A sharp increase in the level of serotonin 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 methods of treatment can modern medicine offer and what is the risk of the absence of therapy?
Serotonin syndrome: what is it?
In fact, the first information about such a condition appeared not so long ago. In the 1960s, 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 to some extent associated with taking antidepressants.
As you know, the syndrome of serotonin deficiency leads to the development of depression. And in the last century, a cure for such disorders was invented, now known as"antidepressants". Such drugs help increase the level of serotonin, popularly known as the "hormone of happiness." Under their influence, chronic fatigue and apathy gradually disappear, and the person gradually returns to the normal rhythm of life. However, in too large quantities, serotonin acts as a toxin, damaging nerve cells, causing a lot of disorders in the body. A similar syndrome can be the 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 recorded not so often. But, according to doctors and researchers, this happens only because this disorder is disguised as a mass of subtle symptoms that 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 it is accompanied by.
Main functions of serotonin
It is worth knowing the mechanism of action of the “hormone of happiness” before considering how and why serotonin syndrome develops. What is this substance? The main function of serotonin is the regulation of the functions of some brain neurons. Passing through the 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 systemsto 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;
- development or disappearance of feeling of nausea;
- human sexual behavior;
- mechanisms of thermoregulation;
- pain perception;
- support muscle tone;
- motility of the digestive tract;
- regulation of vascular tone;
- Serotonin has been proven to be involved in migraine development mechanisms.
As you can see, the "hormones of happiness" provide the human body not only with a feeling of euphoria. Having studied the functions of this substance, one 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 disorder mostly develops while taking certain drugs or their combinations. So what drugs can provoke the development of such a dangerous pathology as serotonin syndrome?
- Cipralex and other synthetic inhibitorsreuptake of serotonin and monoamine oxidase.
- Concomitant use of monoamine oxidase inhibitors and thyroid hormones, Clomipramine, Carbamazepine, Imipramine and Amitriptyline.
- Combination of MAO inhibitors and some drugs used for weight loss, in particular Desopimon, Fepranone.
- Combination of SSRI or MAO inhibitors with drugs containing L-tryptophan, St. John's wort extract and ecstasy.
- Combination of antidepressants with lithium preparations, in particular Contemnol and Quilonium.
- Simultaneous intake of inhibitors with dextromethorphan (this is a substance found in many cough syrups, including Caffetin Cold, Glycodin, Tussin Plus, and some others.
- Combination of serotonin reuptake inhibitors with drugs such as Dihydroergotamine, Sumatriptan (medicine for migraine), Levodop (used for Parkinson's disease).
- There is evidence that serotonin syndrome can develop when drinking alcohol while taking antidepressants.
It is worth saying right away 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. However, if you are prescribed antidepressants, then be sure to tell your doctor about all the medicines you are taking and be sure to consult about the introduction of new ones into the therapy regimen, even if it is a regular cough syrup.
Main characteristics of the clinical picture
How does serotonin syndrome develop? Signs of it in half of 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;
- muscular and peripheral nervous system problems;
- vegetative disorders.
All possible symptoms will be described below, but first it must be said that different disorders individually 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 based on the syndrome
How to recognize serotonin syndrome? Symptoms tend to begin with psychiatric disorders, including:
- emotional excitement;
- inexplicable, causeless feeling of fear and anxiety, sometimes up to panic attacks;
- sometimes there is another picture - a person experiences a feeling of euphoria, intense joy, a desire to move, talk incessantly and do something;
- possible and impaired consciousness;
- in more severe cases, delusions and hallucinations occur.
It is worth noting that the symptoms and their severity directly depend onseverity of toxic effects. For example, sometimes there is only mild arousal. In other cases, there is an exacerbation of the symptoms of the underlying disease (for example, depression), which is why the medication continues. In the most severe cases, the patient suffers from disorientation, confusion in the world around him and his own personality, suffers from delusions and various hallucinations.
Basic 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, autonomic disorders are also observed, including the following:
- dilated pupils and increased lacrimation;
- increased heart rate, tachycardia;
- increased respiratory rate;
- sometimes there is an increase in body temperature (usually it is small, but a fever of 42 degrees was recorded in some patients);
- a sharp increase in blood pressure with accompanying symptoms up to loss of consciousness;
- appearance of dry mouth and some other mucous membranes;
- acceleration of gastrointestinal motility, which in turn can lead to disorders such as diarrhea, severe nausea and vomiting, flatulence, bloating and abdominal pain of varying severity;
- feeling chilly;
- headaches, sometimes migraines.
