Serotonin syndrome is a potentially fatal reaction sometimes seen in people who take medications that increase levels of the nervous system compound serotonin. Serotonin syndrome has been known to science for over forty years, but has only recently come into the public spotlight.
What is Serotonin?
Serotonin is a neurotransmitter produced by the body’s nerve cells. Neurotransmitters are chemical compounds needed to transmit information from one nerve cell to another. Low serotonin levels in brain tissue have been linked to clinical depression, and many antidepressants treat depression by increasing levels of serotonin.
Antidepressants and Serotonin Syndrome
Serotonin syndrome occurs when serotonin accumulates to dangerously high levels. The most common cause of serotonin syndrome is an interaction between two medications that increase serotonin. Street drugs such as ecstasy, cocaine and LSD can also cause serotonin syndrome.
Depression medication associated with serotonin syndrome includes SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors). Examples of SSRI antidepressants include: Celexa, Lexapro, Paxil, Prozac, and Zoloft. SNRIs include Effexor, Pristiq and Cymbalta.
Older generations of antidepressants, including tricycle antidepressants and MAOIs (monamine oxidase inhibitors) can also increase the risk of serotonin syndrome when combined with other serotonin increasing medication.
Migraine Medication and Other Medication
Triptan migraine medications also increase serotonin, and may cause serotonin syndrome when combined with antidepressants or other serotonin-increasing drugs. Triptan medication includes Amerge, Frova, Imitrex, Maxalt and Zomig, amongst others.
In addition, a number of other medications increase serotonin, including some antibiotics, cough medications, anti-nausea medication and painkillers. People taking antidepressants or migraine medications should check with their doctor before taking any new medication.
St. John’s Wort and Serotonin Syndrome
Medications aren’t the only risk factor for serotonin syndrome. Although generally safe, the dietary supplement St. John’s Wort can cause serotonin syndrome when combined with antidepressants. (St. John’s Wort is often used as a depression home remedy).
Serotonin Syndrome Symptoms
Serotonin syndrome symptoms develop at different rates depending on the individual and the type of medication taken. Some people develop serotonin syndrome symptoms within minutes of taking the medication that triggers the syndrome, while others only develop symptoms after several hours.
Possible symptoms of serotonin syndrome include:
- agitation
- ataxia (loss of coordination)
- confusion
- diarrhea
- fever
- hallucinations
- hyperactive reflexes
- hyperthermia (high body temperature)
- muscle spasms or rigidity
- nausea and / or vomiting
- rapid heart beat
- restlessness
- sudden changes in blood pressure
- sweating
- tremors.
A diagnosis of serotonin syndrome is only made when other possible causes are ruled out, and only if the patient takes medication that increases serotonin. While most cases of serotonin syndrome require the interaction of more than one medication, some people experience symptoms after taking only one type of medication.
Serotonin Syndrome Treatment
Without treatment, serotonin syndrome symptoms can worsen over time, resulting in death in some cases. Serotonin syndrome can cause severe muscle spasms that destroy muscle tissue, which in turn causes serious kidney damage as the byproducts of muscle tissue breakdown filter out of the bloodstream.
Treatment requires 24 hour hospitalization to monitor symptoms, and the cessation of any medications known to increase serotonin. Medication to reduce agitation and seizures may be administered, as may cyproheptadine, a medication that prevents serotonin production.
The FDA now requires producers of serotonin-influencing medication to provide warnings about serotonin syndrome on their products. The increase in serotonin syndrome cases in recent years may be due to increased use of antidepressants and triptan migraine medication.
Resources
U.S. National Library of Medicine. (Retrieved 19 September, 2009). Serotonin Syndrome
U.S. Pharmacist. (Retrieved 19 September, 2009). SSRIs and Serotonin Syndrome
Disclaimer: The information contained within this article is for informational purposes only, and is not intended to be a substitute in any way for care and treatment by a qualified health professional.
Michael McGrath - Michael McGrath began providing web content shortly after finishing his graduate degree in English at the University of Alberta. His broad ...
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