Serotonin syndrome

, medical expert
Last reviewed: 11.04.2020

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Deviations in the work of the nervous system can arise for various reasons. Serotonin syndrome is a consequence of improper use of medications, resulting in changes in the metabolic processes of serotonin. In many cases, the cause of the disease is hidden in the reception of selective inhibitors of re-uptake.

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Causes of the serotonin syndrome

Disease of this type occurs under the negative impact of drugs. Inadmissible combination of some medicines can provoke serious disorders from the nervous system. The causes of the development of serotonin syndrome occur when an unsuccessful combination of the following components:

  • SSRI and selegelin;
  • sertraline and moclobemide;
  • imipramine and moclobemide.

Combined treatment does not always underlie the appearance of the disease. Often this process is caused by a sharp change of one antidepressant to another. Medications of this type accumulate in the body. Therefore, a sharp introduction of a new drug leads to severe consequences. Together with antidepressants it is not recommended to use the following types of medicines:

  • opioid analgesics;
  • antibiotics;
  • means against cough;
  • preparations for vomiting;
  • funds for headache.

Often, the development of the disease is due to inattentive patients. Many of them take medicines along with alcohol, which is unacceptable.

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In the human brain there are neurons that work thanks to serotonin. Some of them allow the nervous system to function normally. In one cell, serotonin forms bubbles, along with which it is released into a special space. The component then joins the membrane of another neuron and activates it. The entire process is responding to serotonin. The pathogenesis of the syndrome lies in the fact that excessive development of this component occurs.

Neurons are in the brain stem, they are responsible for a lot of functions of the human body. Including a dream, an appetite, a sexual attraction, pain and emotions. With excessive production of serotonin, the process of its return is developing. Moreover, the synthesis of the component itself also increases. As a result, the body fails, affecting the overall health of the person. The sleep process, the work of the digestive system, muscle contractions, etc. Are disturbed. A detailed clinical picture will be described below.

trusted-source[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]

Symptoms of the serotonin syndrome

At the initial stage of the disease, there are no specific signs. The human is being disturbed by disorders of the digestive system, namely nausea and vomiting. Fixed problems with coordination of movements, mild fever, bubbling in the abdomen. The main symptoms that indicate the rapid development of serotonin syndrome, appear later.

Neurological manifestations include:

  • presence of panic attacks;
  • periodic tremor;
  • muscular hypertonia;
  • the appearance of seizures.

Antidepressants have no significant effect on the cardiovascular system. However, during the development of the syndrome, single attacks of tachycardia are possible, and an increase in blood pressure.

The severe stage of the disease is supplemented by such symptoms:

  • jumps of ideas;
  • unrelated speech;
  • sleep disturbance;
  • hyperactivity;
  • temperature fluctuations;
  • the appearance of profuse sweat;
  • the presence of excessive greasiness of the face.

The disease can lead to death, but only in the case of heart failure.

The first signs of the disease

As mentioned above, at the initial stage the clinical picture is nonspecific. Therefore, it is not so easy to suspect the development of serotonin syndrome. The first signs of rejection are as follows:

  • nausea and vomiting;
  • grumbling in the abdomen;
  • diarrhea;
  • increased excitability.

Gradually, the state begins to deteriorate. To the described symptomatology are added mental disorders. Man has manic conditions, accompanied by obsessions. The victim is completely disoriented, his speech is disjointed, his view is almost not focused.

With the development of negative symptoms, it is advisable to seek help from a specialist. Medical intervention will allow to normalize a person's condition.

What is the syndrome of serotonin deficiency?

Serotonin syndrome is a rare disease, in the absence of help it is deadly. This reaction can develop due to excessive use of drugs or drugs. The condition of serotonin deficiency or a syndrome may be the body's response to an unfavorable combination of medications.

Often, the disease is due to a combination of two antidepressants. The state can develop due to the reception of funds that affect the reuptake of serotonin or its blockage. As a result of this influence, an excessive development of a component that affects the overall well-being of a person occurs. Deviations occur in many organs and systems, if there is no help, there is a high probability of death.

Is it possible to use tritiko in case of serotonin syndrome?

