin.

Symptoms

Serotonin syndrome symptoms usu -ally occur within several hours of taking a new medication or increasing the dose of a medication you're already taking.

Signs and symptoms include:

  • Agitation or restlessness
  • Insomnia
  • The confusion
  • Acceleration of the heart rate and high blood pressure
  • Dilation of the pupils
  • The loss of muscle coordination or spasms of the muscles
  • High blood pressure
  • Stiffness of the muscles
  • Excessive sweating
  • Diarrhea
  • Headache
  • The tremor
  • Goosebumps

Severe serotonin syndrome can be life-threatening. The signs include:

  • High fever
  • Tremor
  • Seizures
  • Irregular heartbeat
  • Unconsciousness

When to see a doctor

If you suspect you might have serotonin syndrome after starting a new medication or increasing the dose of a medication you're already taking, call your health care provider immediately or go to the emergency room. If you have severe or rapidly worsening symptoms, seek emergency treatment immediately.

Causes

The excessive accumulation of serotonin in the body creates symptoms of serotonin syndrome.

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

Other nerve cells in the body, primarily in the intestines, they also produce serotonin. Serotonin plays a role in the regulation of the digestive process, blood flow and breathing.

Although it is possible that taking only one drug each timeit levels of serotonin can result in serotonin syndrome in some people, this condition occurs most often when people combine certain drugs.

For example, serotonin syndrome can occur if you take an antidepressant with a migraine medication. It can also happen if you take an antidepressant with an opioid pain medication.

Another cause of serotonin syndrome is intentional overdose of anti-depressant medications.

A number of over-the-counter and prescription drugs may be associated with serotonin syndrome, spicelly antidepressants. Illicit drugs and dietary supplements also may be associated with the disease.

Medications and supplements that could potentially cause serotonin syndrome include:

  • Selective serotonin reuptake inhibitors (Ssris), antidepressants as citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), escitalopram (Lexapro), paroxetine (Paxil, Pexeva, Brisdelle) and sertraline (Zoloft)
  • The serotonin and noradrenaline reuptake inhibitors (Snris), antidepressants, such as desvenlafaxine (Pristiq), levomilnacipran (Fetzima), milnacipran (Savella), duloxetine (Cymbalta, Drizalma Sprinkle) and venlafaxine (Effexor XR)
  • Bupropion (Zyban, Wellbutrin SR, Wellbutrin XL), an antidepressant and tobacco-addiction medication
  • Tricyclic antidepressants, as of amitriptyline and nortriptyline (Pamelor)
  • Monoamine oxidase inhibitors (Maoi) antidepressants such as isocarboxazid (Marplan) and phenelzine (Nardil)
  • Anti-migraine medications, such as carbamazepine (Tegretol, Carbatrol, others), valproic acid, and the journey totans, which include sumatriptan, naratriptan (Amerge) and sumatriptan (Imitrex, Tosymra, other)
  • Pain medications, such as opioid pain medications, such as codeine, fentanyl (Duragesic, Abstral, others), hydrocodone (Hysingla ER), meperidine (Demerol), oxycodone (Oxycontin, Roxicodone, others), and tramadol (Ultram, ConZip)
  • Lithium (Lithobid), a mood stabilizer
  • Illicit drugs, including LSD, ecstasy, cocaine, and amphetamines
  • Herbal supplements, including St. John's wort, ginseng and nutmeg
  • Over-the-counter cough and cold medicines that contain dextromethorphan (Delsym)
  • Anti-nausea medications such as granisetron (Sancusor, Sustol), metoclopramide (Reglan), droperidol (Inapsine), and ondansetron (Zofran)
  • Linezolid (Zyvox), an antibiotic
  • Ritonavir (Norvir), an anti-retroviral drug used to treat human immunodeficiency virus (HIV).

Risk factors

Some people are more likeland to be affected by medications and supplements that cause serotonin syndrome than others, but the condition can occur in any person.

You are at increased risk of serotonin syndrome if:

  • Recently it has begun to take or increase the dose of a medication known to increase the levels of serotonin
  • You take more of a medication known to increase the levels of serotonin
  • Take herbal supplements known to increase the levels of serotonin
  • Use the illicit nature of the drug known to increase the levels of serotonin

Complications

The serotonin syndrome in general does not cause any problem, after which serotonin levels are back to their original levels.

If left untreated, severe serotonin syndrome can lead to unconsciousness and death.

Prevention

Taking more of a serotonin-related medication or increasing the dose of serotonin related to the medication increases the risk of serotonin syndrome. Know what medications you take and share a complete list of your medications with your doctor or pharmacist.

Be sure to talk with your doctor if you or a family member has experienced symptoms after taking the drug.

Also talk with your doctor about the possible risks. Do not stop taking any medication on your own. If your doctor prescribes a new medication, make sure he or she knows about all other medicines you are taking, particularly if you receive prescriptions from more than one doctor.

