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What Is Serotonin Syndrome? Causes, Symptoms, Complications And Treatments

Serotonin syndrome, also known as serotonin toxicity, is a life-threatening condition caused by too much serotonin in the body due to the use of serotonergic drugs.

The syndrome occurs when the serotonin-based medications are taken either for therapeutic purposes or overdosed intentionally or taken with some recreational drugs that have caused the drug interaction. [1] A multitude of drug combinations can also result in serotonin syndrome.

Serotonin, also known as or 5-hydroxytryptamine (5-HT), is a neurotransmitter that helps in the regulation of behaviour, memory and mood. It is used in many neurological and psychiatric conditions such as depression, aggressive behaviour, anxiety, phobia and bipolar disorders, as in these conditions, the serotonin levels are low and thus serotonin-based drugs help prevent and treat the condition to a large extent. [2]

Serotonin syndrome is known to cause symptoms ranging from mild to fatal, especially related to the brain and nervous system. Let's get to the details of the syndrome.

Causes Of Serotonin Syndrome

As aforementioned, serotonin syndrome mainly occurs as a result of drug interactions, therapeutic use or intentional overdose. The toxicity is induced by a variety of mechanisms.

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and paroxetine, mainly used for the treatment of depression, may impair uptake of serotonin and cause the condition. [3]

Other drugs that are also known to impair serotonin reuptake include tramadol, valproate, dextromethorphan and cyclobenzaprine. Some serotonin modulators like trazodone also do the same impairment, along with some herbs like St. John's wort and tricyclic antidepressants.

Tryptophan, an amino acid naturally found in certain foods like chicken, nuts, seeds and milk may also increase serotonin formation when consumed with certain serotonergic drugs. Cocaine and certain illicit drugs like MDMA (Ecstasy and Molly) also impair serotonin uptake.

Symptoms Of Serotonin Syndrome

The symptoms of serotonin syndrome often begin within 24 hours of the ingestion of serotonergic agents. Some of the mild symptoms include: [4]

  • Mild hypertension
  • Shivering
  • Tremor
  • Diaphoresis or excessive sweating
  • Myoclonus or quick involuntary muscle jerk
  • Hyperreflexia or overactive or over-responsive reflexes.
  • Diarrhoea
  • Vomiting
  • Muscle rigidity
  • Restlessness
  • Dry mouth

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Patients with moderate and severe symptoms experience:

  • Increased in body temperature
  • Mild agitation
  • Pressured speech
  • Increase in bowel sounds
  • Fast heartbeat
  • delirium

Complications Of Serotonin Syndrome

Untreated serotonin syndrome for a longer period can cause complications: [1]

  • Seizures
  • Kidney failure
  • Myoglobinuria
  • Acute respiratory distress syndrome
  • Intravascular blood clotting [5]
  • Metabolic acidosis
  • Coma
  • Death

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Diagnosis Of Serotonin Syndrome

The diagnosis of serotonin syndrome requires a range of tests to confirm the condition. The medical expert analyses the history of patients, whether he/she is on certain serotonergic drugs, that includes the history of illicit drugs, any psychiatric drugs or dietary supplements. The analysis is followed by physical examination and then certain tests to detect the condition of vital organs like the kidney.

Treatments And Management Of Serotonin Syndrome

If a person is found with the aforementioned symptoms related to ingestion of serotonergic drugs, they are provided with immediate supportive care to stabilise their symptoms, followed by mechanical ventilation to give oxygen, monitoring of heartbeat, administration of intravenous fluids and giving serotonin antagonists to reduce the effects of serotonergic agents. [6]

  • Mild cases: They are treated by discontinuing the serotonergic agents, followed by sedation with benzodiazepines and observing the patients for at least six hours.
  • Moderate cases: They are treated with serotonin antagonists with cardiac monitoring of the patient.
  • Severe cases: They are treated mainly in the intensive care unit (ICU) with intubation and additional sedation.

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To Conclude

Serotonin syndrome, if early diagnosed and treated, can be supportive for patients and save their lives. However, if the diagnosis remains unclear, the treatment may get delayed leading to life-threatening complications and even death.

Therefore, the best way is to discontinue any type of serotonergic agents and start providing supportive care, even if the diagnosis is not clear, as sometimes it is quite confusing for medical experts to detect who will develop the symptom and for what exact cause.

How do you manage serotonin syndrome?

The way for the management of mild cases of serotonin syndrome is by discontinuing the serotonergic drugs which are causing the syndrome. For moderate and severe cases, it is better to rush the patient to hospital for emergency treatment.

How quickly can you develop serotonin syndrome?

According to studies, serotonin syndrome can start within 24 hours, and may be as early as six hours depending on the cause of increased serotonin levels in the body and severity of the condition.

What disorders are caused by serotonin?

Low levels of serotonin causes conditions such as eating disorders, anxiety and a range of depressive symptoms, while excess accumulation of serotonin in the body results in serotonin syndrome causing life threatening symptoms like seizures, hypertension, coma and death.

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