Serotonin syndrome

This from an article in the New York Times today by Jane E Brody: A Mix of Medicines That Can Be Lethal

Recognizing the early signs is tricky because it has varying symptoms that can be easily confused with less serious conditions, including tremor, diarrhea, high blood pressure, anxiety and agitation. The examining physician may regard early symptoms as inconsequential and may not think to relate them to drug therapy.

In its classic form, serotonin syndrome involves three categories of symptoms:

• Cognitive-behavioral symptoms like confusion, disorientation, agitation, irritability, unresponsiveness and anxiety.

• Neuromuscular symptoms like muscle spasms, exaggerated reflexes, muscular rigidity, tremors, loss of coordination and shivering.

• Autonomic nervous system symptoms like fever, profuse sweating, rapid heart rate, raised blood pressure and dilated pupils.

Widespread ignorance of the syndrome is another diagnostic impediment. But even when doctors know about it, the strict diagnostic criteria may rule out “what are now recognized as mild, early or subacute stages of the disorder,” Dr. Edward Boyer and Dr. Michael Shannon wrote in their review in The New England Journal of Medicine.

Perhaps adding to the diagnostic challenge is the fact that a huge number of drugs — prescription, over the counter, recreational and herbal — can trigger the syndrome. In addition to selective serotonin reuptake inhibitors like Zoloft, Prozac and Paxil and serotonin/norepinephrine reuptake inhibitors like Effexor, the list includes tricyclic antidepressants and MAOIs (for monoamine oxidase inhibitors); narcotic painkillers like fentanyl and tramadol; over-the-counter cough and cold remedies containing dextromethorphan; the anticonvulsant valproate; triptans like Imitrex used to treat and prevent migraines; the antibiotic Zyvox (linezolide); antinausea drugs; the anti-Parkinson’s drug L-dopa; the weight-loss drug Meridia (sibutramine); lithium; the dietary supplements tryptophan, St. John’s wort and ginseng; and several drugs of abuse, including ecstasy, LSD, amphetamines, the hallucinogens foxy methoxy and Syrian rue.

Although serotonin poisoning can be caused by an antidepressant overdose, it more often results from a combination of an S.S.R.I. or MAOI with another serotonin-raising substance. Patients at particular risk, some experts say, are those taking combinations of antidepressant and antipsychotic drugs sometimes prescribed to treat resistant depression. All it may take is a small dose of another serotonin-inducing drug to cause the syndrome.

Most important to preventing the syndrome is for patients to give each of their doctors a complete list of drugs they regularly take — including prescriptions, over-the-counter medication, dietary supplements and recreational drugs — before a doctor prescribes something new.

Indeed, if you are taking any of the drugs described above, you might ask whether a new prescription is safe. And when filling a new prescription, it’s not a bad idea to also ask the pharmacist whether the medication, or an over-the-counter remedy you are considering, is safe to combine with any other drugs you take.

Great – so we now know that Serotonin has nothing to do with causing depression or curing it – but it can cause Serotonin Syndrome…

Will someone please, please tell me what’s going on?

19 Responses to “Serotonin syndrome”

  1. truthman30 Says:

    Serotonin syndrome is caused by an excess of serotonin in the body, usually induced by SSRI medication, medications such as Seroxat..

  2. LoLo Says:

    Is there anyone else out there who has also suffered from Serotonin Syndrome and dealing with the after effects?

  3. admin Says:

    LoLo – I’m afraid I don’t know, but have you been to http://www.paxilprogress.com?

    Great place to share views and problems and maybe you’ll find some help if you need it.

    Hope you’re OK

  4. Lila Says:

    I suffered serotonin syndrome in November during and post surgery. It feels like I still have the foggy effects. Since then, I feel that my mind is not sharp but rather dull. Anyone else ever experience this?

    • Brandy Kloth Says:

      Heck, yes I do. I can’t remember basic things like dates, days of the week, etc. I have way more muscle spasms/tremors than before, more migraine headaches, too. And lets not forget the insomnia. I want to know if I will ever be normal again. Also I am a college student, what if this effects my grades?

    • Hayley Says:

      Lila yes I am experiencing this. I suffered serotonin syndrome on the 16th December 2013 from taking one pill of sertraline 50mg (BIG MISTAKE), and had the most terrifying symptoms I had never felt in my life. I never went to the hospital and eventually most symptoms subsided. BUT I am still suffering from major brain fog/memory problems and muscle spasms which are painful at times. I noticed your comment is 6 years old and you may never look at this again. But I hope you recovered🙂

  5. Kizmit Says:

    I am currently recovering from serotonin syndrome – I was prescribed Remeron in the hopes that it would control severe anxiety and moderate depression, I am wondering if anybody has the common medical history of being on a narcotic pain reliever for chronic pain, a history of elevated blood pressure, amitriptyline for neuropathic pain, severe anxiety and moderate depression – what’s next?

  6. laura lewis Says:

    i took prozac and st johns wort and felt like i was trying towalk on the moon. didnt know what was wrong then worked out it was taking the two tablets. It has been 4 weeks since taking the tablets and still feel so ill. my brain is so dizzy, feels shaky like ti is working overtime all the time. i just dont want to move my head, i feel so week have no appitate and would just like to be dead. prior to the tablets together i was fine full of life. been to dcotors and hospital and they say it is all in my head and cant do anything for me. they have given me valium but to scared to take it after the effects of the other two tablets tofgether. just want to get back to normal and dont think it is ever going to happen.

