Causes and Risk Factors

Written by Fred McConnell

Serotonin syndrome is a potentially deadly condition caused by an excess of serotonin in the brain, most often caused by drug interactions or overdose. While this condition is becoming more common as antidepressants that impact serotonin levels become more popular, the medical community remains underinformed concerning the condition. Boosting patient and doctor awareness of serotonin syndrome can help health care providers more easily and effectively diagnose this dangerous, but eminently treatable condition.

Serotonin is an important chemical in the body. In the digestive system, it helps regulate muscle movement. In the brain, this chemical plays a wider role, acting as a neurotransmitter. Neurotransmitters are chemicals in the brain which are used to relay signals by stimulating nerve cells. Serotonin impacts a variety of functions in the brain, including memory, cognition, body temperature and behavior.

Too little serotonin can result in a variety of psychological problems, including depression, anxiety and sexual problems. Drugs like SNRIs and SSRIs that impact the level of serotonin in the body are becoming an increasingly popular method of treating depression and other problems, as they have proven very effective.

Just as too little serotonin can have negative impacts, so can too much. An excess in serotonin in the brain can cause serotonin syndrome, which can send some bodily processes haywire. When serotonin syndrome occurs, it most commonly happens because the patient has started a new treatment using drugs that affect serotonin levels or has changed dosages. In some cases, this condition can be instigated by taking just one drug affecting your serotonin levels, but in most cases it occurs because of an interaction between drugs. For example, serotonin syndrome may occur if you take an antidepressant along with an illegal drug such as LSD or ecstasy.

Drug interactions

Here's a list of drugs and other substances that can lead to serotonin syndrome:

Monoamine oxidase inhibitors -- These are antidepressants. Some common brands include Marplan and Nardil.
Lithium -- This is a mood stabilizer used to treat bipolar disorder. Common brands include Lithobid and Eskalith.
Serotonin reuptake inhibitors -- These are drugs used to boost serotonin levels by blocking reuptake of serotonin by nerve cells. Some common SSRIs include Celexa, Prozac, Paxil and Zoloft.
Bupropion -- This is an antidepressant that is also used to help people stop smoking. Common brands include Zyban and Wellbutrin.
Anti-migraine medications -- Some common brands include Axert, Amerge and Zomig.
Pain medications -- Some pain medications that may contribute to serotonin syndrome include Demerol, Ultram and Sublimaze.
Herbal supplements -- Ginseng and St. John's Wort impact serotonin levels and may cause serotonin syndrome.
Over-the-counter cough medication: Brands that include dextromethorphan, such as Robitussin and Sudal.
Illegal drugs: Drugs that affect serotonin, such as LSD and Ecstasy can cause serotonin syndrome.
Antibiotics: Zyvox can interact with other drugs to cause serotonin syndrome.
HIV medication: Norvir can interact with other drugs to cause serotonin syndrome.

If you're taking any of these drugs, it's important that you consult with your mental health care professional and your general health care provider to limit the risk of being prescribed drugs that may cause an interaction that results in serotonin syndrome. Serotonin syndrome is easily treatable, but the medical community at large is not as informed about it as they should be, so its important that you be aware of serotonin syndrome and your chances of developing this condition.

Some people are more likely to develop serotonin syndrome than others, based on heredity and past medical history. Folks at particular risk of developing serotonin syndrome are people who have started therapy with an antidepressant that impacts serotonin levels, people who take illegal drugs and people who improperly mix prescription antidepressants and/or illegal drugs.

Serotonin syndrome is dangerous, but easily treatable if health care providers know what to look for. Understanding your medications and how they might cause serotonin syndrome can be valuable knowledge in the event that you start suffering the symptoms of serotonin syndrome.

A recent survey found that in 2005 about 7,000 cases and more than 100 deaths related to serotonin syndrome were reported. Experts believe that serotonin syndrome is often underreported, because the medical community is currently underinformed about this condition. Another recent survey found that nearly 85 percent of emergency health care providers were underinformed about serotonin syndrome.

Boosting patient and doctor knowledge of this condition is key to preventing more deaths and mitigating the negative impact of this condition.

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