Further, there is no lab test to confirm the diagnosis of this condition. Rather lab tests are generally used to rule out other medical problems.
Unfortunately, mild serotonin toxicity can progress rapidly, especially if the medication causing the problem is not immediately stopped. For this reason, it is vital to catch symptoms early before a more serious condition develops. The onset of serotonin syndrome can happen quickly. A person may experience symptoms within a few hours of taking the medication that alters serotonin levels. Mild serotonin syndrome symptoms often includes the following:.
Given the prevalence of these symptoms among other diseases and ailments, it is easy to see how the signs of mild serotonin syndrome can be overlooked. If the above symptoms are noted in any individual, it is important to call immediately as serotonin syndrome can be fatal if not treated.
Usually, the doctor will eliminate the presence of other conditions first. Other conditions that can be confused with serotonin syndromes include infections i.
Serotonergic agents are substances that alter serotonin levels in the body. Oftentimes, a person is prescribed a serotonergic agent to address a mental illness such as depression.
Examples of serotonergic agents include antidepressants such as:. In addition, many prescription drugs and over-the-counter remedies can cause an increase in serotonin levels.
While serotonin syndrome may occur after taking a single medication, this is unlikely. Rather, it is usually the result of a combination of products that increase serotonin or alters serotonin uptake. Alternatively, someone may intentionally or accidentally take too much of the same medication causing a serotonin overdose.
Examples of other serotonergic drugs that pose a danger if they are combined serotonin increasing drugs include:.
To avoid severe serotonin toxicity, It is important to be vigilant of symptoms of mild serotonin syndrome when switching medications, increasing dosages, or beginning a new medication.
Fortunately, mild serotonin syndrome will resolve when the medication is stopped or corrected. And usually, mild serotonin syndrome recovery takes anywhere from one to three days. However, if mild serotonin toxicity is not caught it could progress very quickly, resulting in a medical emergency.
Treatment for severe symptoms of serotonin toxicity includes immediate cessation of serotonergic drugs and drugs like benzodiazepines may be administered to relieve any muscular symptoms. One of the best things you can do is be aware of your prescriptions and supplements, especially if you have a condition like depression that requires one of the products that alters serotonin.
Alternatively, using these medications in conjunction with recreational drug use or combining serotonin-enhancing prescriptions with illegal drugs will elevate the risk of serotonin overdose. Symptoms of serotonin syndrome can range from mild to life threatening.
In extreme cases, body temperature can become very high, muscles may break down, and a person may go into shock. Of those cases, 7, were considered moderate or severe, and 93 resulted in death.
Just two years later, there were 48, cases, 8, moderate or severe cases, and deaths. The key to successful treatment is early recognition. Lab tests don't help much, so doctors need to be aware of the signs and symptoms," said Su. According to the AACN Advanced Critical Care study, having a history of taking a serotonin-raising drug and having three of the major symptoms or signs of serotonin syndrome are enough to make the diagnosis.
Blood tests may be done to look for drugs that raise serotonin levels. Serotonin syndrome usually requires treatment in a hospital. The first step is to stop any drugs that raise serotonin. You may need medication to control anxiety and relieve muscles spasms and possibly a drug that blocks serotonin production, cyproheptadine. Sometimes we need to crush it and give it through a nasogastric tube.
Diagnosis of SS depends on physical examinations. We suggest that any patient on serotonergic drug, if develops any new symptom, should be examined for the presence of tremor, hypertonia, hyperreflexia, and clonus. It is a retrospective study and possibilities of unrecognized selection bias and recall bias exist.
Temporal relation of onset of clinical features with administration of serotonergic drugs and the presence of various physical signs clonus, hyperreflexia, etc. In the same way, resolution of symptoms by removal of the offending agents and treatment with cyproheptadine reconfirm the possibility of SS.
However, we cannot rule out a possibility of another cause as full evaluation for secondary cause was not done on each patient.
As there is no guideline for the treatment of mild SS, the management protocol was not standardized. A possibility of placebo response is also there in these patients and spontaneous remission may occur in a few patients.
The incidence of SS is increasing with widespread use of proserotonergic agents. But, it is highly under diagnosed condition. Under diagnosis is more likely with mild SS.
Every patient with mild SS is a potential candidate for developing life-threatening, severe SS. There is a need to increase its awareness. It is suggested that every patient on serotonergic drug should be examined for the presence of tremor, hypertonia, hyperreflexia, and clonus. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Ann Indian Acad Neurol. Author information Article notes Copyright and License information Disclaimer.
For correspondence: Dr. E-mail: ni. Received Sep 16; Accepted Nov This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Serotonin syndrome SS is an under diagnosed and under reported condition. Keywords: Antidepressant, clonus, cyproheptadine, drug toxicity, selective serotonin reuptake inhibitors, serotonin syndrome, tremor.
Introduction Serotonin syndrome SS is a drug-induced constellation of various clinical features. Materials and Methods This study was conducted as a retrospective chart review of 12 consecutive patients observed over 12 months in neurology outpatient clinic who had hyperreflexia with tremor and had taken serotonergic agents in the past 5 weeks. Table 1 Details of patients with mild serotonin syndrome SS. Open in a separate window.
Results The median age at symptom onset was Table 2 Clinical details of 12 patients with mild serotonin syndrome. Limitations It is a retrospective study and possibilities of unrecognized selection bias and recall bias exist. Conclusion The incidence of SS is increasing with widespread use of proserotonergic agents.
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