Medication of this type is used to suppress depressive states, anxiety and normalization of sleep. Experts can recommend it in the presence of sexual dysfunction, without a clear cause of development. Trittico with serotonin syndrome has a positive effect on the body. However, many doctors say that using it can aggravate the situation. In this issue, opinions diverge.

This drug has antidepressant effect. Using it with serotonin syndrome can provoke serious complications on the part of the body. In particular, if the condition was provoked by taking antidepressants.

Trittico is not a safe drug that can cause a number of side effects, including heart failure. It is used only under the supervision of a doctor.

Syndromes of dysfunction of the nervous system: tyramine and serotonin

Tyramine syndrome is often called "raw." It is the development of hypertensive crises and other complications, due to the use of antidepressants. In most cases occurs when these drugs are used simultaneously with foods that contain tyramine. The condition can be accompanied by jumps in body temperature, and lead to the development of a heart attack. In contrast to tyramine, serotonin syndrome occurs against the background of simultaneous use of antidepressants.

In their clinical manifestations, the conditions are practically the same. In neglected form, they can trigger heart rhythm disturbances and vascular insufficiency.

Tyramin syndrome occurs after 15-90 minutes after ingestion. After 6 hours all the negative symptoms disappear on their own. In the case of serotonin syndrome, the clinical picture develops gradually.

Complications and consequences

In the absence of medical intervention, there is a high probability of deterioration of the human condition. The main consequences of the syndrome is a violation of the nervous and cardiovascular system. As a result, irreversible processes occur in the body. The lack of qualified care leads to the development of heart failure, and myocardial infarction.

In view of the fact that the disease is deadly, there is a high risk of death.


Diagnostics of the serotonin syndrome

Specific diagnostic measures do not exist. To identify deviations, specialists have proposed special techniques. So, for the diagnosis of serotonin syndrome, it is necessary to monitor the condition of a person. With increasing dosage of the drug, it is necessary to exclude such symptoms as agitation, hyperreflexia and diarrhea. If they are available, it is common to diagnose the disease.

This clinical picture is not enough, so attention is drawn to ancillary symptoms. Among them are violations of metabolic processes, signs of intoxication and fever.

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Analyzes for determining the disease

Specific laboratory studies are not conducted. In most cases, in the presence of abnormalities, the tests do not go beyond the norm. Therefore, it is impossible to diagnose a disease by the composition of blood.

Laboratory tests are important in identifying complications, and monitoring the condition of the victim. The presence of a high serotonin level in the blood does not in all cases indicate the development of a deviation.

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Are instrumental diagnostic methods used?

To determine the serotonin syndrome, instrumental diagnostic methods are not used. Only differentiation is widely used. Detailed information on this technique will be presented below.

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Differential diagnosis

Diagnosis of the disease is carried out by the method of elimination. The specialist should assess the condition of the victim, and then pokurdeno start to exclude all the underlying pathologies. So differential diagnosis is carried out regarding encephalitis, spontaneous hyperthermia, intoxication of unexplained etiology and withdrawal syndrome.

In the presence of a clinical picture indicating a progression of the serotonin status, the doctor can make a diagnosis. In the account take drugs that a person previously took. In many cases, the diagnosis is based on clinical observations of the patient.

With neuroleptic syndrome of malignant course, violations are noted on the part of the digestive system, plastic stiffness and myoclonus are observed.

Anticholinergic syndrome is accompanied by drying of the skin and mucous membranes, increased pressure and accelerated peristalsis of the gastrointestinal tract.

With malignant hyperthermia, there are no myoclonus. Opiate abstinence is accompanied by dilated pupils, joint pains and a condition close to colds.

An overdose of narcotic analgesics leads to hypotension, hypothermia, bradycardia and hyporeflexia.

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Who to contact?

Treatment of the serotonin syndrome

There are no special therapeutic measures for the development of the disease. There are special recommendations for individual cases. So, with the development of serotonin syndrome, treatment implies the exclusion of all drugs that can provoke increased production of serotonin. This will achieve relief within 6-12 hours. If the reason for the development of the syndrome was the administration of fluoxetanin, this period can last up to several days.

Symptomatic therapy underlies the recovery of a person. In severe cases Metisergide is used. To maintain optimal body temperature, ordinary Paracetamol is used. It is used together with external cooling.

