The hormone serotonin is popularly considered to be the ultimate happiness hormone: It lifts the mood and puts you in a good mood. But what happens when it is in the body in a very large amount? Then it not only harms our health, but in the worst case even puts us in mortal danger. The Serotonin syndrome is therefore a serious disease.
What is Serotonin Syndrome?
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At the Serotonin syndrome it is a syndrome that is associated with different complaints. This disease is caused by the accumulation of the hormone serotonin, which functions both as a tissue hormone and as a neurotransmitter and has an impact on various body functions. Serotonin is located as a neurotransmitter in the central and peripheral nervous system.
There it takes on the task of activating many different receptors. As part of the central nervous system, it controls our attention and mood, for example, and is also responsible there for regulating body heat. In the peripheral nervous system, it influences the movement of the gastrointestinal tract as well as the bronchial and skeletal muscles.
In an appropriate amount, serotonin is therefore vital for the human organism. The term "serotonin syndrome" was coined by H. Sternbach, who in 1991 first described the three typical symptoms of serotonin syndrome.
causes
Serotonin syndrome is a disease that arises as a result of a disruption of the central or peripheral serotonin receptors. According to Sternbach, the disease also occurs after the administration of a drug that increases serotonin levels. For example, therapy with triptans or antidepressants causes mild symptoms.
And the serotonin syndrome often comes about through the interaction of different drugs. If several serotonin-stimulating drugs are used in combination, the increased serotonin release can even have life-threatening effects. The interaction between drugs that stimulate serotonin and certain foods should not be underestimated.
Symptoms, ailments & signs
Serotonin syndrome can vary in severity in each patient. It can also occur in people of all ages. How bad the symptoms actually are can also be related to the triggering drug. There are a number of typical signs of serotonin syndrome. The symptoms are divided into three categories:
1. Mental disorders: confusion, agitation, restlessness, disorientation and feelings of fear. 2. Autonomic disorders: increased, profuse sweating, chills, tachycardia (cardiac arrhythmia), hyperthermia (rapidly increasing body temperature), hypertension (high blood pressure) as well as diarrhea and vomiting. 3. Neuromuscular disorders: involuntary and spasmodic muscle twitching, tremor (hyperactivity with tremors) and hyperreflexia.
The symptoms mentioned can appear just a few hours after taking a drug or a drug combination or increasing the dose. As a rule, the serotonin syndrome becomes noticeable within 24 hours, in around 60 percent of all patients even within six hours. And it is precisely on this point that the serotonin syndrome differs from the malignant neuroleptic syndrome, which is associated with very similar symptoms.
In the case of neuroleptic malignant syndrome, however, the first signs appear much more slowly and can only be observed a few days after taking the drug. In the worst case, serotonin syndrome can put the patient's life at great risk: severe cardiac arrhythmias, hyperthermias above 41 degrees Celsius and hypertensive crises are life-threatening forms of serotonin syndrome that can trigger cardiogenic shock.
Diagnosis & course of disease
It is not uncommon for slight manifestations of the serotonin syndrome to be overlooked - simply because the disease is not yet widely known and the symptoms are quite unspecific. In addition, the symptoms are often not associated with the use of medication. The serotonin syndrome can be diagnosed quite well with the help of the drug history.
One method of determining serotonin syndrome is called differential diagnosis, in which neuroleptic malignant syndrome, malignant hyperthermia, poisoning, sepsis, meningitis, tetanus and mental illnesses such as depression are excluded.
Complications
Serotonin syndrome can cause mental, autonomic, and neuromuscular disorders. In the case of mental disorders, feelings of fear and restlessness are among the possible complaints. The autonomic disorders include complications such as cardiac arrhythmias, gastrointestinal complaints and high blood pressure. The most severe are the neuromuscular disorders - spasmodic muscle twitching, tremors and hyperreflexia are complications.
If the syndrome is not treated promptly, it can also lead to a fever above 41 degrees Celsius, a sudden rise in blood pressure, and other life-threatening complications. In extreme cases, the symptoms mentioned trigger a cardiogenic shock, which can lead to shortness of breath, pulmonary edema and ultimately heart failure. As a result of severe complaints, multiple organ failure can also occur, which is usually also life-threatening.
Further complications can arise during treatment, either as a result of surgical interventions such as percutaneous coronary intervention or the accompanying medication prescribed. Thrombin inhibitors and anti-inflammatory drugs, which can damage the already stressed cardiovascular system, are the main risks. When using a balloon pump there is a risk that the vessels will be injured. In addition, infections, wound healing disorders and allergic reactions can occur, which are associated with further complications.
When should you go to the doctor?
