Symptoms and Treatment of Serotonin Syndrome

A sharp increase in the level of serotonin is a rather serious condition, which is accompanied by a mass of disturbances in the work of the whole organism. Typically, such changes are the result of taking certain medications or overdosing with certain medications. In the absence of timely medical care, this situation is fraught with dangerous, sometimes irreversible consequences. That is why it is worth considering information about what are the main causes and symptoms of serotonin syndrome. What methods of treatment can modern medicine offer and what can lead to a lack of therapy?

Serotonin syndrome: what is it?

In fact, the first information about this state appeared not so long ago. In 1960, the first studies on this subject were published in the US. The fact is that the causes of the syndrome, which, in fact, is accompanied by a sharp increase in the amount of this substance in nerve cells, are to some extent associated with taking antidepressants.

As is known, the syndrome of serotonin deficiency leads to the development of depressive states. And in the last century, a drug was invented for such disorders, now known as "antidepressants." Such drugs help to increase the level of serotonin known in the people as a "hormone of happiness". Under their influence, chronic fatigue and apathy gradually pass, and the person gradually returns to the normal rhythm of life. Nevertheless, too much serotonin acts as a toxin, damagingly affecting the nerve cells, causing a lot of disorders in the body. Such a syndrome can be either the result of taking antidepressants, or a combination of antidepressants and other medications (for example, some cough syrups, etc.).

In fact, in the modern world, cases of serotonin syndrome are not registered very often. But, according to doctors and researchers, this happens only because this disorder is masked by a lot of imperceptible symptoms, which are usually written off as nervous overstrain or fatigue. That is why it is worthwhile to know why a serotonin syndrome can occur, what it is and what signs accompany it.

The main functions of serotonin

It is worth to learn the mechanism of the "hormone of happiness", before considering the question of how and why the serotonin syndrome develops. What is this substance? The main function of serotonin is the regulation of the functions of certain neurons of the brain. Passing through the synaptic cleft from one neuron, this substance reacts with special receptors in the membrane of the neighboring nerve cell, activating it and triggering the nerve impulse.

There are several systems that allow you to regulate the amount of serotonin in the body. In particular, this is a reverse capture, in which the molecule returns to the process of the first neuron (by the way, most antidepressants are inhibitors of serotonin reuptake), as well as enzymatic regulation in which special active substances break down the hormone molecule.

Serotonin regulates many processes in the body, including:

• Periods of sleep and wakefulness;
• appetite;
• Development or disappearance of a feeling of nausea;
• Sexual behavior of a person;
• Mechanisms of thermoregulation;
• Perception of pain;
• Support of muscle tone;
• The motility of the digestive tract;
• Regulation of the vascular tone;
• It is proved that serotonin takes part in the mechanisms of migraine development.

As you can see, the "hormones of happiness" provide the human body not only a sense of euphoria. Having studied the functions of this substance, one can roughly imagine the symptoms of serotonin syndrome. By the way, the maximum concentration of the hormone is observed in the brain stem and reticular formation.

Serotonin syndrome: biochemistry. What can trigger a violation?

As already mentioned, this disorder mostly develops on the background of taking certain drugs or their combinations. So what drugs can trigger the development of such a dangerous pathology, as serotonin syndrome?

• "Cipralex" and other synthetic inhibitors of the reuptake of serotonin and monoamine oxidase.
• Simultaneous administration of monoamine oxidase inhibitors and thyroid hormones, "Clomipramine", "Carbamazepine", "Imipramine" and "Amitriptyline."
• A combination of MAO inhibitors and some drugs used for weight loss, in particular Desopimon, Fepranone.
• Combination of SSRI or MAO inhibitors with preparations containing L-tryptophan, St. John's wort extract and ecstasy.
• Combination of antidepressants with lithium preparations, in particular "Contemnol" and "Quilinium".
• Simultaneous administration of inhibitors with dextromethorphan (a substance found in many cough syrups, including "Kaffetin Cold", "Glikodin", "Tussin Plus" and some others.
• Combination of serotonin reuptake inhibitors with such drugs as "Dihydroergotamine", "Sumatriptan" (medications for migraine), "Levodop" (used in Parkinson's disease).
• There is evidence that serotonin syndrome can develop with alcohol while antidepressant therapy.

