No single test can confirm a serotonin syndrome diagnosis. Your doctor will diagnose the condition by ruling out other possibilities. Your doctor will likely begin by asking about your symptoms, medical history and any medications you're taking. Your doctor will also conduct a physical examination.
Serotonin syndrome symptoms develop quickly after taking the precipitating medicine—60% of cases occur within six hours. But symptoms may gradually get worse, becoming dangerous or life-threatening if not treated.
The serotonin test measures the level of serotonin in the blood. Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. Preparation may vary depending on the specific test.
Cases of serotonin syndrome resulting in hospitalization or death are rare. Most cases do not require medication intervention, but can be managed by stopping the drug or decreasing the dose. Mild toxicity appears to be rare but is likely under-reported, unrecognized, or confused with other syndromes.
Serotonin syndrome (SS) is an under diagnosed and under reported condition. Mild SS is easily overlooked by physicians. Every patient with mild SS is a potential candidate for developing life-threatening severe SS because of inadvertent overdose or the addition of the second serotonergic drug.
Serotonin is a chemical that the body produces naturally. It's needed for the nerve cells and brain to function. But too much serotonin causes signs and symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can cause death if not treated.
Fortunately, there are generally no long-term or lasting complications of serotonin syndrome, though you should be conscious to avoid serotonin syndrome in the future. Talk to your doctor about prevention, especially if you are taking multiple medications that contain serotonin.
You might be at higher risk if you take two or more drugs and/or supplements that affect your serotonin levels. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressants. They work by raising your serotonin levels.
Serotonin syndrome happens when you have too much serotonin (a normal chemical) in your body. It's usually caused by taking drugs or medications that affect serotonin levels. Stopping the drug(s) or medication(s) causing serotonin syndrome is the main treatment.
Nonserotonergic antidepressants such as mirtazapine and bupropion are possible alternatives. Most tricyclic antidepressants (e.g., amitriptyline, desipramine and nortriptyline) are also less serotonergic than SSRIs, though clomipramine and imipramine are notable exceptions.
Serotonin syndrome often resolves within 24 hours of discontinuing the serotonergic agent and initiating care, but drugs with long half-lives or active metabolites may cause symptoms to persist [1]. Irreversible monoamine oxidase inhibitors (MAOIs) carry the greatest risk, and symptoms can persist for several days.
Most patients improve within 24 hours of stopping the precipitating drug and starting therapy. For mild serotonin syndrome, treatment involves discontinuing the offending agent and supportive therapy with intravenous fluids, correction of vital signs, and symptomatic treatment with a benzodiazepine.
Patients with some anxiety disorders, including social anxiety, have been found to have higher, not lower, levels of serotonin.
Researchers also found that the incidence of serotonin syndrome was 0 to 4 cases per 10,000 person-years of exposure to coprescription of triptans and SSRI or SNRI antidepressants.
While serotonin syndrome typically resolves quickly, it can persist in some cases. Experts have explained that some medications have longer-lasting effects, which can cause serotonin syndrome to last for a few days, or in some cases, weeks.
Selective loss of Purkinje cells has previously been described in neuroleptic malignant syndrome and heatstroke, conditions that are characterized by hyperthermia. This suggests that hyperthermia may be a causative factor of brain damage in serotonin syndrome.
Mild serotonin syndrome symptoms often includes the following: Shivering and tremors. Twitching or involuntary muscle movements. Excessive sweating. Dilated pupils.
They found that serotonin produced by these cells is a signal to other neurons in the circuit, leading to an increase in anxiety. Giving mice an SSRI has the same effect on this brain circuit as putting the animals in a fearful situation: Serotonin levels rise and anxiety-like behaviors increase.
The serotonin levels were measured by ELISA every hour at night (20:00-08:00 h) and every 4 h during the daytime (08:00-20:00 h). Ours results show that the maximum levels of serotonin in plasma were obtained at 09:00 and 22:00 and a minor peak at 01:00 h.
Serotonin plays several roles in your body, including influencing learning, memory, happiness as well as regulating body temperature, sleep, sexual behavior and hunger. Lack of enough serotonin is thought to play a role in depression, anxiety, mania and other health conditions.
Diffuse body pain may be an initial presentation of serotonin syndrome. Medications such as ondansetron used to symptomatically treat the nausea and vomiting that may accompany serotonin syndrome can actually exacerbate the condition.
Serotonin syndrome should not be treated at home with over-the-counter medications. The prescription antihistamine, cyproheptadine, works as an antidote for excessive serotonin, but other antihistamines, like Benadryl (diphenhydramine), work differently.
"A single antidepressant can cause serotonin syndrome if a patient overdoses on the drug. Another cause is starting a new antidepressant before an old antidepressant has been completely washed out of the body," said Dr. Su. "But the most common cause is adding on another type of drug.
Serotonin syndrome (SS) is a rare, potentially life-threatening adverse drug reaction. Selective serotonin reuptake inhibitors (SSRIs) are among a number of pharmaceuticals that all contribute to SS, but SS caused by SSRI monotherapy is rare.