Serotonin syndrome: What you need to know

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Serotonin syndrome is usually caused by an excessive build-up of serotonin in the body due to the use of certain migraine medications in combination with antidepressants. This is a serious health condition that can even be fatal if not treated promptly.

1. What is Serotonin Syndrome?

Serotonin is a chemical messenger, called a neurotransmitter, that acts on blood vessels and pain control pathways in the brain. Some medications used to prevent headaches can affect the amount of serotonin in the body. Serotonin is also responsible for controlling mood, attention, sleep, and pain.
Nerve cells normally produce serotonin, which helps to regulate:
Digestion Blood Flow Body Temperature Breathing Serotonin also plays an important role in the normal functioning of nerve cells and the brain and is thought to have affect mood.
In essence, Serotonin is a chemical that your body produces on its own, it is necessary for your nerve cells and brain to function. But having too much serotonin causes signs and symptoms that can range from as mild as shivering and diarrhea, to as severe as muscle stiffness, fever, and seizures, and can be fatal if left untreated.
If you take different prescribed medicines together, you can lead to too much serotonin in the body. Medications that can lead to serotonin syndrome include those used to treat depression, migraines, and pain control.
Serotonin syndrome can also occur when you start using a new medication that interferes with serotonin. It can also occur if you increase the dose of the medication you are taking.

Serotonin syndrome can occur when you increase the dose of certain drugs or add a new drug to your regimen. Certain illicit drugs and supplements have also been linked to serotonin syndrome.
Milder forms of serotonin syndrome can go away within a day of stopping the medication causing the symptoms and sometimes serotonin blocking drugs are used.

2. Symptoms of Serotonin Syndrome

Serotonin syndrome symptoms usually occur within a few hours of taking a new medication or increasing the dose of one you are taking. Signs and symptoms include:
Agitation or restlessness Confusion Irritability Disorientation Anxiety Tachycardia and high blood pressure Dilated pupils Loss of muscle coordination or twitching Muscle stiffness Sweating profuse sweating Diarrhea Headache Shivering Goose bumps Nausea Vomiting Severe serotonin syndrome can be life threatening. Signs include:
High fever Convulsions Irregular heartbeat Coma

3. Causes of serotonin syndrome

Excessive accumulation of serotonin in your body will produce the symptoms of serotonin syndrome.
Under normal circumstances, nerve cells in your brain and spinal cord produce serotonin that helps regulate your attention, behavior, and body temperature.
Other nerve cells in the body also produce serotonin, mainly in the gut. Serotonin plays a role in regulating your digestion, blood flow, and breathing.
While it is possible that just one medication that increases serotonin levels can cause serotonin syndrome in susceptible individuals, it occurs most often when certain medications are used in combination.
Specifically, serotonin syndrome can occur if you take antidepressants with migraine medications. It can also happen if you take antidepressants with opioid pain relievers.
Another cause of serotonin syndrome is intentional overdose of antidepressants.

Certain over-the-counter and prescription medications may be associated with serotonin syndrome, especially antidepressants. Illegal drugs and supplements can also be linked to this condition.
Drugs and supplements that can cause serotonin syndrome include:
Selective serotonin reuptake inhibitors, antidepressants such as fluoxetine (Prozac, Sarafem), citalopram (Celexa), fluvoxamine, paroxetine (Paxil, Pexeva, Brisdelle) and sertraline (Zoloft). Serotonin and norepinephrine reuptake inhibitors, antidepressants such as duloxetine (Drizalma Sprinkle, Cymbalta) and venlafaxine (Effexor XR). Antidepressants and smoking cessation medications such as: Bupropion (Zyban, Wellbutrin SR, Wellbutrin XL). Tricyclic antidepressants, such as amitriptyline and nortriptyline (Pamelor). Monoamine oxidase inhibitors (MAOIs), antidepressants such as phenelzine (Nardil), and isocarboxazid (Marplan). Anti-migraine medications, such as carbamazepine (Tegretol, Carbatrol, others), valproic acid (Depakene), and triptans, including almotriptan, naratriptan (Amerge), and sumatriptan (Imitrex, Tosymra, others). Pain relievers like opioid painkillers include codeine, fentanyl (Duragesic, Abstral, others), hydrocodone (Hysingla ER, Zohydro ER), meperidine (Demerol), oxycodone (Oxycontin, Roxicodone, others), and tramadol ( Ultram, ConZip). Lithium (Lithobid) is a mood stabilizer. Illegal drugs, including LSD, ecstasy, cocaine, and amphetamines. Herbal supplements, including St. John's wort, ginseng and nutmeg. Over-the-counter cough and cold medicines containing dextromethorphan (Delsym) Anti-nausea medicines such as granisetron (Sancuso, Sustol), metoclopramide (Reglan), droperidol (Inapsine), and ondansetron (Zofran, Zuplenz). Linezolid (Zyvox) is an antibiotic. Ritonavir (Norvir) is an antiretroviral medicine used to treat HIV.

