Serotonin syndrome

Abnormalities in the functioning of the nervous system can occur for various reasons. Serotonin syndrome is a consequence of improper use of medications, which results in changes in the metabolic processes of serotonin. In many cases, the cause of the disease is hidden in the use of selective reuptake inhibitors.

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Causes serotonin syndrome

This type of disease occurs under the negative influence of medications. An unacceptable combination of some medications can provoke serious disorders of the nervous system. The causes of serotonin syndrome occur with an unsuccessful combination of the following components:

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

Combination treatment is not always the cause of the disease. Often this process is caused by a sudden change from one antidepressant to another. Medicines of this type accumulate in the body. Therefore, a sudden introduction of a new drug leads to serious consequences. The following types of medicines are not recommended to be used together with antidepressants:

• opioid analgesics;
• antibiotics;
• cough suppressants;
• anti-emetic drugs;
• headache remedies.

Often the development of the disease is caused by the inattention of patients. Many of them take medications together with alcohol, which is unacceptable.

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Pathogenesis

The human brain contains neurons that work thanks to serotonin. Some of them allow the nervous system to function normally. In one cell, serotonin forms bubbles, with which it is released into a special space. Then the component attaches to the membrane of another neuron and activates it. Serotonin is responsible for this entire process. The pathogenesis of the syndrome is that there is excessive production of this component.

Neurons are located in the brain stem, they are responsible for a lot of functions of the human body. Including sleep, appetite, sexual desire, pain and emotions. With excessive production of serotonin, the process of its reverse return develops. Moreover, the synthesis of the component itself increases. As a result, a failure occurs in the body, affecting the general well-being of a person. The process of sleep, the work of the digestive system, muscle contractions, etc. are disrupted. A detailed clinical picture will be described below.

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Symptoms serotonin syndrome

At the initial stage of the disease, there are no specific signs. The person is bothered by digestive system disorders, namely nausea and vomiting. Problems with coordination of movements, mild fever, and rumbling in the stomach are recorded. The main symptoms indicating the rapid development of serotonin syndrome appear later.

Neurological manifestations include:

• presence of panic attacks;
• periodic tremor;
• muscle hypertonicity;
• the appearance of convulsions.

Antidepressants do not have a pronounced effect on the cardiovascular system. However, during the development of the syndrome, isolated attacks of tachycardia and increased blood pressure are possible.

The severe stage of the disease is accompanied by the following symptoms:

• leaps of ideas;
• incoherent speech;
• sleep disturbance;
• hyperactivity;
• temperature fluctuations;
• the appearance of profuse sweat;
• the presence of excessive oiliness of the face.

The disease can be fatal, but only if heart failure develops.

The first signs of the disease

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

• nausea and vomiting;
• rumbling in the stomach;
• diarrhea;
• increased excitability.

Gradually, the condition begins to deteriorate. Mental disorders are added to the described symptoms. The person experiences manic states accompanied by obsessive ideas. The victim is completely disoriented, his speech is incoherent, his gaze is practically unfocused.

If negative symptoms develop, it is advisable to seek help from a specialist. Medical intervention will help normalize a person's condition.

What is serotonin deficiency syndrome?

Serotonin syndrome is a rare condition that can be fatal if left untreated. This reaction can develop as a result of excessive use of medications or drugs. The condition of serotonin deficiency or syndrome can be the body's response to an unfavorable combination of medications.

Often the disease is caused by a combination of two antidepressants. The condition can develop as a result of taking drugs that affect the reuptake of serotonin or its blocking. As a result of this effect, there is excessive production of the component, which affects the general well-being of a person. Deviations occur in many organs and systems, and in the absence of help, there is a high probability of a fatal outcome.

Is it possible to use trittico for serotonin syndrome?

This type of medication is used to suppress depression, anxiety, and normalize sleep. Experts may recommend it in the presence of sexual dysfunction, without an established cause for its development. Trittico has a positive effect on the body with serotonin syndrome. However, many doctors claim that its use can worsen the situation. Opinions differ on this issue.

This drug has an antidepressant effect. Its use in serotonin syndrome can provoke severe complications from 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 nervous system dysfunction: tyramine and serotonin

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

In their clinical manifestations, the conditions are practically the same. In advanced cases, they can provoke cardiac arrhythmia and vascular insufficiency.

Tyramine syndrome manifests itself 15-90 minutes after eating. After 6 hours, all 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 person's condition. The main consequences of the syndrome are disorders of the nervous and cardiovascular systems. As a result, irreversible processes occur in the body. The absence of qualified assistance entails the development of heart failure and myocardial infarction.

Due to the fact that the disease is life-threatening, the risk of death remains high.

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Diagnostics serotonin syndrome

There are no specific diagnostic measures. To identify deviations, specialists have proposed special methods. Thus, to diagnose serotonin syndrome, it is necessary to monitor the person's condition. When increasing the dosage of the drug, it is necessary to exclude symptoms such as agitation, hyperreflexia and diarrhea. If they are present, it is customary to diagnose the disease.

This clinical picture is not enough, so attention is paid to auxiliary symptoms. These include metabolic disorders, signs of intoxication and fever.

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Tests to determine the disease

Specific laboratory tests are not performed. In most cases, if there are deviations, the tests do not go beyond the normal range. Therefore, it is impossible to diagnose the disease based on the blood composition.

