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387056 tn?1200443777

Serotonin Syndrome - Prognonsis?

I am a 30 year old female chronic pain patient who was treated at a very reputable hospital in Northern California.  I was given amitryptaline to sleep at night, and Lexapro to help me with depression. Immiediately starting the treatment, my legs became numb when I walked up stairs. I thought I had buldged a disc so my pain doc sent me to physical therapy. I started having muscle twitching, mood disturbances, gi disturbances, weakness when climbing stairs, and mild balance issues- doc said I had pain syndrome and was becoming overly fixated on sensations.  By the time my head started involuntarily twitching and I was noticing shortness of breath doing activites that were easy two weeks before (this is two months after the dual anti-depressant treatment began), I stopped the medication and went to go see an internist. My internist says I was suffering from a slowly progressing Serotonin Syndrome. 2 weeks after stopping the medication, none of my symptoms have resolved.

My question for you is - Do you think these symptoms will resolve, and what can I do expedite the process? I'm having difficultly staying calm (which I know is key) as my mood has been significantly changed and I am very anxious and depressed. Has anyone else experienced Serotonin Syndrome and not have the symptoms resolve after stopping the medication?
2 Responses
Avatar universal
Our granddaughter suffered from disinhibition which is similar to Serotonin Syndrome (too much of a good thing).  The doctor said it would take six weeks before the medication was out of her system, but in fact, it took only four weeks.  I don't think there is anything you can do to expedite the process except be patient.  The increase in anxiety and depression will return as there is nothing to contradict these medical issues.  I suspect your doctor will give you another antidepressant in a month or two.  Our granddaughter's psychiatrist chose the second medication from another "family" of meds.  There were no issues with the second choice.  I hope you are as lucky recovering as our GD was.
377600 tn?1225163436
It could be the medication withdrawal that you are in now.


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Serotonin syndrome

Contents of this page:
Alternative Names
Definition
Causes
Symptoms
Exams and Tests
Treatment
Outlook (Prognosis)
Possible Complications
When to Contact a Medical Professional
Prevention
References


Alternative Names    

Hyperserotonemia; Serotonergic syndrome
Definition    Return to top

Serotonin syndrome is a life-threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells.
Causes    Return to top

Serotonin syndrome most often occurs when two drugs that affect the body's level of serotonin are taken together at the same time. The drugs cause too much serotonin to be released or to remain in the brain area.

For example, you can develop this syndrome if you take migraine medicines called triptans together with antidepressants called selective serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SSNRIs). Popular SSRI's include Celexa, Zoloft, Prozac, Zoloft, Paxil, and Lexapro. SNRI's include Cymbalta, and Effexor. Brand names of triptans include Imitrex, Zomig, Frova, Maxalt, Axert, Amerge, and Relpax.

The FDA recently asked the manufacturers of these types of drugs to include warning labels on their products that tell you about the potential risk of serotonin syndrome. Talk to your doctor before stopping any medication.

Serotonin syndrome is more likely to occur when you first start or increase the medicine.

Older antidepressants called monoamine oxidase inhibitors (MAOIs) can also cause serotonin syndrome with the medicines describe above, as well as meperidine (a painkiller) or dextromethorphan (cough medicine).

Drugs of abuse, such as ecstasy and LSD (“acid”), have also been associated with serotonin syndrome.

Symptoms    Return to top

Symptoms occur within minutes to hours, and may include:
Restlessness
Hallucinations
Loss of coordination
Fast heart beat
Rapid changes in blood pressure
Increased body temperature
Overactive reflexes
Nausea
Vomiting
Diarrhea
Exams and Tests    Return to top

The diagnosis is usually made by asking questions about your medical history, including the types of drugs you take.

To be diagnosed with serotonin syndrome, you must have been taking a drug that changes the body's serotonin levels (serotonergic drug) and have at least three of the following signs or symptoms:

Agitation
Uncoordinated movements (ataxia)
Heavy sweating not due to activity (diaphoresis)
Diarrhea
Overactive reflexes (hyperreflexia)
Fever
Mental status changes such as confusion or hypomania
Muscle spasms (myoclonus)
Shivering
Tremor
If you have just start taking or increased the dosage of a tranquilizer (neuroleptic drug), other conditions (such as neuroleptic malignant syndrome) will be considered. Serotonin syndrome is not diagnosed until all other possible causes have been ruled out, including infections, intoxications, metabolism problems, and drug withdrawal. Some symptoms of serotonin syndrome can mimic those due to an overdose of cocaine, lithium, or an MAOI.

Tests may include:

CBC
Thyroid function tests
Drug screen
Electrocardiogram (ECG)
Treatment    Return to top

Patients with serotonin syndrome should stay in the hospital for at least 24 hours for close observation.

Treatment may include:

Withdrawal of medicines that caused the syndrome
Fluids by IV
Cyproheptadine (Periactin), a drug that blocks serotonin production
Benzodiazepines (muscle relaxants), such as Valium or Ativan, will be used to decrease agitation, seizure-like movements, and muscle stiffness
In life-threatening cases, medicines that keep your muscles still (paralyze them) and a temporary breathing tube and breathing machine will be needed to prevent further muscle damage.

Outlook (Prognosis)    Return to top

Patients may get slowly worse and can become severely ill if not quickly treated. Untreated serotonin syndrome can be deadly. However, with treatment, symptoms can usually go away in less than 24 hours.

Possible Complications    Return to top

Uncontrolled muscle spasms can cause severe muscle breakdown. The products produced when the muscles break down will build up in your blood and eventually go through the kidneys. This can cause severe kidney damage if not recognized and treated appropriately.
When to Contact a Medical Professional    Return to top

Call your health care provider right away if you have symptoms of serotonin syndrome.
Prevention    Return to top

Always tell all of your healthcare providers what medicines you take. Patients who take triptans with SSRIs or SNRIs should be closely followed, especially right after starting a medicine or increasing its dosage.

References    Return to top

US Food and Drug Administration. FDA Public Health Advisory: Combined Use of 5-Hydroxytryptamine Receptor Agonists (Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) May Result in Life-threatening Serotonin Syndrome. Rockville, MD: Center for Drug Evaluation and Research; July 19, 2006.

Prator BC. Serotonin syndrome. J Neurosci Nurs. 2006 Apr;38(2):102-5.

Ford MD, Clinical Toxicology. 1st ed. Philadelphia, Pa: WB Saunders; 2001:150, 522, 547, 550.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:2066.

Sternbach H. The Serotonin Syndrome. Am J Psychiatry. 1991: 148:705.

Parrot AC. Recreational Ecstasy/MDMA, the serotonin syndrome, and serotonergic neurotoxicity. Pharmacol Biochem Behav. 2002 Apr;71(4):837-44. Review.


Update Date: 8/1/2006

Updated by: Eric Perez, MD, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY. Review provided by VeriMed Healthcare Network.



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