Immediately it is worth to say that to predict whether the syndrome will develop against the background of a doctor-appointed therapy is almost impossible. Here everything depends on the dose of drugs, the individual characteristics of the patient's body, his age and many other factors. Nevertheless, if you have been prescribed antidepressant medication, be sure to tell the doctor about all the medicines you take and be sure to consult about the introduction of new therapies into the therapy scheme, even the usual cough syrup.

Main characteristics of the clinical picture

How does the serotonin syndrome develop? Signs of it in half the cases appear after 2-4 hours after taking the drugs. But the first symptoms can appear in a day. In connection with the main functions of serotonin, all possible violations are divided into three main groups:

• mental disorders;
• Problems from the muscular and peripheral nervous systems;
• Vegetative disorders.

All possible symptoms will be described below, but first we must say that different violations separately are not grounds for setting such a diagnosis. Only a thorough examination, laboratory tests and the presence of a complex of certain symptoms and possible risk factors make it possible to diagnose excess serotonin in nerve tissues.

Mental disorders on the basis of the syndrome

How to recognize serotonin syndrome? Symptoms usually begin with mental disorders, including:

• Emotional arousal;
• Unexplained, causeless feelings of fear and anxiety, sometimes down to panic attacks;
• Sometimes there is another picture: a person experiences a feeling of euphoria, strong joy, a desire to move, talk without stopping and do something;
• There may be disturbances in consciousness;
• In more severe cases there is the appearance of delirium and hallucinations.

It should be noted that the symptoms and degree of their severity directly depend on the severity of the toxic effect. For example, sometimes there is only a slight excitement. In other cases, there is an exacerbation of the symptoms of the underlying illness (eg, depression), which causes the medication to continue. In the most severe cases, the patient suffers from disorientation, is confused in the surrounding world and self, suffers from delirium and various hallucinations.

The main vegetative symptoms

There are other symptoms that accompany serotonin syndrome. The damage from a sharp jump in the level of this substance may look different. In particular, vegetative disorders are observed, including the following:

• Dilated pupils and increased lacrimation;
• Increased heart rate, tachycardia;
• Increase in the frequency of respiratory movements;
• Sometimes there is an increase in body temperature (usually it is small, but some patients registered a fever of 42 degrees);
• A sharp increase in blood pressure with concomitant symptoms right up to loss of consciousness;
• Appearance of dry mouth and some other mucous membranes;
• Acceleration of the motility of the digestive tract, which, in turn, can lead to disorders such as diarrhea, severe nausea and vomiting, flatulence, bloating and abdominal pain of varying severity;
• Feeling chills;
• Headaches, sometimes migraines.

As you can see, the signs of this pathology are not too specific, as dozens of other diseases can accompany the same symptoms.

Neuromuscular disorders in the background of the syndrome

As already mentioned, serotonin regulates the transmission of nerve impulses. That is why a change in the level of this substance affects neuromuscular activity. Here is a list of possible disorders:

• Increased intensity of tendon reflexes (especially expressed are the reflexes of the lower extremities);
• Increased muscle tone, sometimes up to muscle stiffness;
• Rapid involuntary and nonrhythmic contractions of individual muscles (sometimes even whole muscle groups);
• Trembling in the limbs;
• Involuntary movements of eyeballs (in medicine, the term "nystagmus" is used for this);
• Sometimes there is a so-called spasm of the eye, which is accompanied by an involuntary rolling of eyeballs up or down;
• Occasionally recorded epileptic seizures;
• Lack of coordination;
• Problems with speech, its blurryness and inaccuracy, which appears due to involuntary contraction of the muscles of the articulatory apparatus.

