Serotonin Syndrome - Symptoms, causes and treatment

Serotonin syndrome is a condition when there is too much serotonin in the body. This condition occurs when a person takes drugs that can increase serotonin levels.

Serotonin is a naturally occurring chemical compound produced by the nervous system. These compounds are needed in regulating blood flow, body temperature, digestive system, and respiratory system. Serotonin also plays a role in maintaining the function of nerve cells and brain cells. However, too much serotonin can trigger a number of symptoms, which can be fatal if left untreated.

Serotonin Syndrome Causes and Risk Factors

Serotonin syndrome is caused by excessive levels of serotonin in the body. This condition occurs when a person takes drugs that can increase serotonin levels. The risk of developing serotonin syndrome will be greater if a person takes two or more drugs at the same time.

There are many types of drugs that can increase serotonin levels, including:

  • drugs to treat depression, as fluoxetine, venlafaxine, and amitriptyline.
  • pain reliever medicine, among others codeine, fentanyl, oxycodone, and tramadol.
  • medication for bipolar disorder, for example lithium.
  • medicine for HIV/AIDS, among others nevirapine and efavirenz.
  • medicine for vomiting, for example granisetron, metoclopramide, and ondansentron.
  • Cough medicine, especially those containing dextromethorphan.
  • Medication for headaches or migraines, for example sumatriptan.
  • drugs, including amphetamines, ecstasy, cocaine, and LSD.
  • herbal supplements, like ginseng.

Although serotonin syndrome can affect anyone, this condition is more susceptible to experienced by people who are just starting to take, or increase the dose of drugs that can increase serotonin levels.

SymptomSerotonin Syndrome

Symptoms of serotonin syndrome appear several hours after the drug is taken or the dose is increased. Some of the symptoms that appear include:

  • Confused
  • Nervous
  • Body shaking
  • Heart beat
  • Headache
  • Nauseous
  • Excessive sweating
  • muscle stiffness
  • Hallucinations (sensation when something feels real, but is only in the mind)
  • Diarrhea
  • Excessive body reflex

Immediately see a doctor, if the symptoms that appear are severe and worsen rapidly. Medical help should be given immediately if after taking the drug symptoms appear high fever, seizures, and decreased consciousness.

Serotonin Syndrome Diagnosis

Doctors can suspect a patient has serotonin syndrome if there are a number of the symptoms described previously. However, to be sure, the doctor will ask the patient's medical history, including the drugs and supplements that are consumed.

After knowing the patient's symptoms and medical history, the doctor will make a diagnosis of serotonin syndrome, if there are any of the following signs:

  • Clonus. Clonus is a muscle contraction that occurs involuntarily and triggers an uncontrollable movement. Clonus may occur in the eyes, accompanied by restlessness or cold sweats.
  • Tremor. Tremors or shaking are uncontrollable body movements.
  • hyperreflexia. Hyperreflexia is an exaggerated nervous system reaction when receiving stimuli.
  • Hypertonia. Hypertonia is a condition characterized by increased muscle tension and decreased ability of the muscles to stretch.

Serotonin Syndrome Treatment

Treatment of serotonin syndrome depends on the severity of the symptoms experienced. If the symptoms are mild, the doctor will only consider changing the drug, lowering the dose, or stopping the use of the drug that causes serotonin syndrome. Meanwhile, if the symptoms are severe enough, the patient needs to be hospitalized.

In addition to reviewing drugs that can cause serotonin syndrome, your doctor may prescribe several medications to treat serotonin syndrome, including:

  • Muscle relaxants. Medications to relieve seizures, for example diazepam or lorazepam.
  • Blood pressure control drugs. If the patient's blood pressure becomes too low, the doctor will give epinephrine.
  • Serotonin production inhibitors. Serotonin production inhibitors, such as cyproheptadine, used when other types of drugs are not able to relieve symptoms.

In addition to drug administration, supporting treatment can be done by giving additional oxygen and infusion to replace body fluids. Giving additional oxygen through a tube or oxygen mask is done to maintain oxygen levels in the blood. While fluid infusion is done to replace fluids lost due to dehydration and fever. In severe conditions, instead of oxygen alone, the patient may require a breathing machine.

Symptoms of mild serotonin syndrome may go away within 1 to 3 days, after stopping taking drugs that increase serotonin levels. However, symptoms triggered by taking medication for depression can take several weeks to go away completely. This is because the effects of these drugs in the body last longer, compared to other drugs that can also increase serotonin levels.

Serotonin Syndrome Prevention

To prevent serotonin syndrome, talk to your doctor about the risks that may arise from the medications you are taking. Do not stop taking the drug without first consulting your doctor.

If the doctor judges the benefits of the drug to be greater than the side effects that may arise, use the drug with caution and make regular visits to the doctor.