Serotonin syndrome: what it is, symptoms, causes and treatment

Serotonin syndrome consists of an increase in the activity of serotonin in the central nervous system, caused by the inappropriate use of certain medications, which can affect the brain, muscles and organs of the body, which can lead to death.

Serotonin is a neurotransmitter that acts on the brain, important for the proper functioning of the organism, since it regulates mood, sleep, appetite, heart rate, body temperature and cognitive functions. However, high doses of serotonin can deregulate the body's functioning and lead to the onset of severe symptoms. See more serotonin functions.

The treatment of the serotonin syndrome should be done at the hospital, as soon as possible, through the administration of serum in the vein, suspension of the medication that caused the crisis and use of drugs to relieve the symptoms.

What are the symptoms

Anxiety, irritability, muscle spasms, confusion and hallucinations, tremors and chills, nausea and diarrhea, increased blood pressure and heart rate, increased reflexes, dilated pupils, are the most common symptoms.

In more severe cases and if not treated urgently, serotonin syndrome can give rise to more severe symptoms, such as irregular heartbeat, loss of consciousness, seizures, coma and death.

Possible causes

Serotonin syndrome is caused by the inappropriate use of drugs that increase the levels of serotonin in the body. Thus, the increase in the dosage of drugs that increase serotonin, the combination of these drugs with others that enhance their action, or the use of these drugs simultaneously with drugs, can lead to the occurrence of this syndrome.

Medicines that increase serotonin in the body

Some of the drugs that increase serotonin in the body are:

• Antidepressants, such as imipramine, clomipramine, amitriptyline, nortriptyline, fluoxetine, paroxetine, citalopram, sertraline, fluvoxamine, venlafaxine, duloxetine, nefazodone, trazodone, bupropion, mirtazapine, tranilcipromine and moclobemide;
• Remedies for migraine from the group of triptans, such as zolmitriptan, naratriptan or sumatriptan, for example;
• Cough remedies that contain dextromethorphan, which is a substance that acts on the central nervous system to inhibit cough;
• Opioids used to treat pain, such as codeine, morphine, fentanyl, meperidine and tramadol, for example;
• Remedies for nausea and vomiting, such as metoclopramide and ondansetron;
• Anticonvulsants, such as sodium valproate and carbamazepine;
• Antibiotics, antifungals and antivirals, such as erythromycin, ciprofloxacin, fluconazole and ritonavir;
• Illicit drugs such as cocaine, amphetamines, LSD and ecstasy.

In addition, some natural supplements, such as tryptophan, St. John's wort (St. John's wort) and ginseng, when combined with antidepressants, can also induce serotonin syndrome.

How the treatment is done

Treatment for serotonin syndrome depends on the severity of the symptoms. In moderate to severe cases, it should be done as soon as possible, in the hospital, where the person is monitored and can receive serum in the vein and medicines to treat the symptoms, such as fever, agitation and muscle spasms, for example. In more severe cases, it may be necessary to take medications that block the action of serotonin.

In addition, the medication that the person takes must be reviewed and readjusted by the doctor, as well as the prescribed doses.

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Bibliography

• JOURNAL OF THE PSYCHIATRY SERVICE OF HOSPITAL FERNANDO FONSECA. Serotonin Syndrome - Clinical Manifestations, Diagnosis, Therapeutics. Available in: . Accessed on 23 Jul 2020
• FRANCESCANGELI, James et. al .. The Serotonin Syndrome: From Molecular Mechanisms to Clinical Practice. Int. J. Mol. Sci .. Vol.20. 1-17, 2019
• MEDSAFE. Serotonin syndrome. 2015. Available at:. Accessed on 23 Jul 2020
• WANG, Robert Z. et. al .. Serotonin syndrome: Preventing, recognizing, and treating it. CLEVELAND CLINIC JOURNAL OF MEDICINE. Vol.83. 11.ed; 810-817, 2016