If you and your doctor decide that the benefits of the combination of certain serotonin-level-affecting drugs outweigh the risks, be alert to the possibility of serotonin syndrome.

Serotonin syndrome

Diagnosis

There is No single test that confirms a serotonin syndrome diagnosis. Your doctor will diagnose the condition by ruling out other possibilities.

Your doctor will likely begin by asking questions about your symptoms, medical history and the medications you are taking. Your doctor will do a physical exam.

To make sure that your symptoms are caused by serotonin syndrome and it is not due to another cause, the doctor may use tests to:

  • To measure the levels of the medicines that you are using
  • Check if there are signs of infection
  • Check body functions that can be affected by the serotonin syndrome

A number of conditions that can cause symptoms similar to those of serotonin syndrome. Mild symptoms can be caused by various conditions. Moderate and severe symptoms similar to those of serotonin syndrome may be caused by:

  • A severe reaction to certain medications, such as some anesthetics, medications, antipsychotics, and other agents that are known to produce these severe reactions
  • An overdose of illicit drugs, medications, antidepressants, or other medications that increaseserotonin levels and
  • The damages associated with the use of illicit drugs
  • Severe alcohol withdrawal

Your doctor may order additional tests to rule out other causes of your symptoms. Tests may include:

  • Blood and urine tests
  • Chest X-ray
  • Computed tomography (CT scan)
  • Lumbar puncture (lumbar puncture)

Treatment

Treatment of the serotonin syndrome depends on the severity of your symptoms.

  • If your symptoms are mild, a visit to the doctor and the suspension of the medication causing the problem may be enough.
  • If you have symptoms that concern your doctor, you may need to go to the hospital. Your doctor may have you stay in the hospital for several hours to make sure that your symptoms improve.
  • If you have severe serotonin syndrome, you will need an intensive treatment in a hospital.

Dependedng on your symptoms, you may receive the following treatments:

  • Muscle relaxants. Benzodiazepines, such as diazepam (Valium, Diastat) or lorazepam (Ativan), can help control the agitation, seizures, and muscle stiffness.
  • The antagonists of serotonin. If other treatmentss are not working, serotonin antagonists such as medicine cyproheptadine can help. These drugs work by blocking certain serotonin receptors, decreased the activity that causes the symptoms.
  • The oxygen and intravenous (IV) fluids. The breathing of oxygen through a mask helps maintain the levels of oxygen in the blood and IV fluids are used to treat dehydration and fever.
  • Drugs that control heart rate and blood pressure.These may include esmolol (Brevibloc), or sodium nitroprusside (Nitropress) to reduce a high heart rate or high blood pressure. If your blood pressure is too low, the doctor may give you phenylephrine (Vazculep) or epinephrine (Adrenalin, Epipen, etc.).
  • A breathing tube and machine and medication to paralyze the muscles. You may need this treatment if you have a high fever.

Drugs that control heart rate and blood pressure. These may include esmolol (Brevibloc), or sodium nitroprusside (Nitropress) to reduce a high heart rate or high blood pressure.

If your blood pressure is too low, the doctor may give you phenylephrine (Vazculep) or epinephrine (Adrenalin, Epipen, etc.).

The milder forms of serotonin syndrome usually resolve within 24 to 72 hours after you stop taking the medications that increase serotonin. You may need to take medications to block the effects of serotonin alreadyon your system.

However, the symptoms of serotonin syndrome caused by some antidepressants may take several weeks to disappear completely. These drugs remain in your system for a longer time than other drugs that may cause serotonin syndrome.

The preparation of for of your appointment

Because the serotonin syndrome can be a life-threatening condition, seek emergency treatment if you have worsening or severe symptoms.

If your symptoms are not severe, you will likely start by seeing your family doctor or a general practitioner. Here's some information to help you prepare for your appointment and know what to expect from your doctor.

What you can do

  • Be aware of the pre-appointment steps you need to take. When you make your appointment, be sure to ask if there is anything that you need to do in advance, such as letting any of the current medicines or supplements you take.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a note of the key of per -sonal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking.
  • Have a family member or friend along, if possible. Sometimes it can be difficult to absorb all of the informationabout provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their doctor.

Prepare a list of questions will help you make the most of your time with your doctor. For symptoms you think may be caused by serotonin syndrome, some basic questions to ask your doctor include:

  • It is the serotonin syndrome, most likely causing my symptoms, or it could be something more?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What kinds of tests do I need?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • I can take the drugs I have been prescribed, or do I have to change or change the dose?
  • Are there any restrictions I need to follow, such as avoiding certain medications or supplements?

Don't hesitate to ask any questions you may have.

What to expect from your doctor

Your doctor is likely to ask a series of questions, such as:

  • When did you begin experiencing symptoms?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What prescription medications and over-the-counter medicines that you take?
  • To do that, orare illicit drugs?
  • Do you take dietary supplements?
Symptoms and treatment of Serotonin syndrome