4. Risk factors for Serotonin syndrome

Some people are more sensitive to medications and supplements that cause serotonin syndrome than others, but this condition can happen to anyone.
You are more at risk of serotonin syndrome if:
You have recently started or increased your dose of a medication known to increase serotonin levels. You take many medications that are known to increase serotonin levels. You take herbal supplements known to increase serotonin levels. You take an illegal drug known to increase serotonin levels.

5. Complications of Serotonin Syndrome

Serotonin syndrome usually does not cause any problems when serotonin levels return to normal. But if left untreated, severe serotonin syndrome can lead to:
Convulsions Kidney failure Shortness of breath Coma Death

6. When to see a doctor?

If you suspect you may have serotonin syndrome after starting a new medication or increasing the dose of one you're taking, call your doctor right away or go to the emergency room.
If you have severe or rapidly worsening symptoms, you need immediate medical attention.

7. How is serotonin syndrome diagnosed?

There is no specific test for serotonin syndrome. Your doctor may start by taking a look at your medical history and symptoms. Tell your doctor if you are taking any medications or have used illegal drugs in recent weeks. This information can help your doctor make a more accurate diagnosis.
The doctor will usually perform several other tests. These will help your doctor check if certain organs or body functions are affected. The tests can also help your doctor rule out other conditions.
Some conditions have similar symptoms to serotonin syndrome such as: infections, drug overdoses and hormone problems. A condition called neuroleptic malignant syndrome has similar symptoms. It is an adverse reaction to drugs used to treat mental illnesses.
Tests that your doctor may ask you to do include:
Complete blood count (CBC) Blood chemistry to check: Checking thyroid function. Check the patient for drug use. Check kidney function. Check liver function.

8. What are the treatments for serotonin syndrome?

If you have very mild serotonin syndrome, your doctor may just advise you to immediately stop taking the medication that is causing the problem.
If you have severe symptoms, you need to go to the hospital. At the hospital, your doctor will closely monitor your condition. You can also get treatment with the following:
Stop taking any medicine that is causing the condition. Intravenous fluids to rehydrate as fever causes dehydration. Medicines to help relieve muscle stiffness or agitation. Anti-serotonin drugs.

9. Prevention of Serotonin Syndrome

Taking more than one serotonin-related drug or increasing the dose of a serotonin-related drug increases the risk of serotonin syndrome. Therefore, to prevent Serotonin syndrome, you can do the following:
Call your doctor if you or a family member experiences symptoms after taking the medicine. Do not self-medicate with any medication. If your doctor prescribes a new medication, make sure they know about all the other medications you're taking, especially if you get prescriptions from more than one doctor. If you and your doctor determine the benefit of combining certain medications that affect higher serotonin levels, be on the lookout for the possibility of serotonin syndrome. Using drugs exactly as prescribed and safely is an effective way to prevent serotonin syndrome, so each person needs to be aware of the use of drugs according to the doctor's instructions, do not arbitrarily buy drugs for treatment and result in poor results. fit them together. If you are worried about how to use medicine properly, you can go to the Pharmacy Department - Vinmec International General Hospital with a system of modern facilities, medical equipment, and the same team. With a team of experts, doctors and pharmacists with many years of experience in medical examination, consultation and treatment, patients can rest assured when listening to advice on drug use at the Hospital.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.

References: mayoclinic.org, webmd.com, healthline.com