Serotonin syndrome
Serotonin syndrome is a group of symptoms that may occur with the use of certain serotonergic medications or drugs. The degree of symptoms can range from mild to severe. Symptoms in mild cases include high blood pressure and a fast heart rate. In severe cases body temperature can increase to greater than 41. 1 °C. Complications may include seizures and extensive muscle breakdown. It occurs in about 15% of SSRI overdoses. With appropriate treatment the risk of death is less than one percent.
About Serotonin syndrome in brief
Serotonin syndrome is a group of symptoms that may occur with the use of certain serotonergic medications or drugs. The degree of symptoms can range from mild to severe. Symptoms in mild cases include high blood pressure and a fast heart rate; usually without a fever. In severe cases body temperature can increase to greater than 41. 1 °C. Complications may include seizures and extensive muscle breakdown. It occurs in about 15% of SSRI overdoses. With appropriate treatment the risk of death is less than one percent. The high-profile case of Libby Zion, who is generally accepted to have died from serotonin syndrome, resulted in changes to graduate medical education in New York State. A large number of medications and street drugs can cause serotonin syndrome when taken alone at high doses or in combination with other drugs. Many cases of serotonin toxicity occur in people who have ingested drug combinations that synergistically increase synaptic serotonin. It can take at least four weeks for this enzyme to be irreversibly inhibited by the body in the instance of irreversible tricyclic antidepressants. Many MAOIs with precursors such as L-tryptophan or 5-HTP pose a risk of acute life-threatening serotonin syndrome. The case of combination of MAIs with tryptamine agonists can present similar dangers as their precursor, this phenomenon has been described in general terms as “cheese effect” Many reports have implicated atypical antipsychotics in serotonin syndrome but it appears based on their pharmacology that they are unlikely to cause the syndrome.
Many medications may have been incorrectly thought to cause this syndrome, but it is unlikely that these are the cause of the condition. The symptoms are often described as a clinical triad of abnormalities: hypervigilance or insomnia and agitation. Severe symptoms include severe increases in heart rate and blood pressure that may lead to shock. The overactive reflexes and clonus in moderate cases may be greater in the lower limbs than in the upper limbs. Moderate intoxication includes additional abnormalities such as hyperactive bowel sounds, high blood Pressure and hyperthermia; a temperature as high as 40 °C. In life- threatening cases, the temperature may rise to above 41.1 °F in those with a high body temperature. If this is not sufficient, a serotonin antagonist such as cyproheptadine may be used. In those with an elevated body temperature active cooling measures may be needed. It is a predictable consequence of excess serotonin on the central nervous system. Onset of symptoms is typically within a day of the extra serotonin. Symptom onset is usually rapid, often occurring within minutes of elevated serotonin levels. However, many of these symptoms may be side effects of the drug or drug interaction causing excessive levels of serotonin; not an effect of the elevated serotonin itself. For example, Tremor is a common side effect of MDMA’s action on dopamine, whereas hyperreflexia is symptomatic of exposure to serotonin agonists.
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This page is based on the article Serotonin syndrome published in Wikipedia (as of Dec. 30, 2020) and was automatically summarized using artificial intelligence.