As you can see, the signs of this pathology are not too specific, since the same symptoms canaccompanied by dozens of other diseases.
Neuromuscular disorders associated with the syndrome
As already mentioned, serotonin regulates the transmission of nerve impulses. That is why a change in the level of this substance affects the 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 rigidity;
- fast involuntary and irregular contractions of individual muscles (sometimes even entire muscle groups);
- trembling limbs;
- involuntary movements of the eyeballs (in medicine, the term "nystagmus" is used for this);
- sometimes there is a so-called eye spasm, which is accompanied by an involuntary rolling of the eyeballs up or down;
- occasionally recorded epileptic seizures;
- discoordination;
- problems with speech, its blurring and inaccuracy, which appears due to involuntary contraction of the muscles of the articulatory apparatus.
It should be understood that all the above signs of serotonin syndrome are extremely rare. In most cases, patients suffer from only some disorders, and therefore the diagnosis of pathology is a rather difficult process.
Severity of pathology
In modern medicine, it is customary to distinguish three degrees of severity of the development of the syndrome, namely:
- Mild pathologyaccompanied, as a rule, by excessive sweating, slight trembling in the hands and knees, and a not too pronounced increase in the frequency of heart contractions. The reflexes also become slightly pronounced, although the body temperature does not rise. Sometimes the patient may notice dilated pupils. It is only natural that people with these symptoms rarely see a doctor and continue to take drugs, because the above symptoms may well be caused by stress or overexertion.
- With moderate severity of the disease, the clinical picture is more pronounced. Patients note a sharp increase in body temperature (often up to 40 degrees) and blood pressure, persistent dilation of the pupils, muscle contractions of the limbs, motor and mental excitement. As a rule, such symptoms make a person seek help, but unfortunately, it is not always possible to make a correct diagnosis.
- Severe serotonin syndrome is extremely dangerous, as it can lead to complications. With this form of pathology, severe tachycardia, increased blood pressure, fever, muscle spasms up to rigidity, nervous disorders, and disorientation are observed. Patients usually have very vivid 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 you should never ignore the symptoms, because serotonin levels can be masked under the usual overworksyndrome. How to get out of this state and are there effective methods of treatment?
First aid in a similar condition
What to do if a person is suspected of having serotonin syndrome? Emergency care, as a rule, consists in the immediate cessation of the drug that provoked 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 the medicine that has not yet been absorbed. 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 withdrawal of drugs and cleansing the body of their remnants is not always enough. So what kind of therapy does serotonin syndrome require? Treatment, of course, depends on the stage and severity. As a rule, the patient is prescribed serotonin receptor antagonists, including Metisergide and Cyproheptadine. In addition, symptomatic therapy is carried out, which directly depends on the presence of certain disorders.
- For example, for epileptic seizures and muscle rigidity, benzodiazepines are prescribed, including Lorazepam and Sibazon.
- In the presence of fever, cold rubdowns and some other procedures are performed. The fact is that the temperature increase in serotonin syndrome is not associated withinflammation, but with increased muscle contractility, and therefore conventional antipyretic and non-steroidal anti-inflammatory drugs have no effect. The only exception is paracetamol, although it must be used carefully.
- When the temperature rises to 40 or more, the patient is given muscle relaxants. These drugs help relax muscles, reduce fever, and prevent various disorders, including blood clotting problems.
- Intravenous infusions are also given as excessive sweating, muscle tension and diarrhea lead to dehydration.
- In addition, it is necessary to monitor the patient's blood pressure and heart rate, if necessary, normalize these indicators with the help of drugs.
In most cases, properly administered therapy allows you to quickly improve the patient's condition and avoid consequences. Unfortunately, in rare cases, especially if the patient has not received timely medical care, serotonin syndrome can lead to the breakdown of muscle tissue, damage to the kidneys and liver, nerve endings, and eventually to death. That is why you should never thoughtlessly take antidepressants and other medicines.
