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Table of Contents

Symptoms

Diagnosis

Causes

Risk Factors

Treatment

Prevention

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Serotonin is a type of chemical known as aneurotransmitterthat communicates with nerve cells and has various functions throughout your body, primarily in your central nervous system and intestines.

In the right amounts, serotonin is necessary for important bodily functions, but when your body builds up too much, and your levels get too high, symptoms can range from unpleasant to severe. If it’s left untreated, serotonin syndrome can potentially lead to death.

Serotonin Syndrome Symptoms

Symptoms of serotonin syndrome can be mild to severe indicating anything from a slight serotonin excess to a life-threatening imbalance. The most common symptoms include:

If your condition becomes severe, it can turn into a life-threatening situation and may include signs like:

If you suspect you or a loved one is showing signs of serotonin syndrome, contact your doctor immediately. If your symptoms are getting worse or they’re severe, head to the emergency room or call 911. Immediate treatment is important because you can become seriously ill and your condition can become fatal the longer you go untreated.

SSRI Discontinuation Syndrome

It should be noted that some of the same symptoms listed above may also occur when you abruptly stop taking an antidepressant, or you taper it off too quickly. This is known asSSRI discontinuation syndrome.

Agitation, headaches, shock-like sensations, poor coordination, chills, and impaired concentration are characteristics common to both syndromes. Because of this risk, you must never stop taking your antidepressant abruptly without discussing it with your doctor.

How to Taper Off Your Antidepressant

Serotonin Syndrome Diagnosis

Because the symptoms are similar to many other issues, you won’t be diagnosed with serotonin syndrome until every other possible diagnosis has been ruled out. This is mainly because serotonin syndrome has to be diagnosed purely on your symptoms, history, and your physical and neurological exam.

Other conditions that need to be ruled out include:

The tests your doctor may order to rule these conditions out include:

While serotonin levels can be measured using a blood test, such tests cannot confirm whether or not a person has serotonin syndrome.

Serotonin Syndrome Causes

Medications Associated With Serotonin Syndrome

The medications that are most often associated with serotonin syndrome areantidepressantssuch as:

There are other medications that are also considered serotonergic drugs, though they may not be as well-known.Some examples of these include:

Other substances and supplements that can contribute to serotonin syndrome include:

All of these drugs and substances affect serotonin in some way. Some block nerve receptors; some blockreuptake; some slow the breakdown of serotonin; and some increase the release of serotonin.

Because so many medications can contribute to serotonin syndrome, it’s essential that any doctors you see who prescribe you medication always know about all the over-the-counter and prescription medications and supplements you’re currently taking.

Medications That Increase Serotonin

Risk Factors for Serotonin Syndrome

Your risk of developing serotonin syndrome goes up under the following circumstances.

You’re Taking a New Medication or Dose

If you just started taking a serotonergic medication or you had your dose increased, you should watch for signs of serotonin syndrome. Some people’s bodies are naturally slower than others at metabolizing serotonin, and this isn’t something you or your doctor will know until you are on a drug that boosts serotonin.

Most cases of serotonin syndrome start within 24 hours after starting or increasing a serotonergic medication and the majority of those start within six hours.

You’re Switching to a New Medication

If you’re switching from anMAOIto another antidepressant or vice versa, be especially careful to follow your doctor’s guidance. Almost all antidepressants contain a warning that you should wait for at least two weeks, and sometimes more, when you switch antidepressant types.

One of the main reasons for this is the danger that having both types of drugs in your system can lead to serotonin syndrome.Prozac(fluoxetine), in particular, takes several weeks to be flushed out of your body.

You’re Taking More Than One Medication

Taking more than one serotonergic medication, supplement, or substance at the same time increases your risk of serotonin syndrome. For instance, you’re on Wellbutrin for depression and you take an Imitrex (sumatriptan) for a migraine or you’re taking Zoloft (sertraline) and you treat a cold with DayQuil (dextromethorphan).

Serotonin Syndrome Treatment

Once you’ve been diagnosed with serotonin syndrome, the first line of treatment is to discontinue all serotonergic drugs. Treatment may also include the use of medications to relieve symptoms or hospitalization to stabilize your condition.

Medication

Benzodiazepineslike Valium (diazepam) or Ativan (lorazepam) may be helpful to relieve any muscular symptoms, and you may need supportive treatment like oxygen and intravenous (IV) fluids and stabilization of vital signs. Drugs that specifically act against serotonin, called serotonin antagonists, can potentially be useful.

For mild to moderate cases, your symptoms should subside within 24 to 72 hours once you’ve discontinued taking the serotonergic drug and you can expect to fully recover.

Hospitalization

If your symptoms are worrisome, your doctor may have you hospitalized until you’re stabilized. In cases where you’re exhibiting signs of severe serotonin syndrome, you’ll likely need to be hospitalized in the intensive care unit (ICU) until all your symptoms are gone.