Laboratory tests are important in identifying complications and monitoring the victim's condition. The presence of high levels of serotonin in the blood does not always indicate the development of a disorder.

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Are instrumental diagnostic methods used?

Instrumental diagnostic methods are not used to determine serotonin syndrome. Only differentiation is widely used. Detailed information about this method will be presented below.

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Differential diagnosis

The diagnosis of the disease is carried out by the method of exclusion. The specialist must assess the condition of the victim, and then begin to exclude all the initial pathologies one by one. Thus, differential diagnosis is carried out in relation to encephalitis, spontaneous hyperthermia, intoxication of unknown etiology and withdrawal syndrome.

If there is a clinical picture indicating progression of the serotonin state, the doctor can make a diagnosis. The drugs that the person has previously taken are taken into account. In many cases, the diagnosis is based on clinical observations of the patient.

In neuroleptic syndrome of malignant course, disturbances in the digestive system are recorded, plastic rigidity and myoclonus are observed.

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

There is no myoclonus in malignant hyperthermia. Opiate withdrawal is accompanied by dilated pupils, joint pain, and a cold-like condition.

Overdose of narcotic analgesics results in hypotension, hypothermia, bradycardia and hyporeflexia.

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Treatment serotonin syndrome

There are no special therapeutic measures for the development of the disease. There are special recommendations for individual cases. Thus, in the development of serotonin syndrome, treatment involves the exclusion of all drugs that can provoke increased production of serotonin. This will provide relief within 6-12 hours. If the cause of the syndrome was the intake of Fluoxetine, this period can last up to several days.

Symptomatic therapy is the basis of human recovery. In severe cases, Methysergide is used. Regular Paracetamol is used to maintain optimal body temperature. It is used together with external cooling.

Lorazepam is used to reduce muscle rigidity. It can also be used to control agitation. To maintain blood pressure, specialists prescribe Adrenaline or Norepinephrine.

Medicines are used in extreme cases, and there are no specific remedies for serotonin syndrome. Therefore, the treatment is symptomatic, a detailed recovery plan is prescribed by a specialist on an individual basis.

What medications are used?

Drug therapy is used to maintain the general condition of a person. The most commonly used drugs are Methysergide, Paracetamol, Lorazepam and Adrenaline.

• Methysergide. The drug has antiserotonin activity. It is used orally at 2 mg 2-4 times a day during meals. The drug improves the general condition, relieves headaches and improves sleep. The drug cannot be used in case of low blood pressure, ischemic heart disease, liver and kidney disorders. If used incorrectly, it can lead to the development of side effects. In this case, a person experiences rapid heartbeat, digestive disorders, a state of euphoria and insomnia.
• Paracetamol has antipyretic and analgesic effects. The optimal dose is 1 tablet 3-4 times a day, with an interval of 6 hours between doses. The drug should not be used in case of hypersensitivity to its components, during pregnancy and with inflammatory processes of the rectal mucosa. It can cause side effects such as anemia, renal colic, nausea and skin rashes.
• Lorazepam. The drug normalizes sleep and reduces the severity of emotional reactive states. The daily dose of the drug is 2 mg, it should be divided into 3 doses. A smaller portion is taken in the morning, a larger portion in the evening and before bedtime. The drug cannot be used in case of closed-angle glaucoma, liver and kidney disorders, psychosis and epilepsy. Side effects such as nausea, dry mouth and muscle weakness are possible.
• 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, a single dose should not exceed 1 ml, and a daily dose should not exceed 5 ml. The injection solution cannot be used in case of tachycardia, arrhythmia, pregnancy and hypersensitivity to the components of the drug. Headache, sleep disorders, nausea, vomiting and bronchospasm may develop.

Are vitamins used?

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

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Is physical therapy used?

The condition can be maintained only by some types of drugs, which were described above. Physiotherapy treatment is not used.

Folk remedies to combat increased serotonin production

When the syndrome develops, it is necessary to exclude the negative impact of all medications, including alternative medicine. Folk treatment is not used.

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Is herbal treatment possible?

Some herbs, including St. John's wort, can cause the development of serotonin syndrome. Therefore, it should not be used while taking antidepressants. Herbal treatment for elevated serotonin levels is not used. Such an effect can worsen the situation.

Homeopathy and its healing properties

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

Surgical treatment of patients

Due to the specific nature of the disease, surgical treatment is not used. Therapy is aimed at reducing serotonin levels; a positive result can be achieved by discontinuing antidepressants.

Prevention

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

If it is necessary to use antidepressants in courses, it is necessary to take a break between changing medications. This period should be at least 14 days. If Fluoxetine was used previously, the recovery period takes 5-6 weeks.

To prevent the development of the symptom, it is necessary to avoid dangerous combinations, which were presented in the first point. Antidepressants should be used independently. If this rule is followed, the risk of developing the syndrome is minimized.

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Forecast

Correct diagnosis and treatment can lead to an improvement in a person's condition. In this case, the prognosis is favorable. No specialist can make unambiguous conclusions regarding the person's further well-being. The patient must be closely monitored throughout the treatment. If serotonin syndrome is noticed too late, the prognosis is unfavorable.

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