    • admin Says:

      Did you tell them you were taking both? – I think the Docs should have known it was not good and should have known about Serotonin syndrome.

      Just stop the SJW – do not take it with an SSRI.

    • don Says:

      I’m experiencing this right know and have done research to try to find out what I can do to relieve this and found that you might have to take benzos and something called cyproheptadine. I read that you will be back to normal within 24 hours. I called my primary care doctor and he told me to wait another week but I think that he just doesn’t understand. I now realize how people have killed themselves coming of antidepressants. But remember that killing yourself is NOT an option. Mention this to your doctor. Hope it works.

  7. Leanna Says:

    I have gone through this twice. I get ninty adderall a month and thirty twenty mg prozac. One morning my heart started beating really hard and wouldnt stop then i started feeling this tingling in my hands and feet. Very soon after i became very confused and my body wouldnt stop shaking. My doctor had never told me about this so as this was going on i read up on it and cooled my body down and took a xanax. Its been three weeks and my musles still hurt and i sorta feel like im not 100% here all the time. I really think doctors should really tell people about this. Most of all in my case. I hope its the scariest thing i have to go through but i really believe he should have told me this

  8. Jose Says:

    Been through this it gets better!!!
    I smoke marijuana now on a daily basis instead of taking a bunch of crap
    Klonopin reduces serotonin activity and helps me out in combination with
    marijuana…
    not giving medical advice just sharing my story
    I had serotonin syndrome more than 10 times
    It is horrible 1.5 years later I still feel “sick”
    but i can deal with it thanks to MJ

  9. mathew Says:

    ive been through this before. it just about killed me. i went in for simple dental surgery and llow and behold i was allergic to demerol. i was taken to first babtist hospital in nlr ar, and the doctors wa sall confused and didnt understand what was wrong. i ended up being rushed to childrens where the doctor said if i lived it would be three weeks before i would be awake and could talk. he believed i would have brain damage after the event becauuse of how high my body temperature had been and i wouldnt be able to move much. i lost 15lbs of muscle when all this happened. through prayer and grace of god i woke up th next morning with only slight pains. i couldnt move around on my own for a week and my equilibrium was messed up for a while too. it has been two years since this happened and i am still suffering from some of the effects. my liver kidneys and heart was all hurt by this and i cannot fully remember what happened two monthes before this.

  10. Lynn Says:

    I know this sounds craxy but its nice to heae im npt alone. I am going through this after affect crap and im frustrated. I get dizzy light headed anxiety goes through the roof. Now my left eye is fuzzy feels “dead” and hard to see out of. Im also stuttering horribly! Im hoping this all will pass WITHOUT having to take another med. Im not sure i can put abother pill in my mouth. I keep praying. Thats all i feel i have left!

  11. GayeLynn Says:

    Well, as it nears the end of the year, I’m wondering if anyone will read this again?
    I’ll check in to see because I have 4 incidents that I’d love to share but not to me, myself and I.
    (They include 2 ER trips and 2 oui stops~all within 2 years and my 2nd oui was car accident involved so I was given TWO oui’s for one.)
    I feel so alone and hope someone would like to listen.
    Happy Healthy Holidays to all.

  12. Hayley Says:

    On 16th December 2013 I was prescribed 50mg Sertraline for intrusive thoughts (big mistake) and woke to the the most terrifying symptoms I had never experienced in my life: Waves of nervous energy flowing through my body like painful electric shocks Inner tremor Mania Extreme pressure in head Extreme panic and fear…dread
    Confusion/Delirium High Fever Flu-like symptoms Extreme nausea Waves of sensations throughout my body and skin
    Visual hallucinations Visual impairments Dizzy spells Akathisia (inability to stop moving) Panic Unable to lay down
    Dizziness Loud ringing in the ears Racing and violent thoughts BRAIN ZAPS (Immediate equilibrium interruption or disruption) Racing, uncontrollable thoughts. I was really convinced I was dying that night. For the first 3 days I had flu like symptoms with diarrhea for 3 a week. It’s been a month and a half and I am still suffering from painful muscle twitches and major brain fog, have I got brain failure?

  13. Tonay Paul Says:

    If serotonin level test can ease my diagnosis.

    I was taking clonazepam .5 for last 20 days in alternative days along with rosutatin daily but nervousness along with increased heart beat happens once in a week which disturbs my sleep and make my night tremor.

    After that I have consulted neuro-phychiatrist who has prescribed LUPIZEP PLUS 12.5 and TETRAFOL 7.5.After taking above medicine along with ongoing rosustatin, I got severe discomfort, heartbeat increase,couldn’t sleep whole night jus taking once the above dose.

    Is this a Serotonin syndrome or something else.What should I do to recover ?

    • admin Says:

      I’m sorry – I have no idea at all what may be the problem. What I do know is that there is no way to measure Seratonin levels in the brains of living people.
      Please talk to your doctors.


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