A sharp increase in serotonin levels is a rather serious condition, which is accompanied by a mass of disturbances in the work of the whole organism. As a rule, such changes are the result of taking certain medications or an overdose of certain drugs. In the absence of timely medical care, such a situation is fraught with dangerous, sometimes irreversible, consequences. That is why it is worth considering information about what are the main causes and symptoms of serotonin syndrome. What treatment methods can modern medicine offer and what is the reason for the lack of therapy?
Serotonin syndrome: what is it?
In fact, the first information about this condition appeared not so long ago. In 1960, the first studies on this subject were published in the United States. The fact is that the causes of the syndrome, which, in fact, is accompanied by a sharp increase in the amount of this substance in nerve cells, are more or less associated with the use of antidepressants.
As you know, serotonin deficiency syndrome leads to the development of depressive states. And in the last century, a cure for such disorders was invented, now known as "antidepressants." Such drugs help to increase the level of serotonin, popularly known as the "hormone of happiness." Under their influence, chronic fatigue and apathy gradually pass, and a person gradually returns to a normal rhythm of life. Nevertheless, in too large quantities, serotonin acts as a toxin, destructively affecting nerve cells, causing a lot of disorders in the body. A similar syndrome can be a result of taking antidepressants, or a combination of antidepressants and other drugs (for example, some cough syrups, etc.).
In fact, in the modern world, cases of serotonin syndrome are not recorded so often. But, according to doctors and researchers, this happens only because this disorder is masked under a mass of imperceptible symptoms, which are usually attributed to nervous strain or fatigue. That is why it is worth knowing why serotonin syndrome can occur, what it is and what signs are accompanied.
The main functions of serotonin
It is worth knowing the mechanism of action of the “hormone of happiness” before considering the question of how and why serotonin syndrome develops. What is this substance? The main function of serotonin is the regulation of the functions of certain neurons in the brain. Passing through a synaptic cleft from one neuron, this substance reacts with special receptors in the membrane of a neighboring nerve cell, activating it and triggering a nerve impulse.
There are several systems that allow you to regulate the amount of serotonin in the body. In particular, this is reuptake, in which the molecule returns to the process of the first neuron (by the way, most antidepressants are serotonin reuptake inhibitors), as well as enzymatic regulation, in which special active substances break down the hormone molecule.
Serotonin regulates many processes in the body, including:
- periods of sleep and wakefulness;
- appetite;
- the development or disappearance of a feeling of nausea;
- human sexual behavior;
- thermoregulation mechanisms;
- pain perception;
- muscle tone support;
- digestive tract motility;
- regulation of vascular tone;
- Serotonin has been shown to be involved in the development of migraines.
As you can see, “hormones of happiness” provide the human body with not only a feeling of euphoria. After studying the functions of this substance, you can roughly imagine the symptoms of serotonin syndrome. By the way, the maximum concentration of the hormone is observed in the brain stem and reticular formation.
Serotonin syndrome: biochemistry. What can provoke a violation?
As already mentioned, this violation for the most part develops against the background of taking certain drugs or their combinations. So what drugs can trigger the development of such a dangerous pathology as serotonin syndrome?
- Cipralex and other synthetic serotonin and monoamine oxidase reuptake inhibitors.
- Concomitant use of monoamine oxidase inhibitors and thyroid hormones, Clomipramine, Carbamazepine, Imipramine and Amitriptyline.
- The combination of MAO inhibitors and some drugs used for weight loss, in particular, "Desopimon", "Fepranona."
- A combination of SSRI or MAO inhibitors with drugs containing L-tryptophan, St. John's wort extract and ecstasy.
- The combination of antidepressants with lithium preparations, in particular, Kontemnol and Quilonium.
- The simultaneous use of inhibitors with dextromethorphan (a substance that is found in many cough syrups, including Kaffetin Cold, Glycodin, Tussin Plus, and some others.
- The combination of serotonin reuptake inhibitors with drugs such as Dihydroergotamine, Sumatriptan (migraine medication), Levodop (used for Parkinson's disease).
- There is evidence that serotonin syndrome can develop with alcohol consumption during antidepressant therapy.
It is immediately worth saying that it is almost impossible to predict whether the syndrome will develop against the background of the therapy prescribed by the doctor. It all depends on the dose of drugs, the individual characteristics of the patient’s body, his age and many other factors. Nevertheless, if you have been prescribed antidepressants, then be sure to tell your doctor about all the medicines you are taking and be sure to consult about introducing new ones into the treatment regimen, even a regular cough syrup.
The main characteristics of the clinical picture
How does serotonin syndrome develop? Signs of it in half the cases appear 2-4 hours after taking the drugs. But the first symptoms may appear in a day. In connection with the main functions of serotonin, all possible disorders are usually divided into three main groups:
- mental disorders;
- problems from the muscular and peripheral nervous systems;
- vegetative disturbances.
All possible symptoms will be described below, but first you need to say that different violations separately are not the basis for making such a diagnosis. Only a full examination, laboratory tests and the presence of a complex of certain symptoms and possible risk factors make it possible to diagnose an excess of serotonin in nerve tissues.
Mental disorders due to syndrome
How to recognize serotonin syndrome? Symptoms usually begin with mental disorders, including:
- emotional arousal;
- inexplicable, unreasonable feeling of fear and anxiety, sometimes even up to panic attacks;
- sometimes a different picture is observed - a person experiences a feeling of euphoria, intense joy, a desire to move, speak incessantly, and do something;
- impaired consciousness;
- in more severe cases, the appearance of delirium and hallucinations is observed.
