Serotonin Syndrome

What Is Serotonin Syndrome?

Serotonin syndrome is when your body has too much of a chemical called serotonin, usually because of a medication or combinations of medications.

Your body makes serotonin to help your brain cells and other nervous system cells communicate with each other. Researchers think a lack of serotonin in your brain may play a role in depression. But too much of it can lead to extreme nerve cell activity and dangerous symptoms.

Serotonin Syndrome Symptoms

Serotonin syndrome symptoms often begin hours after you take a new medication that affects your serotonin levels or after you raise your dose of a current drug. Symptoms may include:

• Confusion
• Agitation or restlessness
• Dilated pupils
• Headache
• Changes in blood pressure and/or temperature
• Nausea
• Vomiting
• Diarrhea
• Rapid heart rate
• Tremor
• Loss of muscle control or twitching muscles
• Shivering and goosebumps
• Heavy sweating

In severe cases, serotonin syndrome can be life-threatening. Call 911 or go to the emergency room if you have any of these symptoms:

• High fever
• Seizures
• Uneven heartbeat
• Passing out

Serotonin Syndrome Causes and Risk Factors

Medications usually cause serotonin syndrome, especially certain antidepressants. You might be at higher risk if you take two or more drugs and/ or supplements that affect your serotonin levels.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressants. They work by raising your serotonin levels. These drugs include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Other prescription and over-the-counter drugs that can raise serotonin levels, either alone or when you take them together, include:

• Serotonin and norepinephrine reuptake inhibitors (SNRIs), a class of antidepressants including desvenlafaxine (Khedezla), desvenlafaxine succinate (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), and venlafaxine (Effexor)
• Monoamine oxidase inhibitors (MAOIs), a class of antidepressants including isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and transdermal selegiline (EMSAM)
• Buspirone (BuSpar), a drug used to treat anxiety disorders
• Trazodone (Desyrel), a drug that treats depression or insomnia
• Migraine treatments such as almotriptan (Axert), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
• Certain pain medications, especially opioids and related medications including fentanyl (Sublimaze, Fentora), fentanyl citrate (Actiq), meperidine (Demerol), pentazocine (Talwin), and tramadol (Ultram)
• Dextromethorphan, a cough suppressant in many over-the-counter and prescription cough medicines or cold medicines
• Certain medications for nausea, such as granisetron (Kytril), metoclopramide (Reglan), and ondansetron (Zofran)
• Antidepressants that affect multiple serotonin receptors, such as vilazodone (Viibryd) and vortioxetine (Trintellix)

Some recreational drugs, such as LSD and cocaine, and dietary supplements, including St. John's wort and ginseng, can also cause serotonin syndrome when you take them with these antidepressants.

The FDA has asked drugmakers to add warning labels about the risk of serotonin syndrome. If you have questions about a medication, check the label or ask your doctor. Don't stop taking any medication before talking to your doctor.

Serotonin Syndrome Complications

Without treatment, serotonin syndrome can cause seizures, kidney failure, trouble breathing, coma, and death.

Serotonin Syndrome Diagnosis

No single test can tell your doctor that you have serotonin syndrome. Instead, they’ll ask about your medical history -- including your use of medications, supplements, and recreational drugs -- and do a physical exam. They may order lab tests to rule out other health conditions that can look like serotonin syndrome, such as tetanus, sepsis, encephalitis, or heatstroke.

Serotonin Syndrome Treatment

You’ll probably need to stay in the hospital so your doctor can treat your symptoms and monitor your recovery.

Removing the drug that caused your serotonin syndrome is crucial. You’ll probably feel better within a day of stopping the medication, although some drugs can take longer to leave your system. You might also need to get fluids through a vein (intravenous, or IV).

In severe cases, you might take a medication called cyproheptadine (Periactin) to keep your body from making serotonin.

Serotonin Syndrome Prevention

Be sure your doctor knows about all the medications and supplements you take and any reactions you have, especially if you get prescriptions from more than one place.

If you use more than one drug that affects your serotonin levels, know the symptoms of serotonin syndrome so you can watch for them.

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