Treating Serotonin Syndrome

Written by Fred McConnell

Serotonin syndrome is a potentially deadly condition caused by a surfeit of the neurotransmitter serotonin in the brain. It's most often caused by interactions between serotonin-affecting drugs and other medications, and can be treated effectively if diagnosed properly by doctors.

Serotonin is a neurotransmitter in the brain that impacts mood, memory and cognition, among other things. Too little serotonin can result in depression and other psychological disorders. Too much can result in various systems in the brain going haywire, producing symptoms such as extreme irritability, vomiting and nausea, hallucinations and coma.

Serotonin syndrome was first identified in the early 1980s. Cases of serotonin syndrome have increased since then as the condition has been identified more often by health care providers, as recreational use of drugs like LSD and MDMA has increased and as antidepressants using serotonin-affecting chemicals have become more popular as a means of treating depression. According to a recent survey, serotonin syndrome resulted in thousands of hospital visits and more than 100 deaths in the early 2000s.

Despite the growing incidence of serotonin syndrome, emergency responders as a whole remain largely unaware of how the condition presents, leaving a serious knowledge gap in the treatment of this condition. According to a recent survey, almost 85 percent of doctors may be unaware of serotonin syndrome. This lack of knowledge may also extend to the pharmacy, where pharmacists may be unaware of how serotonin syndrome may be caused by interactions between various drugs, including over-the-counter cold medicine.

Increasing awareness among the medical community regarding serotonin syndrome is key to successfully treating patients who have the condition, and possibly saving lives.

How serotonin syndrome is treated

Health care providers generally diagnose serotonin syndrome by asking the patient, or the person accompanying the patient about their medical history and the medications they are currently taken. If the medications fit the pattern, and the patient displays three of the symptoms of serotonin syndrome, doctors usually will make a diagnosis of serotonin syndrome and begin treatment.

When health care providers have diagnosed a patient with serotonin syndrome, there are a number of treatment options that they can avail themselves of. How a health care provider chooses to treat serotonin syndrome depends upon the severity of the patient's symptoms. While serotonin syndrome can be life threatening, the risk to most patients is much less severe.

For minor symptoms, a thorough doctor's visit and prescribed medication will likely be enough to take care of the problem. For patients with moderate symptoms, health care providers may recommend that the patient be kept under observation in a hospital environment. For more severe cases of serotonin syndrome, treatment may include a variety of medications, including paralytics, and a more lengthy hospital stay.

Depending on the patient's symptoms and their severity, the patient may receive treatments that include:

Muscle relaxants like Valium and Ativan that can help control symptoms including agitation, muscle stiffness and seizures.
Drugs like Breviblocc and Nitropress that will act to control heart rate or blood pressure. Heart rate and blood pressure problems are among the most severe symptoms of serotonin syndrome, and must be treated aggressively.
Drugs that block serotonin production. If your brain has too much serotonin floating around, the best thing to do is to carefully lower the level. Drugs like cyproheptadine can help to reduce serotonin production.
Oxygen and IV may be used in some cases to help maintain a normal level of oxygen in the blood and to help ward of dehydration and fever.
Paralytics and a breathing apparatus are used in severe cases to mitigate fever and to prevent muscle damage.

Other treatments include activated charcoal to induce vomiting to remove undigested serotonin-affecting medication, ice for fever and benzodiazepines for rigidity, agitation and seizures.

The good news is that in most cases, treatment of serotonin syndrome will be successful in less than 24 hours. Following successful treatment for serotonin syndrome, patients will likely need to seek a change in their prescription drugs or a rehabilitation program if their serotonin syndrome was caused by illegal drug use.

Serotonin syndrome is a treatable condition, and with greater awareness, more patients can be successfully treated for it. Also, with greater knowledge regarding serotonin syndrome, doctors, pharmacists and patients can make better choices regarding medications to avoid the development of serotonin syndrome.

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