Learn About Serotonin Syndrome

What is the definition of Serotonin Syndrome?

Serotonin syndrome (SS) is a potentially life-threatening drug reaction. It causes the body to have too much serotonin, a chemical produced by nerve cells.

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What are the alternative names for Serotonin Syndrome?

Hyperserotonemia; Serotonergic syndrome; Serotonin toxicity; SSRI - serotonin syndrome; MAO - serotonin syndrome

What are the causes of Serotonin Syndrome?

SS most often occurs when two medicines that affect the body's level of serotonin are taken together at the same time. The medicines cause too much serotonin to be released or to remain in the brain area.

For example, you can develop this syndrome if you take migraine medicines called triptans together with antidepressants called selective serotonin reuptake inhibitors (SSRIs), and selective serotonin/norepinephrine reuptake inhibitors (SSNRIs).

Common SSRIs include citalopram (Celexa), sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), and escitalopram (Lexapro). SSNRIs include duloxetine (Cymbalta), venlafaxine (Effexor), Desvenlafaxine (Pristiq), Milnacipran (Savella), and Levomilnacipran (Fetzima). Common triptans include sumatriptan (Imitrex), zolmitriptan (Zomig), frovatriptan (Frova), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), and eletriptan (Relpax).

If you take these medicines, be sure to read the warning on the packaging. It tells you about the potential risk of serotonin syndrome. However, do not stop taking your medicine. Talk to your doctor about your concerns first.

SS is more likely to occur on starting or increasing the medicine.

Older antidepressants called monoamine oxidase inhibitors (MAOIs) can also cause SS with the medicines described above, as well as meperidine (Demerol, a painkiller) or dextromethorphan (cough medicine).

Drugs of abuse, such as ecstasy, LSD, cocaine, and amphetamines have also been associated with SS.

What are the symptoms of Serotonin Syndrome?

Symptoms occur within minutes to hours, and may include:

  • Agitation or restlessness
  • Abnormal eye movements
  • Diarrhea
  • Fast heartbeat and high blood pressure
  • Hallucinations
  • Increased body temperature
  • Loss of coordination
  • Nausea and vomiting
  • Overactive reflexes
  • Rapid changes in blood pressure
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What are the current treatments for Serotonin Syndrome?

People with SS will likely stay in the hospital for at least 24 hours for close observation.

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
  • Discontinuation of medicines that caused the syndrome

In life-threatening cases, medicines that keep the muscles still (paralyze them), and a temporary breathing tube and breathing machine will be needed to prevent further muscle damage.

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What is the outlook (prognosis) for Serotonin Syndrome?

People may get slowly worse and can become severely ill if not quickly treated. Untreated, SS can be deadly. With treatment, symptoms usually go away in less than 24 hours. Permanent organ damage may result, even with treatment.

What are the possible complications of Serotonin Syndrome?

Uncontrolled muscle spasms can cause severe muscle breakdown. The products produced when the muscles break down are released into the blood and eventually go through the kidneys. This can cause severe kidney damage if SS isn't recognized and treated properly.

When should I contact a medical professional for Serotonin Syndrome?

Call your health care provider right away if you have symptoms of serotonin syndrome.

How do I prevent Serotonin Syndrome?

Always tell your providers which medicines you take. People who take triptans with SSRIs or SSNRIs should be closely followed, especially right after starting a medicine or increasing its dosage.

What are the latest Serotonin Syndrome Clinical Trials?
Evaluation of Dual Energy CT for the Detection of Gastrointestinal Carcinoids

Summary: This trial studies the use of a special type of computed (CT) scan called dual energy CT in detecting gastrointestinal carcinoid tumors. CT is an imaging technique that uses x-rays and a computer to create images of areas inside the body. Dual energy computed tomography is a technique used during routine CT scans to help obtain and process the image after the scan is complete. Doctors want to lear...

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Monitoring Telotristat Ethyl Inhibition of Tryptophan Hydroxylase (TPH) in Neuroendocrine Tumors Using ?-[11C]Methyl-L-tryptophan (AMT)-PET

Summary: This pilot trial studies how well telotristat etiprate works in treating participants with well differentiated neuroendocrine neoplasm that has spread to other places in the body and monitored by carbon C 11 alpha-methyltryptophan (AMT)-emission tomography (PET). Telotristat etiprate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Studying the changes wit...

What are the Latest Advances for Serotonin Syndrome?
Safety Findings in Lasmiditan as a Novel Acute Treatment of Migraine in Chinese Patients: A Post Hoc Analysis of the Randomized Controlled Phase 3 CENTURION Trial.
Buspirone in the management of refractory irritable bowel syndrome: A case report.
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Safety findings from CENTURION, a phase 3 consistency study of lasmiditan for the acute treatment of migraine.
Who are the sources who wrote this article ?

Published Date: March 28, 2020
Published By: Jacob L. Heller, MD, MHA, Emergency Medicine, Emeritus, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Fricchione GL, Beach SR, Huffman JC, Bush G, Stern TA. Life-threatening conditions in psychiatry: catatonia, neuroleptic malignant syndrome, and serotonin syndrome. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 55.

Levine MD, Ruha AM. Antidepressants. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 146.

Meehan TJ. Approach to the poisoned patient. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 139.