Serotonin syndrome

Symptom onset is usually rapid, often occurring within minutes and includes the following –

• Cognitive – Headache, agitation, hypomania, confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation, anxiety, hallucinationswhere someone sees, hears, smells, tastes or feels things that don't exist outside of their mind, coma,
• Autonomous – Shivering, sweating, hyperthermiaThis is a condition in which the body's temperature is higher than normal More, hypertensionhigh blood pressure, tachycardiarapid pulse rate, nausea, diarrhoeaWhere you frequently pass watery or loose faeces,
• Somatic – Twitching, tremors ¹.
• confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation,
• agitation,
• jerky muscles,
• rigid muscles,
• tremors,
• lack of coordination,
• seizuresthe outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness More,
• coma ².

Serotonin is a neurotransmitter involved in multiple states including aggression, pain, sleep, appetite, anxiety, depression, migraines, and vomiting. In humans, the effects of excess serotonin were first noted in 1960 in patients receiving a MAOI and tryptophan in combination. The syndrome is caused by an unregulatable excess of serotonin in the central nervous systembrain and spinal cord. Other neurotransmitters may also play a role; NMDA receptor antagonists and GABAGamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter in your brain, meaning it slows your brain's functions. GABA is known for producing a calming effect. have been suggested as being involved the development of the syndrome ¹.

A large number of medications (either alone in high dose or in combination) can produce serotonin syndrome. In recent years, the serotonin system has become a target of many types of drugs such as painkillers (tramadol), anti-anxiety medications (buspirone) and anti-psychotics (aripiprazole) as well as the obvious anti-depressant medications (fluoxetine). With the increasing use of serotonin receptorsnerve endings that sense changes in the body More as targets for a wide range of medication, it is becoming harder to predict medication’s pharmacological profile and whether or not it has the potential to cause serotonin syndrome ¹.

Diagnosis of serotonin syndrome includes observing the symptoms produced and a thorough investigation of the patient’s history. The syndrome has a characteristic picture but can be mistaken for other illnesses in some people, particularly those with neuroleptic malignant syndrome. No laboratory tests can currently confirm the diagnosis. Treatment consists of discontinuing medications which may contribute, and (in moderate to severe cases) administering a serotonin antagonist. An important side treatment includes controlling agitation with benzodiazepine sedationthe state of being relaxed or sleepy because of a drug More ¹.