The drugs and supplements that could potentially cause serotonin syndrome include: Selective serotonin reuptake inhibitors (SSRIs), antidepressants such as citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), escitalopram (Lexapro), paroxetine (Paxil, Pexeva, Brisdelle) and sertraline (Zoloft)
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.
Signs that you are experiencing serotonin syndrome include: Mental status changes including anxiety, restlessness, delirium and disorientation. Neuromuscular problems including tremor, twitching, overactive reflexes, agitation and muscle rigidity.
Selective serotonin reuptake inhibitors (SSRIs): This class includes fluoxetine (Prozac®), citalopram (Celexa®), sertraline (Zoloft®), paroxetine (Paxil®) and escitalopram (Lexapro®). This drug class is the most common antidepressant class involved in serotonin syndrome due to its widespread use.
Treatment may include: Benzodiazepine medicines, such as diazepam (Valium) or lorazepam (Ativan) to decrease agitation, seizure-like movements, and muscle stiffness. Cyproheptadine (Periactin), a drug that blocks serotonin production. Intravenous (through the vein) fluids.
Mild serotonin syndrome may cause subtle symptoms, such as mild tremors, restlessness, or headaches. Signs of severe serotonin syndrome include rigid muscles, seizures, fever, and nausea or vomiting.
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 should be admitted and observed for 12 to 24 hours to prevent exacerbation.
Serotonin syndrome is diagnosed clinically and requires a thorough review of medications and a careful physical exam. Symptoms tend to develop rapidly after exposure to the precipitating drug: 30% within one hour, 60% within 6 hours, and nearly all patients with toxicity developing symptoms within 24 hours of exposure.
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.
The hallmark signs and symptoms of serotonin syndrome are anxiety and restlessness, diaphoresis, mydriasis, clonus, hyperrflexia, tachycardia and hypertension. Treatment is mainly supportive care and includes intravenous fluids, benzodiazepines titrated to symptom control and blood pressure control as needed.
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).
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.
Serotonin syndrome (SS) is an under diagnosed and under reported condition. Mild SS is easily overlooked by physicians.
Mild-to-moderate cases of SS usually resolve in one to three days after stopping the serotonergic drugs, whereas a severe patient presentation is a medical emergency and requires rapid and intensive supportive care.
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.
Because serotonin is produced primarily in the gastrointestinal tract, digestive problems like nausea and diarrhea are common. A person experiencing serotonin syndrome may also be confused, dizzy, or disoriented. In severe cases, an individual may develop hallucinations and seizures.
The length of serotonin syndrome depends on the severity of the case. Mild serotonin syndrome will resolve on its own within a few days as long as the medication causing the problems is stopped. More severe cases will require medical attention and may take a week or longer to resolve.
Chronic stress is known to affect serotonin (5HT) neurotransmission in the brain and to alter body temperature.
Certain drugs and substances such as caffeine, alcohol, nicotine, NutraSweet, antidepressants, and some cholesterol-lowering medications deplete serotonin and other neurotransmitter levels. Hormone changes cause low levels of serotonin and neurotransmitter imbalances.
Serotonin syndrome can manifest with findings that range from benign to fatal. About 7300 diagnosed cases of serotonin syndrome occur each year, and about 100 of these cases result in death.
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.
Preventing Serotonin Syndrome
The best way to prevent serotonin syndrome is to let all of your caregivers know about all of your medications before adding any new ones. If you're on any drug that increases your serotonin level, check with your doctor before taking even an over-the-counter medication or supplement.
Foods high in trans fats: Eating foods high in trans fats like potato chips, pizza, and fast food are linked to decreasing serotonin levels. These foods affect our mental health by causing inflammation that could prevent the production of Omega-3 fatty acids that improve brain function and mental health.
Can serotonin syndrome go away naturally? If someone stops taking the serotonin-releasing medication, symptoms from mild serotonin syndrome will go away on their own after 24-72 hours. People with mild symptoms should stay in touch with their healthcare providers but in general they don't need any other treatment.
It was previously reported that caffeine has the capability to reduce brain serotonin synthesis by inhibiting tryptophan hydroxylase, the rate-limiting enzyme for central serotonin biosynthesis (Lim et al., 2001), and/or to reduce brain serotonin/dopamine ratio by blocking adenosine α1 and α2 receptors within the CNS.