It is worthwhile to understand that all the above-described signs of serotonin syndrome are extremely rare. In most cases, patients suffer only from certain disorders, and therefore the diagnosis of pathology is a rather difficult process.

Degrees of severity of pathology

In modern medicine, it is common to distinguish three degrees of severity of the syndrome, namely:

• An easy degree of pathology is accompanied, as a rule, by excessive sweating, slight tremor in the hands and knees, not a very pronounced increase in the frequency of contractions of the heart. Reflexes also become slightly pronounced, although body temperature does not increase. Sometimes the patient can see a dilated pupil. It is only natural that people with such symptoms rarely go to the doctor and continue to take medications, as the above symptoms may well be caused by stress or overexertion.
• At an average severity of the disease, the clinical picture is more pronounced. Patients report a sharp increase in body temperature (often up to 40 degrees) and blood pressure, persistent dilated pupils, muscle contractions of the limbs, motor and mental arousal. As a rule, such symptoms cause a person to seek help, but unfortunately, it is not always possible to put the correct diagnosis.
• Severe serotonin syndrome is extremely dangerous, as it can lead to complications. With this form of pathology, severe tachycardia, increased blood pressure, fever, muscle spasms up to rigidity, nervous disorders, disorientation are observed. Patients, as a rule, have very bright hallucinations. In the absence of timely assistance, damage to the muscles, liver and kidneys is possible. Quite often patients fall into a coma. Occasionally, multiple organ dysfunction develops, which, as a rule, results in death.

That's why in no case should you ignore the symptoms, because under normal fatigue can mask the serotonin syndrome. How to get out of this condition and are there effective methods of treatment?

First aid in a similar condition

What should I do if a person is suspected of having a serotonin syndrome? Emergency care, as a rule, consists in the immediate discontinuation of the drug that provoked this condition. Naturally, the patient should definitely be taken to the hospital.

First of all, the stomach is washed, which makes it possible to purify the body of a medicine that has not yet been absorbed. For the same purpose, patients are assigned sorbents and other drugs that remove toxins from the body. In light cases such events are enough to make a person feel better. Symptoms go to decline after 6-12 hours.

How is the syndrome treated?

Unfortunately, the abolition of medicines and cleansing the body of their remnants is not always enough. So what kind of therapy does the serotonin syndrome require? Treatment, of course, depends on the stage and severity. As a rule, serotonin receptor antagonists are prescribed to the patient, including "Metisergid" and "Cyproheptadine". In addition, symptomatic therapy is performed, which directly depends on the presence of certain violations.

• For example, with epileptic seizures and rigidity of the muscles, benzodiazepines are prescribed, including "Lorazepam" and "Sibazon."
• In the presence of fever, cold wipes and some other procedures are performed. The fact is that the increase in temperature with serotonin syndrome is not associated with inflammation, but with increased muscle contractility, and therefore the usual antipyretic and non-steroidal anti-inflammatory drugs have no effect. The only exception is paracetamol, although it must be used cautiously.
• When the temperature rises to 40 or more, the patient is injected with muscle relaxants. These drugs help relax the muscles, eliminate fever, prevent the development of various disorders, including problems with blood clotting.
• Also, intravenous infusions are performed, as excessive sweating, muscle tension and diarrhea lead to dehydration.
• In addition, it is necessary to monitor the arterial pressure and heart rhythm of the patient, if necessary, normalizing these indicators with the help of drugs.

In most cases, properly conducted therapy allows you to quickly improve the patient's condition and avoid consequences. Unfortunately, in rare cases, especially if the patient was not provided with timely medical care, serotonin syndrome can lead to the disintegration of muscle tissue, kidney and liver damage, nerve endings and eventually death. That's why in no case should it be thoughtless to take antidepressants and other medicines.