For high fever, you may need to be sedated and given a medication that keeps you still (paralytic) to avoid any more damage to your muscles, in which case, you’ll also have a breathing tube and ventilator.

How to Prevent Serotonin Syndrome

There are also steps you can take to prevent or minimize your risk of developing serotonin syndrome.

Also, always follow your doctor’s prescribing instructions. Do not change your dose or stop taking your medication without first talking to your doctor.

4 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Volpi-Abadie J, Kaye AM, Kaye AD.Serotonin syndrome.Ochsner J.2013;13(4):533-540.Foong AL, Grindrod KA, Patel T, Kellar J.Demystifying serotonin syndrome (orserotonin toxicity).Can Fam Physician.2018;64(10):720-727.Renoir T.Selective serotonin reuptake inhibitor antidepressant treatment discontinuation syndrome: A review of the clinical evidence and the possible mechanisms involved.Front Pharmacol. 2013;4:45. doi:10.3389/fphar.2013.00045Isbister GK, Buckley NA, Whyte IM.Serotonin toxicity: A practical approach to diagnosis and treatment.Med J Aust.2007;187(6):361-365.Additional ReadingBoyer EW.Serotonin Syndrome (Serotonin Toxicity). UpToDate. Updated March 12, 2018.Mayo Clinic Staff.Serotonin Syndrome. Mayo Clinic. Updated January 20, 2017.MedlinePlus.Serotonin Syndrome. The American Society of Health-System Pharmacists, Inc. National Institutes of Health. U.S. National Library of Medicine. Updated August 14, 2018.

4 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Volpi-Abadie J, Kaye AM, Kaye AD.Serotonin syndrome.Ochsner J.2013;13(4):533-540.Foong AL, Grindrod KA, Patel T, Kellar J.Demystifying serotonin syndrome (orserotonin toxicity).Can Fam Physician.2018;64(10):720-727.Renoir T.Selective serotonin reuptake inhibitor antidepressant treatment discontinuation syndrome: A review of the clinical evidence and the possible mechanisms involved.Front Pharmacol. 2013;4:45. doi:10.3389/fphar.2013.00045Isbister GK, Buckley NA, Whyte IM.Serotonin toxicity: A practical approach to diagnosis and treatment.Med J Aust.2007;187(6):361-365.Additional ReadingBoyer EW.Serotonin Syndrome (Serotonin Toxicity). UpToDate. Updated March 12, 2018.Mayo Clinic Staff.Serotonin Syndrome. Mayo Clinic. Updated January 20, 2017.MedlinePlus.Serotonin Syndrome. The American Society of Health-System Pharmacists, Inc. National Institutes of Health. U.S. National Library of Medicine. Updated August 14, 2018.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Volpi-Abadie J, Kaye AM, Kaye AD.Serotonin syndrome.Ochsner J.2013;13(4):533-540.Foong AL, Grindrod KA, Patel T, Kellar J.Demystifying serotonin syndrome (orserotonin toxicity).Can Fam Physician.2018;64(10):720-727.Renoir T.Selective serotonin reuptake inhibitor antidepressant treatment discontinuation syndrome: A review of the clinical evidence and the possible mechanisms involved.Front Pharmacol. 2013;4:45. doi:10.3389/fphar.2013.00045Isbister GK, Buckley NA, Whyte IM.Serotonin toxicity: A practical approach to diagnosis and treatment.Med J Aust.2007;187(6):361-365.

Volpi-Abadie J, Kaye AM, Kaye AD.Serotonin syndrome.Ochsner J.2013;13(4):533-540.

Foong AL, Grindrod KA, Patel T, Kellar J.Demystifying serotonin syndrome (orserotonin toxicity).Can Fam Physician.2018;64(10):720-727.

Renoir T.Selective serotonin reuptake inhibitor antidepressant treatment discontinuation syndrome: A review of the clinical evidence and the possible mechanisms involved.Front Pharmacol. 2013;4:45. doi:10.3389/fphar.2013.00045

Isbister GK, Buckley NA, Whyte IM.Serotonin toxicity: A practical approach to diagnosis and treatment.Med J Aust.2007;187(6):361-365.

Boyer EW.Serotonin Syndrome (Serotonin Toxicity). UpToDate. Updated March 12, 2018.Mayo Clinic Staff.Serotonin Syndrome. Mayo Clinic. Updated January 20, 2017.MedlinePlus.Serotonin Syndrome. The American Society of Health-System Pharmacists, Inc. National Institutes of Health. U.S. National Library of Medicine. Updated August 14, 2018.

Boyer EW.Serotonin Syndrome (Serotonin Toxicity). UpToDate. Updated March 12, 2018.

Mayo Clinic Staff.Serotonin Syndrome. Mayo Clinic. Updated January 20, 2017.

MedlinePlus.Serotonin Syndrome. The American Society of Health-System Pharmacists, Inc. National Institutes of Health. U.S. National Library of Medicine. Updated August 14, 2018.

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