Serotonin syndrome should always be treated by a healthcare professional. As a rule, this disease cannot cure independently, so that the person affected is always dependent on medical treatment. In order not to restrict life expectancy, a doctor should be consulted at the first signs of this disease. In the case of serotonin syndrome, a doctor should be consulted if the person concerned suffers from mental disorders. This leads to disruptions in orientation or inner unrest.
Persistent vomiting or diarrhea can also indicate serotonin syndrome and must be examined by a doctor. Persistent tremors in the hands often indicate the disease and require a medical examination. In many cases, depression can also be a sign of serotonin syndrome. In the case of serotonin syndrome, the family doctor can be consulted. Further treatment is usually carried out by a specialist. Whether there will be a complete healing cannot be universally predicted.
Treatment & Therapy
To treat serotonin syndrome, the trigger must first be combated. In other words, if a drug is to blame for the disease, it must be discontinued immediately. Instead, the patient is prescribed a different drug. At the same time, his state of health is closely monitored.
This is the only way to stop the overproduction of serotonin. In mild cases, an improvement occurs within 24 hours. Medicines can also be administered to treat the symptoms. For example, if the syndrome is mild, mainly lorazepam is prescribed. This medicine is used solely for general calming.
In the case of moderate to severe illness, the doctor may administer cyproheptadine to inhibit the effect of serotonin in a non-specific way. However, autonomic disorders are not easy to treat. This is the case, for example, when blood pressure fluctuates significantly. And if even life-threatening symptoms such as hyperthermia, kidney failure or aspiration occur, emergency measures are of course used.
In contrast to fever, hyperthermia is not due to the disturbed temperature regulation in the hypothalamus, but to the uncontrolled increased activity of the muscles. Therefore, treatment with paracetamol does not make sense in this case. Means with a long duration of action or a long half-life are particularly dangerous.
It takes several days to restore the affected enzymes to full activity. The symptoms persist for several days to weeks after stopping the trigger drug. Fluoxetine, for example, with a half-life of one week is one of the dangerous substances.
You can find your medication here
➔ Medicines to calm down and strengthen nervesprevention
If a patient tolerates an antidepressant particularly well, then the risk of serotonin syndrome is high. So it is advisable that he pay attention to any physical changes. In this way, the first signs of illness can be recognized at an early stage and discussed with the doctor. The same applies after increasing the dose of a drug. In addition, caution is advised when self-medication with preparations containing St. John's wort extracts, dextromethorphan or tryptophan, as these active ingredients promote the production of serotonin.
Aftercare
Serotonin syndrome causes physical, neurological and psychological complaints. Follow-up care is advisable to counteract the symptoms even after the treatment has been completed. The syndrome should no longer occur in the future. The focus here is on the quality of life of the person affected.
Serotonin syndrome can have various causes. There is no generally valid trigger. The causal disease is treated with medication. During follow-up care, the doctor will reduce the dose to the point of complete discontinuation. He also checks to what extent the patient can tolerate the medicine. The condition of the person concerned is recorded in regular checks.If the symptoms recur, the treatment starts again. For this purpose, further examinations are necessary at the discretion of the specialist (differential diagnosis).
Neurological symptoms are accompanied by cramps or tremors. In severe cases, the respiratory muscles are affected. This situation is life-threatening for the person concerned. A hospital stay is urgently needed. Follow-up care takes place in the hospital. It is ended when there is no longer any mortal danger and the patient is allowed to leave the clinic.
There is a connection between serotonin syndrome and an increased risk of suicide. If there is an acute risk of suicide, the emergency services must be called immediately. He gives first aid. If the danger persists, the person concerned is admitted to hospital.
You can do that yourself
Since this disease can be fatal, it is essential to seek medical treatment. Spontaneous healing is not possible. It is also important to find out which drugs caused the syndrome in the patient. They have to be discontinued or replaced. This is the only way to improve the symptoms and prevent a renewed increase in serotonin levels.
To do this, it is necessary for the patient concerned to state which medication he has taken. This also applies if they were over-the-counter products, such as St. John's wort preparations. They too increase serotonin and may have contributed to a dangerous interaction.
If patients with serotonin syndrome are not already undergoing psychotherapeutic treatment, they should start now at the latest. This can prevent future depression and enable patients to live without taking serotonin-increasing drugs.
A changed lifestyle also has an antidepressant effect. Regular endurance sport, for example, regulates the metabolism and at the same time ensures a good mood. Studies have shown that a conscious, balanced diet also has a positive effect on existing depression and prevents it. The renunciation of stimulants such as nicotine or alcohol as well as regular rest and sleep times also help the patient to remain mentally stable. Many people also benefit from self-help groups. Voluntary work also gives new meaning to life.
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