Serotonin syndrome is a life-threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells. It is an iatrogenic (i.e. caused by medical treatment) toxidrome. Serotonin syndrome is caused by increased serotonin in the central nervous system. It is the result of overstimulation of 5-HT1A receptors in central grey nuclei and the medulla and, perhaps, of overstimulation of 5-HT2 receptors. Serotonin syndrome is not a spontaneous drug reaction, it is a consequence of excess serotonergic activity at central nervous system (CNS) and peripheral serotonin receptors. Serotonin syndrome can occur when you take certain combinations of prescription medications that affect serotonin levels in your body.

Signs and symptoms of serotonin syndrome range from restlessness and rapid heartbeat to muscle rigidity and seizures. Severe case often have agitated delirium as well as muscular rigidity and high muscular tension. Temperature may rise to above 41.1°C (105.98°F) in life-threatening cases. Other abnormalities include metabolic acidosis, rhabdomyolysis, seizures, renal failure, and disseminated intravascular coagulation. Risk factors for the development of serotonin syndrome are unclear, but some trends are becoming apparent as more cases appear in the literature. Peripheral vascular disease and atherosclerosis may lead to severe vasospasm and hypertension in the presence of elevated serotonin levels. Another risk factor relates to drug metabolism rate.

Slow metabolizers of SSRIs (approximately 7% of the population) may produce higher than normal levels of these antidepressants in the blood. Serotonin syndrome can be life threatening. The most important treatment is to discontinue the offending agent. Benzodiazepines, such as diazepam (Valium) or lorazepam (Ativan), can help control agitation, seizure-like movements and muscle stiffness. Moderate cases should have all thermal and cardiorespiratory abnormalities corrected and can benefit from serotonin antagonists (i.e. cyproheptadine). Esmolol (Brevibloc) or nitroprusside (Nitropress) drugs to reduce an increased heart rate or high blood pressure. If other treatments aren't working cyproheptadine (Periactin), a drug that blocks serotonin production.

Serotonin Syndrome Treatment Tips

1. Cyproheptadine (Periactin), a drug that blocks serotonin production.

2. Lorazepam and diazepam have been shown to be effective in treating serotonin syndrome.

3. Benzodiazepines, such as diazepam (Valium) or lorazepam (Ativan), can help control agitation.

4. Rigidity, seizures, and agitation are treated with benzodiazepines.

5. Esmolol or nitroprusside drugs to reduce an increased heart rate or high blood pressure.