NC Neuropsych

Definition
Serotonin syndrome is a condition characterized by dangerously high levels of serotonin — a chemical produced by nerve cells — in your body.
Serotonin
… is a neurotransmitter that controls anger, aggression, body temperature, mood, sleep, sexuality, appetite, and metabolism, and it stimulates vomiting
Causes of Serotonin Syndrome
Serotonin syndrome can occur when you take certain combinations of prescription medications that affect serotonin levels in your body.
It can also occur when you start a single new drug that affects serotonin levels or when you take an increased dose of such a drug that you've previously used.
Medications that cause serotonin syndrome
They may include, but are not limited to the following:

Symptoms
Signs and symptoms of serotonin syndrome typically occur within several hours of taking a new drug or taking a previously used drug at an increased dosage level, and may include:
 Extreme agitation or restlessness
 Confusion
 Hallucinations
 Loss of coordination
 Fast heartbeat
 Rapid changes in blood pressure
 Fever
 Heavy sweating
 Overactive reflexes
 Nausea, vomiting and diarrhea
 Seizures
 Coma
 Shivering
 tremor
How it’s diagnosed
There are no specific blood tests or radiology tests to diagnose. The diagnosis is based on symptoms and medication history.
Treatments and drugs
Serotonin syndrome is treated by stopping any medications you're taking that could be increasing your serotonin levels. Your doctor also may keep you in the hospital for observation for several hours. Serotonin syndrome often resolves within 24 hours of stopping any medication that increases serotonin and starting any necessary treatment.
More severe cases of serotonin syndrome may require additional medications and longer hospitalization. Depending on your symptoms, you may receive the following treatments:
 Monitoring your vital signs, such as heart rate, blood pressure and temperature, and treating those as needed.
 Muscle relaxants. Benzodiazepines, such as diazepam (Valium) or lorazepam (Ativan), can help control agitation, seizure-like movements and muscle stiffness.
 Serotonin-production blocking agents. If other treatments aren't working, the drug cyproheptadine can help by blocking serotonin production.
 Drugs that control heart rate and blood pressure. These could include esmolol (Brevibloc) or nitroprusside (Nitropress) to reduce an increased heart rate or high blood pressure, or phenylephrine (Neo-Synephrine) or epinephrine to increase blood pressure that's too low.
Prevention
Inform all your providers of all medications you are taking, including over the counter medications. Don’t stop taking any medications on your own. Increasing or decreasing doses of serotonin related drugs can cause serotonin syndrome. So, do it under your provider’s instructions only.
If you experience any of the mentioned symptoms, contact you provider.