Modern view of serotonin syndrome: symptoms and treatment

Serotonin is not often called a "hormone of happiness", as its level rises in such moments as ecstasy and euphoria. The level of this hormone goes down during periods of depression.

But serotonin is not only necessary for developing positive emotions, it has much more functions. Lack of it in the body leads to depressive states. And taking certain medicines to raise its level provokes a serotonin syndrome.

Description of the syndrome and its features

Serotonin syndrome arises as a result of increased increase in activity of serotonergic systems, this effect is caused by metatoninomimetic means thatleads to motor, autonomic and mental disorders.

The administration of the following medicines can lead to serotonin syndrome:

• tricyclic and tetracyclic antidepressants;
• serotonin reuptake inhibitors;
• Tryptophan;
• amphetamines;
• MAO inhibitors;
• medication with lithium content;
• Bromocriptine and Pentazocine.

This condition can occur at the very beginning of taking medication or after the dose of the drug has been increased, the same syndrome develops at the time of the introduction of an additional medication.

As a result, a pathological process develops, which is manifested in a violation of the production of serotonin. If you ignore the symptoms of the disease may be fatal.

Serotonin intoxication - what are its causes?

The reason lies primarily in the violation of the norms for taking appropriate medicines. These are antidepressants of an inhibitory type, biological substances. The next reason for the appearance of serotonin syndrome lies in the intake of narcotic substances.

The diagnosis is relatively young, since the first information about this syndrome appeared only in the 60s of the last century in the USA.Doctors began to describe the behavior and condition of patients who were treated for depression through antidepressants.

Later, they established a relationship between the patient's condition and the intake of antidepressants with other medications. Doctors claimed that serotonin syndrome can occur even with a single dose of medication.

Unfortunately, statistics are not so great as to make unambiguous conclusions and there are several reasons:

The patient does not always seek medical help.

1. Even in the presence of symptoms similar to serotonin syndrome, doctors do not always make such a diagnosis.
2. Diagnosis is complicated by the fact that even with a worsening of the patient's condition, the presence in the blood of the substances of the medication taken does not exceed the permissible norm. Conversely, a high level of the drug in the blood does not always lead to the development of intoxication.
3. If serotonin intoxication develops on the background of taking drugs, then in this case there is no statistical data at all. Since all the signs of drug intoxication are treated as narcotic euphoria.

The first signs and the increase in symptoms

Doctors face with serotonin syndrome quite rarely, but, nevertheless, it is very dangerous. To help the doctor was timely, it is necessary to diagnose the condition in time.

Doctors do not define this syndrome in the category of diseases, it is rather a complication of the body, which is manifested by certain symptoms that are manifested in the violation of the work of the psyche, the vegetative system and neuromuscular disorders.

The first signs of the disease appear unexpectedly and skyrocket. At first it can be a little excitement, and this state can end with strong hallucinations up to a coma.

Thus, the initial signs of the syndrome include:

• weak stimulation of the emotional plan;
• weakness and drowsiness;
• apathetic condition;
• a joyous state, similar to euphoria, is expressed in the desire to immediately flee somewhere and do something;
• feeling of anxiety;
• fears on the verge of panic;
• a change of anxiety and euphoria;
• the appearance of confusion in the mind, the development of hallucinations and delusions;In rare cases, the
• develops a coma.

Vegetative disorders are primarily present in the digestive system disorder. They are expressed as follows:

• , the person begins to vomit, then vomiting occurs;
• in the epigastric region there are pain, bloating, diarrhea appears;
• headache;
• development of tachycardia, a person begins to breathe often;
• increase in body temperature, the patient is shivering;
• blood pressure changes;
• severe sweating and tear.

Symptomatic development

Neuromuscular disorders can manifest themselves in different ways. A limb may tremble in a person, in the worst case severe attacks develop.

Physicians identify the following types of manifestations of the syndrome:

• mental changes;
• increased activity of the ganglionic nervous system;
• disorders are similar to hyperactivity.

Serotonin syndrome is indicated by the following symptoms:

• tremor - a rhythmic twitching of limbs, or body;
• muscle contractions that a person can not control;
• numbness of certain body parts;
• active rotation of the eyeballs( nystagmus), while the patient can suddenly roll up his eyes;
• impaired coordination of movements;
• epileptic seizures;
• slurred speech.

Most often, serotonin syndrome develops immediately after taking a certain group of drugs or narcotics. In 50% of cases violations occur within 2 hours after receiving funds. In 20% of cases, complications develop in the first day. The remaining 25% can feel the changes in the next two days.

