What’s Serotonin Syndrome?

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Serotonin syndrome is a serious and potentially life-threatening disorder caused when the body has abnormally high levels of serotonin, a chemical made in the brain. The condition is most commonly caused when people who are taking certain chemicals or medications that affect serotonin levels either increase their medication or concurrently take another medication that can raise levels. While proper serotonin levels are important, too many health risks and create serious medical risks.

Symptoms of serotonin syndrome usually appear soon after taking another drug or even a single drug that increases serotonin levels. They are hard to ignore and a person may become confused, the heart may appear to pound or actually race, muscles may twitch, or a person may experience a sense of inner restlessness and anxiety called akathisia. Other symptoms could include a severe headache and sweating. Some people feel cold and may shiver or get goosebumps.

If these symptoms are ignored and a person continues with abnormally high serotonin levels by taking multiple medications, they may develop fever and eventually have life-threatening seizures or arrhythmias. People may fall into unconsciousness. These symptoms require emergency medical treatment, while the symptoms in the previous paragraph would require you to contact a doctor immediately for advice on what to do.

Treatment for severe serotonin syndrome may involve hospitalization and a variety of medications that can calm the muscles. Some people require serotonin blocking agents, and in rare and very severe cases, it may be necessary to paralyze people as their serotonin levels drop. This is usually done under local anesthesia so that the person sleeps through much of this experience. Generally, these treatments combined with the gradual leveling of serotonin produce a recovery, although it may take a few weeks after a high-level serotonin crash to feel fully well.

Certain medications, especially when combined, are best used to cause this condition. These may include selective serotonin reuptake inhibitors (SSRIs) and select serotonin norepinephrine reuptake inhibitors (SNRIs). Another class of drugs that can create this problem are monoamine oxidase inhibitors (MAOIs), or alternatively lithium, a mood stabilizing drug, which can be associated with this syndrome, especially when combined with other drugs. Other medications that can increase your risk of serotonin syndrome include over-the-counter cough medicines, some pain relievers, and migraine medications. It should be remembered that the condition occurs more often when more than one of these drugs is combined.

The problem with this condition is that doctors may often need to combine drugs to increase serotonin. A person with bipolar disorder could easily take an SSRI and lithium. People taking MAOIs need to be extremely careful about the over-the-counter medicines they take. Physicians and patients should always weigh the risk against the benefit of combining more than one agent that can cause serotonin syndrome. Usually the benefits, especially when treating serious conditions such as mental illness, outweigh the risk of the syndrome, but patients should always be advised of what signs to look for if they increase the dose of a serotonin-boosting drug or add another drug that it will increase serotonin levels.

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