How to Treat Serotonin Syndrome

Serotonin is a natural chemical produced by the body. It functions as a neurotransmitter, which is a substance that sends messages between between nerve cells (neurons) in the brain and throughout the body. It is found primarily in the digestive system, the brain, and the platelets. In serotonin syndrome, there are dangerously high levels of serotonin, caused mainly by drugs, drug interactions, or rarely, by some supplements.[1] Common symptoms include agitation, confusion and disorientation, rapid heartbeat, chills, excessive sweating, and more. If you believe you have serotonin syndrome, learn how to treat it so you can stay healthy and safe.

Method 1
Method 1 of 3:

Treating Serotonin Syndrome

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    Stop the medication. If you have started a new medication or a new combination of medications and experience any of the milder symptoms listed, contact your doctor to talk about stopping the medication. If you cannot get in touch with your doctor, stop the medication until you talk to your doctor. For mild serotonin syndrome, the effects usually dissipate within one to three days.[2]
    • You should contact your doctor to let her know that you have stopped taking your medication. Your doctor may want to change you to a different medication.
    • You should only stop the medicine cold turkey if you have been on the medicine for less than a few weeks.
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    Contact your physician if you've been taking your medication for a while. If you have been on your medication for more than a few weeks, you should contact your doctor before getting off the medication. Many antidepressants and other medications that cause serotonin syndrome have serious side effects if you stop taking them suddenly.[3]
    • Your doctor needs to discuss with you other options so you will know how best to take any needed medications.
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    Take anti-serotonin medication. If your symptoms do not dissipate after a few days, you have been taking the medications that caused the serotonin syndrome for an extended period of time, or you are having any symptoms worrisome for severe serotonin syndrome (very high blood pressure, mental status changes, etc.), you need to seek medical attention immediately. You may need to take anti-serotonin medication to help treat the condition. A physician can prescribe these types of medications.[4]
    • if treated promptly and appropriately, the symptoms of serotonin syndrome usually resolve within 24 hours.[5]
    • Your doctor can monitor your symptoms to ensure that you are getting better.
    • One example of an anti-serotonin medication is cyproheptadine.
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    Contact emergency services if you experience the severe symptoms. If you have started a new medication or a new combination of medications and experience any of the more severe symptoms listed, stop the medication right away and contact emergency services. Experiencing the severe symptoms may mean that you are facing a potentially life-threatening condition. These severe symptoms can progress rapidly.[6]
    • Severe symptoms include high fever, seizures, an irregular heartbeat, and unconsciousness.
    • You may require hospital treatment for serious symptoms. You may be administered medications to block the action of serotonin, to relax the muscles, and to control heart rate and blood pressure. You may also be given oxygen therapy and IV fluids, along with any other assistance in breathing.
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    Conduct any additional tests. There is no single lab test to diagnose serotonin syndrome. It is mostly diagnosed based on your symptoms and the medications you are taking; however, other disorders may need to be excluded, such as drug withdrawal, malignant hyperthermia, overdose, and others.[7]
    • To exclude these other conditions, your physician or the hospital attendants may order tests to check for the other disorders.
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Method 2
Method 2 of 3:

Recognizing the Symptoms of Serotonin Syndrome

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    Check for symptoms of agitation. Serotonin syndrome is essentially an over-excitation of the nervous system, so the symptoms reflect this. You may feel agitation, restlessness, or irritability. Because of this, you may experience an increased heart rate and palpitations. Your pupils may also be dilated and you may have increased blood pressure.
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    Monitor for confusion or lack of coordination. Another common symptom of serotonin syndrome is confusion and disorientation. You may also experience pronounced clumsiness. Your muscles may feel uncoordinated, making it hard to walk, drive, or perform daily tasks.[8]
    • Your muscles may also end up feeling excessively rigid. You may also experience twitching muscles or muscle tics.
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    Watch for other bodily changes. If you have serotonin syndrome, you may also experience profuse sweating. Instead of sweating, you may experience shivering or have goosebumps break out over your body.
    • You may also experience diarrhea or headaches.
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    Check for severe symptoms. There are some symptoms associated with serotonin syndrome that indicate you are experiencing a serious reaction. These symptoms can be life-threatening, and if you experience them, you should call emergency services immediately. These symptoms include:[9]
    • High fever
    • Seizures
    • An irregular heartbeat
    • Unconsciousness
    • High blood pressure
    • Change in mental status
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    Know that the symptoms can start within a few hours. The symptoms of serotonin syndrome usually begin within a few hours of taking a prescribed medication, an OTC medication, or an herbal supplement. These symptoms are even more common when one or more of these substances are combined.[10]
    • The majority of cases of serotonin syndrome happen within six to 24 hours of a change in dose or starting of a new drug.[11]
    • Serotonin syndrome can be serious and life-threatening, so if you are taking any of the medications listed or have just started a new medication and experience any of the symptoms, call your physician, emergency services, or go to an emergency room right away.
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Method 3
Method 3 of 3:

