DIFFERENTIAL DIAGNOSIS The differential diagnosis of serotonin syndrome includes neuroleptic malignant syndrome (NMS), anticholinergic toxicity, malignant hyperthermia, intoxication from sympathomimetic agents, sedative-hypnotic (eg, alcohol, benzodiazepine, clonidine, baclofen) withdrawal, thyroid storm, acute ...
Serotonin syndrome is a toxic state caused mainly by excess serotonin within the central nervous system. It results in a variety of mental, autonomic and neuromuscular changes, which can range in severity from mild to life-threatening. Most cases are self-limiting.
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.
Serotonin syndrome occurs when someone has an excess of the neurotransmitter serotonin in their nervous system. The condition's symptoms generally fall into three categories: Altered mental status (irritability, agitation, restlessness, and anxiety)
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.
If you are experiencing serotonin syndrome, you may notice some of these symptoms: Dilated pupils. Agitation or restlessness. Confusion.
Notably, it is normal for nontoxic increases in serotonin to cause anxiety, restlessness, and irritability for 1 to 2 weeks after starting a drug or increasing a dose.
Signs and symptoms include agitation, anxiety, restlessness, disorientation, diaphoresis, hyperthermia, tachycardia, nausea, vomiting, tremor, muscle rigidity, hyperreflexia, myoclonus, dilated pupils, ocular clonus, dry mucous membranes, flushed skin, increased bowel sounds, and a bilateral Babinski sign.
Serotonin Syndrome Symptoms
Gastrointestinal symptoms include diarrhea and vomiting. Nervous system symptoms include overactive reflexes and muscle spasms, said Su. Other serotonin syndrome symptoms include high body temperature, sweating, shivering, clumsiness, tremors, and confusion and other mental changes.
Anyone who takes certain prescription medications, over-the-counter drugs, herbal or dietary supplements and illegal drugs that affect their body's serotonin levels could be at risk for serotonin syndrome. It happens to people of any age.
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 is a chemical in the brain that can affect mood. Eating foods that contain the essential amino acid known as tryptophan can help the body to produce more serotonin. Foods, including salmon, eggs, spinach, and seeds are among those that help boost serotonin naturally.
Severe cases may result in complications, such as seizures, rhabdomyolysis, myoglobinuria, metabolic acidosis, renal failure, acute respiratory distress syndrome, respiratory failure, diffuse intravascular clotting, coma, and death.
In their review in The New England Journal of Medicine, Dr. Boyer and Dr. Shannon cited a report based on calls to poison control centers around the country in 2002 showing 7,349 cases of serotonin toxicity and 93 deaths. (In 2005, the last year for which statistics are available, 118 deaths were reported.)
Serotonin has been linked to fatigue because of its well known effects on sleep, lethargy and drowsiness and loss of motivation.
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 elevation of serotonin levels causes mild serotonin toxicity and manifest as hyperreflexia, inducible clonus, tremors, anxiety, and restlessness. We hypothesize that mild SS may remain unnoticed for a longer duration and will manifest as insidious onset nonspecific symptoms.
The first report of a clinical picture consistent with what nowadays is termed SS was in 1960,4 which described the coadministration of L-tryptophan (the substrate of the rate-limiting enzyme, tryptophan hydroxylase [TPH], in the biochemical synthesis of serotonin) with a monoamine oxidase inhibitor (MAOI) inducing ...
Serotonin controls your mood and is responsible for happiness. It helps regulate when you sleep and wake, helps you think, maintains your mood, and controls your sexual desire.
Brain zaps are sensory disturbances that feel like electrical shock sensations in the brain. A person may also notice a brief buzzing sound and feel faint or black out momentarily. Brain zaps can happen when a person decreases or stops using certain medications, particularly antidepressants.
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.
If a patient notifies you of spontaneous clonus (involuntary muscle contractions) or new tremor and hyperreflexia (feeling twitchy), this is often a strong indication of serotonin syndrome and immediate referral to emergency services is recommended.