Symptoms tend to appear quickly after exposure to a drug. Most people who experience toxicity will develop symptoms within 24 hours , with 30 percent of symptoms appearing within 1 hour and 60 percent within 6 hours. For this reason, it is essential to seek help immediately if anyone shows symptoms that could indicate serotonin syndrome. Typically, the condition occurs when you combine two or more medications, illegal drugs, or nutritional supplements that increase serotonin levels.
For example, you might take medication to help with a migraine after already taking an antidepressant. Some prescription medications, such as opioid pain relievers, may also increase serotonin levels, according to a case report. Certain illegal drugs are associated with serotonin syndrome. These include :. Certain over-the-counter cold and cough medications that contain dextromethorphan may increase the risk of serotonin syndrome, if you take them with other drugs.
Taking too much of a drug or combining two drugs that boost serotonin can sometimes trigger serotonin syndrome. If someone takes an antidepressant alongside MDMA, for example, they may be at risk of serotonin syndrome. Your doctor may begin by reviewing your medical history and symptoms.
This information can help your doctor make a more accurate diagnosis. Your doctor will usually perform several other tests. These will help your doctor find out if certain organs or body functions have been affected. They can also help your doctor rule out other conditions. A condition known as neuroleptic malignant syndrome also has similar symptoms.
If you have a very mild case of serotonin syndrome, your doctor may only advise you to immediately stop taking the medication causing the problem. At the hospital, your doctor will closely monitor your condition. These things seem harmless, right? Think again. These scenarios of mixing medications can cause something called serotonin syndrome, which can be life-threatening. Serotonin is a neurotransmitter. Depression is often associated with low levels of serotonin. Many treatments for depression help increase serotonin levels.
Other medications such as certain migraine medications, pain medications, cough suppressants, and even dietary supplements can also increase serotonin levels.
If you take a medication that increases serotonin, you may feel just fine. But, too much serotonin from a dose that is too high, or from taking two or more medicines that increase serotonin levels, can cause serotonin syndrome. Serotonin syndrome occurs when there is too much serotonin in your system. How do you get too much serotonin in your body? The following medications increase serotonin levels and can be involved in cases of serotonin syndrome.
Serotonin syndrome is even more likely to occur if you take a combination of two or more of these drugs. All of these factors must be considered to avoid harm to the patient. Facts about serotonin syndrome. Am J Emerg Med. Lerner BH. A case that shook medicine. Washington Post. November 28, Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. Serotonin a la carte: supplementation with the serotonin precursor 5-hydroxytryptophan.
Pharmacol Ther. Serotonin syndrome attributed to tramadol addition to paroxetine therapy. Int Clin Psychopharmacol. Manos G. Possible serotonin syndrome associated with buspirone added to fluoxetine. Ann Pharmacother. Linezolid and serotonin syndrome. Sumatriptan contraindications and the serotonin syndrome.
The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. Lane R, Baldwin D. Selective serotonin reuptake inhibitor-induced serotonin syndrome: review. J Clin Psychopharmacol.
Relative toxicity of selective serotonin reuptake inhibitors SSRIs in overdose. J Toxicol Clin Toxicol. Martin TG. Serotonin syndrome. Ann Emerg Med. Drug-induced serotonin syndrome: a review. Some block nerve receptors; some block reuptake ; some slow the breakdown of serotonin; and some increase the release of serotonin.
Because so many medications can contribute to serotonin syndrome, it's essential that any doctors you see who prescribe you medication always know about all the over-the-counter and prescription medications and supplements you're currently taking.
Your risk of developing serotonin syndrome goes up under the following circumstances. If you just started taking a serotonergic medication or you had your dose increased, you should watch for signs of serotonin syndrome. Some people's bodies are naturally slower than others at metabolizing serotonin, and this isn't something you or your doctor will know until you are on a drug that boosts serotonin. Most cases of serotonin syndrome start within 24 hours after starting or increasing a serotonergic medication and the majority of those start within six hours.
If you're switching from an MAOI to another antidepressant or vice versa, be especially careful to follow your doctor's guidance. Almost all antidepressants contain a warning that you should wait for at least two weeks, and sometimes more, when you switch antidepressant types.
One of the main reasons for this is the danger that having both types of drugs in your system can lead to serotonin syndrome. Prozac fluoxetine , in particular, takes several weeks to be flushed out of your body. Taking more than one serotonergic medication, supplement, or substance at the same time increases your risk of serotonin syndrome. For instance, you're on Wellbutrin for depression and you take an Imitrex sumatriptan for a migraine or you're taking Zoloft sertraline and you treat a cold with DayQuil dextromethorphan.
Once you've been diagnosed with serotonin syndrome, the first line of treatment is to discontinue all serotonergic drugs. Benzodiazepines like Valium diazepam or Ativan lorazepam may be helpful to relieve any muscular symptoms, and you may need supportive treatment like oxygen and intravenous IV fluids and stabilization of vital signs. Drugs that specifically act against serotonin, called serotonin antagonists, can potentially be useful.
For mild to moderate cases, your symptoms should subside within 24 to 72 hours once you've discontinued taking the serotonergic drug and you can expect to fully recover. If your symptoms are worrisome, your doctor may have you hospitalized until you're stabilized. In cases where you're exhibiting signs of severe serotonin syndrome, you'll likely need to be hospitalized in the intensive care unit ICU until all your symptoms are gone. For high fever, you may need to be sedated and given a medication that keeps you still paralytic to avoid any more damage to your muscles, in which case, you'll also have a breathing tube and ventilator.
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