Understanding Serotonin Syndrome

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    Learn the causes of serotonin syndrome. Any drug or substance that increases the amount of serotonin in the body (or decreases the breakdown of serotonin in the body) can cause dangerously high levels of serotonin in your blood and potentially cause serotonin syndrome. There are a number of drugs, mainly antidepressants, that can do this. This can happen especially if over-used intentionally or non-intentionally. Serotonin syndrome most often occurs when combining medication from different classes. These include:[12]
    • Selective serotonin reuptake inhibitors (SSRIs): These are antidepressants and include drugs like citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft).
    • Serotonin and norepinephrine reuptake inhibitors (SNRIs): These are a class of antidepressants similar to the SSRIs and include drugs like trazodone, duloxetine (Cymbalta), and venlafaxine (Effexor).
    • Monoamine oxidase inhibitors (MAOIs): This group includes antidepressants like isocarboxazid (Marplan) and phenelzine (Nardil).
    • Other antidepressants: These can include drugs like Bupropion (Wellbutrin, Zyban), and the Tricyclic antidepressants, including amitriptyline and nortriptyline (Pamelor).
    • Medications for migraines: This class includes the triptans (Axert, Amerge, Imitrex), carbamazepine (Tegretol), and valproic acid (Depakene).
    • Pain medications: These include drugs like cyclobenzaprine (Amrix and Fexmid), fentanyl (Duragesic), meperidine (Demerol), and tramadol (Ultram).
    • Mood stabilizers: The main drug in this category is Lithium (Lithobid).
    • Anti-nausea medications: These include the drugs granisetron (Kytril), metoclopramide (Reglan), droperidol (Inapsine), and ondansetron (Zofran).
    • Antibiotics and antiviral medications: This class includes Linezolid (Zyvox), which is an antibiotic and Ritonavir (Norvir). Ritonavir is an antiretroviral used to treat HIV/AIDS.
    • OTC cough and cold medications containing dextromethorphan: This group includes Delsym, Mucinex DM, and other OTC medications.
    • Recreational drugs: This group includes LSD, Ecstasy, cocaine, and amphetamines.
    • Herbal supplements: St. John's wort, ginseng, and nutmeg are in this group.
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    Prevent serotonin syndrome. To prevent serotonin syndrome, always let all physicians that you are working with know all the medications and supplements that you are taking. Supplements such as St John's wort can interact with prescription medications. Prescription medications can interact with each other. Taking prescribed medication from a physician who doesn't have all the facts can lead to problems.[13]
    • For example, if your physician doesn't know that you are taking Lithium because it was prescribed by another physician, and prescribes you an SSRI, this will increase your risk for serotonin syndrome.
    • Only take the amount of pills prescribed. Do not attempt to self-regulate your dose by taking more than directed by your doctor.
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    Identify who is at risk. People who take multiple kinds of medications from the drug classes which often lead to serotonin syndrome are at a high risk for the condition. It commonly occurs when you increase the dosage or start a new medication. If you take multiple medications from these classes, make sure to carefully monitor your symptoms, especially if you have just started a new medication.[14]
    • Serotonin syndrome can be dangerous and lethal, especially in the young, the old, or those with a history of heart disease.
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References

  1. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/
  2. ↑ http://www.aafp.org/afp/2010/0501/p1139.html
  3. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464814/
  4. ↑ http://patient.info/doctor/serotonin-syndrome
  5. ↑ http://www.ncbi.nlm.nih.gov/pubmed?term=9330840
  6. ↑ https://www.drugs.com/cg/serotonin-syndrome.html
  7. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464814/
  8. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/007272.htm
  9. ↑ http://patient.info/doctor/serotonin-syndrome
  1. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/007272.htm
  2. ↑ http://www.ncbi.nlm.nih.gov/pubmed?term=10941349
  3. ↑ http://patient.info/doctor/serotonin-syndrome
  4. ↑ http://www.aafp.org/afp/2010/0501/p1139.html
  5. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/007272.htm

About This Article

Mark Ziats, MD, PhD
Medically reviewed by:
Mark Ziats, MD, PhD
Internal Medicine Physician
This article was medically reviewed by Mark Ziats, MD, PhD. Dr. Mark Ziats is an Internal Medicine Physician, Scientist, Entrepreneur, and the Medical Director of xBiotech. With over five years of experience, he specializes in biotechnology, genomics, and medical devices. He earned a Doctor of Medicine degree from Baylor College of Medicine, a Ph.D. in Genetics from the University of Cambridge, and a BS in Biochemistry and Chemistry from Clemson University. He also completed the INNoVATE Program in Biotechnology Entrepreneurship at The Johns Hopkins University - Carey Business School. Dr. Ziats is board certified by the American Board of Internal Medicine. This article has been viewed 52,374 times.
71 votes - 77%
Co-authors: 7
Updated: September 26, 2022
Views: 52,374
Categories: Nervous System Health

Medical Disclaimer

The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.

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