Serotonin Syndrome

Confusion

Written by Fred McConnell

Although serotonin syndrome is becoming increasingly prevalent as antidepressants that use serotonin-influencing chemicals are seeing more widespread use, the medical community remains largely uninformed concerning this potentially deadly condition. According to a recent survey, nearly 85 percent of doctors are unaware of serotonin syndrome as a clinical diagnosis. This puts patients at a particular risk because serotonin syndrome requires quick treatment to avoid lasting problems or possibly death and because other medical conditions can be easily mistaken for serotonin syndrome. Serotonin syndrome occurs when too much serotonin is present in the brain. Serotonin is a neurotransmitter, or messenger chemical, that relays messages throughout the brain. Serotonin is also used in other parts of the body, such as in the gastrointestinal system where it controls muscle movements. Only a small amount of the body's serotonin is present in the brain, but the chemical affects nearly everyone of the brain's cells. Serotonin is involved in many of the brain's functions, including memory, cognition and behavior. Researchers have found that increased levels of serotonin can stimulate nerves to make patients have a greater sense of well-being and contentment. Because of this, drugs that affect serotonin levels have become a popular method of treating major depression and other psychological problems. Everyone is different, and the right serotonin level for one person may not be the right level for another. Occasionally, when patients start a new treatment using serotonin-affecting antidepressants they may suffer an excess of serotonin, which can cause certain brain functions to go haywire. This can also be caused by interactions between these drugs and other antidepressants or reactions to illegal drugs or dietary supplements like ginseng and St. John's Wort that impact serotonin. The symptoms of serotonin syndrome are terribly unpleasant, but can easily be confused with other conditions. Here's a list of "false friends" that serotonin syndrome can be confused with. Neuroleptic malignant syndrome is a potentially life-threatening condition caused by a reaction to antipsychotic or neuroleptic drugs. The condition is similar to serotonin syndrome in that it often presents with muscle rigidity, autonomic instability, fever and delirium -- all symptoms of serotonin syndrome. While some of the treatment options for serotonin syndrome and NMS are similar, others or not and a misdiagnosis can cause complications in treatment. Anticholinergic syndrome is a condition caused by an overdose of anticholingeric drugs. Anticholingeric drugs are used to treat a variety of respiratory and gastrointenstial disorders. Much like serotonin syndrome, anticholinerigic syndrome can cause symptoms such as fever, delirium, irregular heartbeat and coma. Drugs used to treat anticholinergic syndrome are different than those used to treat serotonin syndrome, so a misdiagnosis could worsen problems caused by the condition. Also, diagnosis can be difficult because some of the illegal drugs that can cause anticholingeric syndrome can also cause serotonin syndrome. In addition to neruoleptic malignant syndrome and anticholinergic syndrome, various other problems such as certain thyroid conditions and alcohol and heroin conditions can be mistaken with serotonin syndrome. A misdiagnosis can be fatal for patients who are experiencing serotonin syndrome.  1984, serotonin syndrome became a cause celebre when the daughter of a prominent New York journalist died in a hospital because doctors failed to recognize that she was suffering from serotonin syndrome and as a result didn't take the correct treatment course. The hospital was sued, and the suit resulted in new guidelines concerning work hours for doctors and supervision of residents. Although this case happened nearly 30 years ago, serotonin syndrome remains too unnoticed by health care professionals. Increased awareness is necessary to help doctors recognize this potentially deadly condition and treat it effectively. The key to avoiding a misdiagnosis is for patients to be aware of their medications, and their chances of developing serotonin syndrome, increased awareness in the medical community concerning serotonin syndrome and good communication between patients and health care providers regarding their medications. A recent survey revealed that more than 7,000 cases of serotonin syndrome and 100 deaths from the condition were reported in 2005. Experts expect more cases and more deaths as antidepressants using serotonin-affecting chemicals become more widespread. Increasing awareness of this condition in the medical community is key to lowering these numbers and allowing more patients to be treated efficiently and effectively for this condition.

 

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