Serotonin Syndrome

When Serotonin Attacks

Serotonin syndrome can be deadly if not treated in a timely manner. This is a syndrome that occurs when two serotonergic (promoting the release of serotonin in the brain) drugs or medications are combined. Onset is usually within a day of when the extra serotonin is made available in the brain. Common drugs and medications include:

• Selective Serotonin Reuptake Inhibitors (SSRIs – antidepressant)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs – antidepressant)
• Monoamine Oxidase Inhibitors (MAOIs – antidepressant)
• Tricyclic Antidepressants
• Amphetamines (stimulants)
• Tramadol (opioid pain medication)
• Dextromethorphan (cough suppressant)
• Buspirone (antidepressant)
• St. John’s Wort (herb with antidepressant properties)
• Ecstasy or MDMA
• Cocaine

The symptoms include:

• High body temperature
• Agitation
• Myoclonus
• Increased reflexes
• Tremors
• Sweating
• Dilated pupils
• Diarrhea

Complications include:

• Seizures
• Muscle breakdown
• Death

Treatment involves stopping the medications, benzodiazepines for agitation or a serotonin antagonist such as Cyproheptadine. When body temperature is extremely elevated, active cooling measures are needed. With appropriate treatment, the risk of death is < 1%. It is important that everyone is educated on medical conditions that can be caused by psychiatric medications.

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