Three stages of the development of the syndrome

Serotonin syndrome is divided into three degrees of severity:

1. Easy degree .The heart rhythm is slightly increased, there is increased sweating, a small tremor in the limbs. The body temperature is not increased, while the pupils are dilated, and the reflexes are expressed. Usually in this state, patients do not go to the doctors, often without linking these symptoms with taking antidepressants. Therefore, an easy form is rarely diagnosed.
2. Degree of medium gravity .The heart rhythm is significantly increased, the work of the intestine is disrupted, epigastric pains occur, the pressure and body temperature are increased. Nystagmus develops and the eyeball rolls up. You can already see the mental excitement of a person, in which reflexes are raised, a tremor of extremities is felt.
3. Heavy stage .There is already developing a threat to the life of the patient. Expressed hypertension, tachycardia, hyperthermia, a person begins to rave, there is a disorientation in time and space. Developed vivid hallucinations. The muscle tone rises, consciousness is disturbed, strong sweating is observed. After that, blood coagulability, metabolic acidosis and muscle decay are disturbed. The liver and kidneys work in an increased mode, which leads to their failure, possibly, the development of multiple organ failure. All these disorders lead to a coma. A lethal outcome is possible. Fortunately, a severe degree is extremely rare.

Diagnostic Aids

Unfortunately, certain diagnostic techniques for this syndrome do not exist. The laboratory data only can reveal the developed complications. Basically, you need to monitor the patient.

If we talk about determining the number of serotonergic drugs in the blood plasma, then most often they show a norm. And if there is a toxic concentration of drugs in the blood, this does not always lead to serotonin syndrome.

But, nevertheless, some diagnostic measures can help to identify this condition in its early stages, in the first place these are symptoms of the disease.

When taking the appropriate drugs, with increasing dosage or adding additional funds, you should monitor the patient's condition.

One or more frequently encountered symptoms - agitation, reflex reflexes, severe sweating, mental disorders, loose stools, febrile condition, myoclonus, tremor, etc. may indicate the beginning of serotonin syndrome.

The method of excluding other causes of development of this condition is also applied. These include encephalitis, neuroleptic manifestations, hyperthermia, poisoning and withdrawal syndrome of antidepressants, etc.

Providing medical care to

For treatment to be positive, it is necessary to abolish all drugs that the patient has previously taken. That is, those that act in a negative way on serotonin metabolism.

For drugs to be completely removed from the body, sorbents are assigned or gastric lavage is done. Then the doctor prescribes treatment that has a symptomatic focus. This is necessary to improve the patient's condition and to restore the body. Further, medications are prescribed to relieve agitation.

Infusion therapy with the use of droppers is also necessary. In order to restore the autonomic nervous system, sometimes strong means are needed.

If the patient experiences respiratory failure, as well as at elevated temperature, a breathing tube is introduced to perform pulmonary ventilation. If the case is extremely severe, serotonin antagonists are introduced.

It is very important to prevent the further development of the syndrome, so doctors recommend seeking help at the initial stages of the development of serotonin syndrome. If the symptoms of the disease are not removed within the first 12 hours, negative consequences are possible.

Here is an example scheme of symptomatic treatment of a patient with a serotonin syndrome:

• benzodiazepines ( Sibazon, Lorazepam) reduce muscle tone and rigidity, relieve mental agitation and epileptic seizures;
• preparations from the Paracetamol group to reduce body temperature;
• in severe cases are prescribed muscle relaxants ;
• intravenous infusion of is necessary with significant loss of fluid.

Mechanical methods can also help in the form of cool wiping or wiping with vinegar;

If timely assistance was not timely provided, the following complications may develop:

• renal failure;
• development of coma;
• has a negative effect on the cardiac muscle and blood vessels;
• is a damaging process in muscle tissues;
• violated acid-base metabolism in the body( metabolic acidosis);
• disrupts the process of blood clotting.

Preventative measures

At the beginning of treatment with drugs that affect the serotonin process, continuous monitoring by the attending physician is necessary. If there are any negative consequences, the drug is immediately canceled.

Knowing about the possible risk, all the drugs from the group of antidepressants are appointed with extreme caution.

The interval between drug intake or the appointment of new types of medication should be at least two weeks. An exception may be the preparation Fluoxetine, since washing time with its use lasts 5-6 weeks, and for elderly patients it is 8 weeks.