hi i'm dr tracey marks a psychiatrist and i make mental health education
videos today i'm talking about serotonin
syndrome and this is based on a few viewer questions about this
sage asks can you do a video about serotonin syndrome
drugs that cause it what it looks like and how fatal is it
thank you sage for that question serotonin is a brain chemical
also called a neurotransmitter that plays
a role in controlling your mood and anxiety
low levels of this in your brain contribute to depression and anxiety
therefore many of the medications that we use to treat depression and anxiety
work by increasing the levels of serotonin in
your brain normally there's no problem with
increasing serotonin in this way after all the reason for the increase is
because of the low levels that you already have
if you're depressed or anxious even if you weren't really depressed or
anxious and you took these medications that small increase wouldn't cause
serotonin syndrome serotonin syndrome happens when you get
an excess amount of serotonin from taking super
high doses of the medication like if you were taking an overdose or
when medications get combined with other medications that also increase
serotonin there are medications that are not
antidepressants that increase serotonin and some of these are pain medications
like tramadol nausea medications like reglan and some
migraine medications like immatrix some other examples that you probably
didn't realize increased serotonin or dextromethorphan
that's found in cough and cold remedies like robitussin
and some antibiotics like ciprofloxacin or fluconazole which is an anti-fungal
drug so if you take multiple medications
someone needs to check the interactions between the medications
to make sure that you don't have this problem normally your doctor would do
this and sometimes your pharmacy will give you a warning
this is why it's important to tell all of your doctors
all the medications that you're taking including things that you take over the
counter but to make sure things don't slip
through the cracks you can check yourself and this is
especially important if you have a cold and you take
something over the counter you can check using webmd's drug
interaction checker it's under drugs and supplements and
then tools it's important to know though that just
because it shows that you're taking two medications that can increase serotonin
doesn't mean that you will get serotonin syndrome it just means
that you need to be on alert for symptoms and pay close attention
if any other medications are added to your regimen
so what does serotonin syndrome look like your symptoms can be mild
to severe and fall under three groupings we call this the triad of symptoms of
serotonin syndrome these are changes in your mental state abnormal
muscular tone and hyperactive autonomic nervous system
let's take a look at these one at a time changes in mental state
also called mental status changes include things like agitation
extreme anxiety being disoriented or confused restlessness and pacing
abnormal muscular tone would be things like tremors
clonus which is an involuntary contraction and relaxation of your
muscle we mostly see this in the ankle but you
can also see it in the wrists it looks like a flapping motion you can
also get overactive reflexes now these are signs that would normally
be picked up on a physical exam and may not be something that you notice
on yourself but one thing that you could notice on
for yourself is muscle rigidity in mild cases it can feel like your body
is stiff like you overdid it with a workout the
day before in severe cases people can feel locked
up and unable to move your autonomic nervous system is the
nerves that control your body functions that are not
within your control like your heart rate your blood pressure and breathing
and digestion so if you have autonomic hyperactivity it's called these body
systems just go wacky and these are the things that
you're more likely to notice and make you feel like something is
wrong some examples are racing heart high blood pressure fast breathing
sweating fever shivering vomiting and dilated
pupils you can see that your pupils are dilated
if you look in the mirror but what you experience is light
sensitivity like like you may have when you wake up
in the morning and someone turns on the lights it takes you a minute for your
eyes to adjust but with this your eyes just don't seem
to adjust to the light and it's just too bright for you
we don't have good numbers for how prevalent this is
and i think it's because many people have mild cases of it and never seek
treatment you may have some anxiety loose stool
and a tremor that you think is related to feeling really anxious
and once the symptoms go away in a day or so you write it off as
maybe you had a stomach bug because of the vomiting and the diarrhea
in my 20 years of practicing i have never seen
one case that required someone to go to the hospital
i've only had probably a handful of people tell me that they had
severe gastrointestinal symptoms and felt like they were coming down with the
flu after they took a medicine like a muscle
relaxer like flexural or something and they were
already on an antidepressant from me in all of
those cases the symptoms resolved in a day and i
didn't hear about it until weeks or months
later at their next appointment the people who
do get diagnosed with this tend to be people
who have more severe symptoms and as you can see from some of the symptoms that i
mentioned many of them are non-specific things
that you can see with other problems so being diagnosed with serotonin
syndrome requires a medical workup and a physical exam it
wouldn't be considered serotonin syndrome unless you had taken
medications that could increase your serotonin
levels and you had symptoms in all of these
three areas it also wouldn't be considered serotonin
syndrome if you had a fast heart rate and diarrhea and nothing else
the serotonin medicines themselves can cause diarrhea as a side effect so
some people like to use the term serotonin toxicity to refer to
extreme one-off symptoms that you can get from taking the medication
but you don't have enough symptoms to call it serotonin syndrome
the last part of sage's question is how deadly
is this the deadly cases are the ones that cause
extreme symptoms like heart rhythm problems or muscular rigidity
that causes internal muscle tissue damage
these cases can lead to death if they're not treated
serotonin syndrome is treated under medical supervision
by stabilizing your vital signs with methods like
lowering your blood pressure or cooling your body to bring your temperature down
it usually resolves in about 24 hours so here are the takeaways from this
number one if you're taking antidepressant
medications be careful anytime you add another medication even
something over the counter you always want to check the drug drug
interactions you can use the drug interaction checker
on webmd and this applies to some prescription
pain medicines like tramanol or immatrix for migraines
number two normal use of your antidepressant shouldn't cause this
problem but if you have combined it with
something look out for odd signs like fever wide open pupils abnormal blood
pressure and muscle stiffness these are not the usual symptoms or
side effects that you would have from your antidepressant
if you are experiencing these things call your doctor or go to your nearest
urgent care or emergency room to determine if you
have serotonin syndrome someone will need to examine you
monitor your vital signs and observe you it usually goes away within 24 hours
once you stop the medications that's it thanks for watching and see you next
time