It is worth noting that the symptoms and their severity directly depend on the severity of the toxic effect. For example, sometimes only mild arousal is observed. In other cases, there is an aggravation of the symptoms of the underlying disease (for example, depression), due to which the medication continues. In the most severe cases, the patient suffers from disorientation, gets confused in the world around him and his own personality, suffers from delirium and various hallucinations.
The main autonomic symptoms
There are other symptoms that accompany serotonin syndrome. The harm from a sharp jump in the level of this substance may look different. In particular, vegetative disorders are observed, including the following:
- dilated pupils and increased lacrimation;
- increased heart rate, tachycardia;
- increased respiratory rate;
- sometimes there is an increase in body temperature (as a rule, it is small, but in some patients a fever of 42 degrees was recorded);
- a sharp increase in blood pressure with concomitant symptoms up to loss of consciousness;
- the appearance of dry mouth and some other mucous membranes;
- acceleration of the motility of the digestive tract, which, in turn, can lead to disorders such as diarrhea, severe nausea and vomiting, flatulence, bloating and abdominal pain of varying severity;
- feeling of chills;
- headaches, sometimes migraines.
As you can see, the signs of this pathology are not too specific, since dozens of other diseases can be accompanied by the same symptoms.
Neuromuscular disorders on the background of the syndrome
As already mentioned, serotonin regulates the transmission of nerve impulses. That is why a change in the level of this substance affects neuromuscular activity. Here is a list of possible disorders:
- increased intensity of tendon reflexes (reflexes of the lower extremities are especially pronounced);
- increased muscle tone, sometimes up to muscle stiffness;
- rapid involuntary and irregular contractions of individual muscles (sometimes even entire muscle groups);
- trembling in the limbs;
- involuntary movements of the eyeballs (in medicine, the term "nystagmus" is used for this);
- sometimes there is a so-called cramp of gaze, which is accompanied by involuntary rolling of the eyeballs up or down;
- epileptic seizures are occasionally recorded;
- impaired coordination;
- problems with speech, its blur and inaccuracy, which appears due to involuntary muscle contraction of the articulation apparatus.
It should be understood that all the above signs of serotonin syndrome are extremely rare. In most cases, patients suffer only from some disorders, and therefore the diagnosis of pathology is a rather difficult process.
The severity of the pathology
In modern medicine, it is customary to distinguish three degrees of severity of the development of the syndrome, namely:
- A mild degree of pathology is accompanied, as a rule, by excessive sweating, a slight trembling in the hands and knees, and a not too pronounced increase in the frequency of heart contractions. Reflexes also become slightly pronounced, although body temperature does not rise. Sometimes the patient may notice dilated pupils. It is only natural that people with such symptoms rarely go to the doctor and continue to take drugs, because the above symptoms may well be caused by stress or overstrain.
- With moderate disease, the clinical picture is more pronounced. Patients note a sharp increase in body temperature (often up to 40 degrees) and blood pressure, persistent expansion of the pupils, contraction of the muscles of the extremities, motor and mental arousal. As a rule, such symptoms make a person seek help, but unfortunately, it is not always possible to make a correct diagnosis.
- A severe degree of serotonin syndrome is extremely dangerous, as it can lead to complications. With this form of pathology, severe tachycardia, increased blood pressure, fever, muscle cramps up to stiffness, nervous disorders, disorientation are observed. Patients, as a rule, have very bright hallucinations. In the absence of timely assistance, damage to the muscles, liver and kidneys is possible. Often patients fall into a coma. Occasionally, multiple organ failure develops, which usually ends in death.
That is why in no case should you ignore the symptoms, since under normal overwork fatigue can mask the serotonin syndrome. How to get out of this condition and are there any effective methods of treatment?
First aid in similar condition
What to do if a person is suspected of serotonin syndrome? Emergency care, as a rule, is to immediately stop taking the drug that triggered this condition. Naturally, the patient should definitely be taken to the hospital.
First of all, gastric lavage is carried out, thanks to which it is possible to cleanse the body of a medicine that has not yet been assimilated. For the same purpose, patients are prescribed sorbents and other drugs that remove toxins from the body. In mild cases, such activities are enough to make a person feel better. Symptoms subside after 6-12 hours.
How is the syndrome treated?
Unfortunately, the abolition of drugs and cleansing the body of their residues is far from always enough. So what therapy does serotonin syndrome require? The treatment, of course, depends on the stage and severity. Typically, serotonin receptor antagonists are prescribed to the patient, including Metisergide and Cyproheptadine. In addition, symptomatic therapy is carried out, which directly depends on the presence of certain violations.
- For example, with epileptic seizures and muscle stiffness, benzodiazepines are prescribed, including Lorazepam and Sibazon.
- If there is a fever, cold rubdowns and some other procedures are performed. The fact is that an increase in temperature with serotonin syndrome is not associated with inflammation, but with increased muscle contraction, and therefore conventional antipyretic and non-steroidal anti-inflammatory drugs have no effect. The only exception is paracetamol, although it must be used with caution.
- When the temperature rises to 40 or more, muscle relaxants are administered to the patient. These drugs help to relax muscles, eliminate fever, and prevent the development of various disorders, including blood clotting problems.
- Intravenous infusions are also given, as increased sweating, muscle tension and diarrhea lead to dehydration.
- In addition, it is necessary to monitor the blood pressure and heart rate of the patient, if necessary, normalize these indicators with the help of drugs.
In most cases, the correct treatment allows you to quickly improve the patient's condition and avoid the consequences. Unfortunately, in rare cases, especially if the patient was not provided with timely medical care, serotonin syndrome can lead to the breakdown of muscle tissue, damage to the kidneys and liver, nerve endings and, ultimately, death. That is why in no case should you take rash antidepressants and other medications.