To reduce muscle rigidity, lorazepam is used. It can also be used to control agitation. To maintain blood pressure, experts appoint Adrenaline or Norepinephrine.

Medications are used in extreme cases, and there are no specific drugs from serotonin syndrome. Therefore, the treatment is symptomatic, a detailed recovery scheme is assigned by a specialist on an individual basis.

What medicines are used?

Drug therapy is used to maintain the general condition of a person. Most commonly used drugs such as Metisergide, Paracetamol, Lorazepam and Adrenaline.

  • Metisergide. The drug has antiserotonin activity. It is applied orally 2 mg 2-4 times a day during meals. The drug improves the general condition, stops the headache and improves sleep. You can not use medicine with low blood pressure, ischemic heart disease, liver and kidney problems. If improperly applied, it can lead to the development of adverse reactions. In this case, a person has fast heartbeat, digestive disorders, a state of euphoria and insomnia.
  • Paracetamol is characterized by antipyretic and analgesic action. The optimal dose of 1 tablet 3-4 times a day, between the intervals should be observed interval of 6 hours. Use the product is not possible with increased sensitivity to its components, during pregnancy and inflammatory processes of the rectal mucosa. May cause adverse reactions in the form of anemia, renal colic, nausea and skin rashes.
  • Lorazepam. The drug normalizes sleep and reduces the intensity of emotional reactive conditions. The daily dose of the drug is 2 mg, it must be divided into 3 divided doses. The smaller part is taken in the morning, the big evening and before bedtime. You can not use medicine with closed-angle glaucoma, liver and kidney disorders, psychoses and epilepsy. Possible development of adverse reactions in the form of nausea, dry mouth and muscle weakness.
  • Adrenaline. It is used in the form of injections. The dosage depends on the person's condition. Usually, 0.2-0.75 ml is administered, the single dose should not exceed 1 ml, and the daily dose - 5 ml. Use injection for injection is not possible with tachycardia, arrhythmia, pregnancy and hypersensitivity to the components of the drug. Perhaps, the development of headache, sleep disturbances, nausea, vomiting and bronchospasm.

Do you use vitamins?

In the elimination of serotonin syndrome, drugs are practically not used. The use of vitamins can, on the contrary, aggravate the situation. Their combination with antidepressants increases the severity of the clinical picture.

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Is physiotherapy used?

Maintain the condition can only be some of the types of drugs that have been described above. Physiotherapy treatment is not applied.

Alternative treatment in the fight against increased production of serotonin

With the development of the syndrome, it is necessary to exclude the negative influence of all medications, including non-traditional medicine. Alternative treatment is not used.

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Treatment with herbs is it possible?

Some herbs, including St. John's Wort, can cause the development of serotonin syndrome. Therefore, when taking antidepressants, it should not be used. Treatment with herbs at an elevated serotonin level is not applied. Such an impact can aggravate the situation.

Homeopathy and its medicinal properties

Homeopathic remedies are based on plant components. They are widely used all over the world. However, even plant-based antidepressants can provoke a worsening of a person's condition. Therefore, homeopathy as a drug therapy is not used.

Surgical treatment of patients

Due to the specific nature of the disease, surgical treatment is not applied. Therapy is aimed at reducing the level of serotonin, you can achieve a positive result by abolishing the use of antidepressants.


The main principle of preventive measures is restriction in the consumption of antidepressants. It is necessary to reduce the negative drug effect of agents that can lead to a violation of serotonin metabolism. This is the prevention of the disease. To achieve optimal results, the drugs must be taken after the doctor's approval.

If you need to use antidepressants courses, you should be able to withstand a pause between the change of medication. This period must be at least 14 days. If fluoxetine was previously used, the recovery period takes 5-6 weeks.

To prevent the development of a symptom, the dangerous combinations that were presented in the first paragraph should be avoided. Antidepressants should be used alone. If this rule is followed, the risk of developing the syndrome is minimized.

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Proper diagnosis and treatment can lead to an improvement in a person's condition. In this case, the outlook is favorable. No single expert can make definite conclusions about the future well-being of a person. During the whole treatment, the patient must be carefully monitored. If the serotonin syndrome was seen too late, the forecast is unfavorable.

trusted-source[57], [58], [59]

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