Serotonin syndrome What we need to know

Serotonin syndrome is the body's reaction to various medications. It develops in response to taking drugs that increase the concentration of serotonin in the body.

What is serotonin?

Serotonin, also known as 5-hydroxytryptamine, is a neurotransmitter that transmits chemical signals from the brain to various organs and tissues through the peripheral nervous system. It also has hormonal properties.

Serotonin is involved in a number of functions in the body, such as: learning, memory, feeling happy, regulating body temperature, sleep, hunger and sexual behavior. Serotonin deficiency plays an important role in the development of anxiety, depression, mania and other pathological conditions.

Serotonin is produced from the essential amino acid tryptophan.

90% of the serotonin found in the body is produced in the lining cells of the intestines. Only 10% is synthesized in the brain stem.

What does serotonin do in the body?

mood

Serotonin in the brain is involved in mood regulation. It is often called the hormone of happiness. With a normal concentration of serotonin, a person is more focused, emotionally stable, calm and happy. Its low level causes mood instability and depression. The effect of anti-depressant and anti-anxiety drugs is precisely to increase the level of serotonin.

digestion

The main volume of serotonin is concentrated in the digestive tract. It controls bowel function. The release of serotonin in the intestine is enhanced to speed up the digestive processes or to quickly get rid of toxic products.

Nausea

Nausea occurs when serotonin is released into the gut faster than it can be digested. This chemical message is received by the brain and nausea develops in response. The effect of anti-nausea-vomiting drugs is caused by inhibition of serotonin receptors in the brain.

sleep

Serotonin and dopamine are important neurotransmitters that ensure sleep quality: duration and depth. Serotonin is also involved in the synthesis of melatonin. Melatonin is a hormone that regulates the sleep-wake cycle.

 wound healing

Serotonin is released into the blood by platelets and participates in the wound healing process. It is also involved in the narrowing of small-caliber blood vessels, which slows the flow of blood to the wound and helps the process of thrombus formation.

Bone metabolism

High levels of serotonin in the small intestine lead to decreased bone mineralization.

Serotonin syndrome

Serotonin syndrome is a condition in which the level of serotonin in the body increases dramatically. As a rule, this is associated with an increase in the dose of drugs that affect the concentration of serotonin in the body.

Causes of serotonin syndrome

Serotonin synthesis is carried out both in the nerve cells of the head and spinal cord, as well as in the autonomic nerve cells of the gastrointestinal tract.

The development of serotonin syndrome is usually the result of taking several medications affecting its concentration.

In particular, the combination of serotonin-containing anti-migraine drugs and tricyclic antidepressants can cause serotonin syndrome.

• Selective serotonin reuptake inhibitors
• Serotonin and norepinephrine reuptake inhibitors
• Medicines to overcome tobacco addiction
• Tricyclic antidepressants
• Monoamine oxidase (MAO) inhibitors
• Anti-migraine drugs: triptans, carbamazepines
• Opioid pain relievers
• Lithium preparations
• Anti-vomiting medications
• Antibiotics of some groups
• Anti-retroviral drugs

Some illegal drugs and nutritional supplements can also cause serotonin syndrome.

• amphetamines
• herbal supplements

Serotonin syndrome  Risk factors

People who take:

• High doses of drugs containing serotonin
• Combinations of drugs containing serotonin
• herbal or nutritional supplements
• drugs of unknown origin and narcotics

Symptoms of serotonin syndrome

Symptoms of serotonin syndrome begin to appear shortly after taking the medication or increasing the dose.

The intensity of symptoms varies from mild to extreme manifestations:

• Anxiety and restlessness
• Insomnia
• confusion of consciousness
• Increase in blood pressure and pulse
• Mydriasis (dilated pupils)
• Muscle tension and coordination deterioration
• Sweating
• Diarrhea
• Shivering

Severe serotonin syndrome also develops:

• high fever
• Tremor of limbs
• Hearts
• Arrhythmia
• Suppression of consciousness

Mild symptoms resolve on their own within a few days. But, if the condition worsens, it is necessary to consult a specialist.

Serotonin syndrome  Complications

If the concentration of serotonin returns to normal in time, it does not pose a problem to health and life. However, a progressive increase in serotonin levels without treatment can be fatal.

Serotonin syndrome  Prevention

Taking more than one medication that affects serotonin levels always creates a risk of developing serotonin syndrome.

As soon as the symptoms appear, it is important to inform a family member or the attending physician in order to take the necessary measures in time.

Arbitrary discontinuation of the medication immediately after the development of symptoms may cause other complications, therefore, it is necessary to consult the attending physician to make the right decision.

Laboratory  "Synevo" We offer the determination of the following hormones:

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Resources

https://my.clevelandclinic.org/health/articles/23411-melatonin

n.manjaparashvili@synevo.ge