Psychology and Psychiatry

Serotonin syndrome

Serotonin syndrome - This is a potentially dangerous reaction, occurring as a result of the consumption of narcotic substances or medications that increase serotonergic transmission. Such a reaction is observed quite rarely, but this does not reduce its mortal danger. Often it occurs as a result of taking antidepressants, as a result of poisoning or a critical reaction to a combination of medicinal or narcotic substances taken.

Causes of Serotonin Syndrome

Modern medicine is developing by leaps and bounds. Every year, provisional companies are struggling to improve the countless number of drugs from various pharmaceutical groups, including antidepressants and other psychoactive drugs. Today, in the development of psychotropic drugs used in the treatment of depressive states, the focus is on finding agents that positively affect the functioning of the serotonergic system, in other words, increase the production of serotonin during the transmission of impulses in cells. With an insufficient level of serotonin in neurons, a depressive state occurs.

Thus, due to the misuse of antidepressants, a complication that is dangerous to the patient’s life, called serotonin syndrome, may develop.

What is serotonin syndrome? This term is used to refer to the response of the body, generated by the influence of certain medications and narcotic substances, whose components can affect the concentration of serotonin. In other words, serotonin syndrome is the so-called serotonin intoxication, which affects most of the primary processes that occur in the cells of the body.

The most commonly described syndrome occurs as a result of taking monoamine oxidase inhibitors and / or as a result of the use of third-generation antidepressants, namely selective serotonin reuptake inhibitors. The main reason for the nucleation of the state in question is an excessive level of serotonin in the space between the membranes of neurons (synaptic cleft), or in the excessive excitation of serotonin receptors located on the membrane of neurons.

Also, the considered complication may develop at the beginning of the use of third-generation antidepressants when their single dosage is exceeded. In addition, there have been cases of serotonin syndrome following the use of antidepressants and alcohol-containing drinks at the same time. Often, the reaction may occur after the abolition of one antidepressant and taking another.

In addition to the listed substances, a number of other pharmacopoeial groups of drugs, such as antiviral (for example, Ritonavir) and antiemetics (Metoclopramide), drugs for migraines (Sumatriptan) and cough (Dextromethorphan), drugs aimed at weight loss ( Sibutramine).

Thus, the main and only factor influencing the occurrence of the syndrome in question is the use of a substance that directly affects the production of the “happiness hormone,” that is, the synthesis of serotonin. From here it is possible to single out the main reasons causing the described complication, namely the negative reaction to the combined intake of certain drugs, drug poisoning, the recreational use of narcotic drugs and the individual reaction to the substance.

Signs of Serotonin Syndrome

This syndrome is considered to be a rather rare phenomenon, but at the same time rather dangerous. Therefore, in order to receive the necessary medical care in a timely manner, you must correctly diagnose the disease. To this end, you need to understand serotonin syndrome, what it is, and know its main manifestations.

Serotonin syndrome, first of all, is a complication manifested by a specific reaction of the body in the form of certain symptoms.

The classic serotonin syndrome encompasses the triad of symptoms represented by mental disorders, autonomic changes and neuromuscular disorders. The following are the symptoms of serotonin syndrome described in more detail.

Signs of changes in the psyche appear in the first turn and are characterized by a rapid increase. So, for example, they can make their debut with a little excitement, and end up with hallucinations up to coma.

The presence of serotonin syndrome is indicated by the following manifestations:

- slight emotional arousal;

- fatigue, drowsiness;

- apathy;

- joy up to euphoria, the desire to urgently run somewhere, do something;

- anxiety;

- fear, reaching panic, for example, a person can frantically rush around the room in search of the desired exit;

- anxiety and euphoria replace each other;

- confusion, hallucinations, delusional states;

- sometimes heavy coma.

Vegetative changes are, in the first turn, disorders of the digestive system:

- nausea with subsequent vomiting;

- epigastric pain with gas and diarrhea;

- severe headaches;

- increased respiration and tachycardia;

- fever or chills;

- pressure drop;

- excessive sweating and tearing.

Symptoms of serotonin syndrome

Clinic of neuromuscular dysfunction with this syndrome is characterized by a variety of manifestations - from trembling limbs to the most severe attacks.

Symptoms of serotonin syndrome are often represented by three manifestations: changes in the psyche, hyperactivity of the ganglion nervous system and disorders that are associated with hyperactivity.

The presence of serotonin syndrome in differential diagnosis will unequivocally indicate the following symptoms: tremor, manifested in rhythmic twitching of the limbs and trunk, involuntary muscle contractions of non-rhythmic nature, numbness, rotation of the eyeballs (nystagmus), sudden roll-up of eyes, movement disorder, epileptic seizures, nephrosis, nystagmus, sudden roll-up of eyes, impaired coordination, epileptic seizures, nephrosis, nystagmus, sudden roll-up of eyes, impaired coordination, epileptic seizures, nephrosis, nystagmus, unexpected roll-up of eyes, movement disorder, epileptic seizures, nephrosis, nystagmus, sudden roll-up of eyes, movement disorder, epileptic seizures, nephritis, blurred eye movement (nystagmus), sudden roll-up of eyes, movement disorder, epileptic seizures, nephritis, blurred eye movement (nystagmus), sudden rolling of the eyes, impaired coordination of movement, epileptic seizures, opacification .

Manifestations of serotonin syndrome often occur after taking drugs or drugs in the early hours. At fifty percent this complication begins after two hours, at twenty-five percent - on the first day, and on the remaining twenty-five percent - within the next two days.

Serotonin syndrome in patients of the age category may occur after three days. The described complication has three degrees of severity.

A mild degree is manifested by a slight increase in heart rate, increased sweating, and a slight tremor in the limbs. Pupils are slightly dilated, reflexes are slightly elevated along with normal body temperature. Naturally, with such a clinic a person will not run to the hospital. Also, he may not associate the symptoms described above with taking antidepressants. Therefore, the first degree is often overlooked by patients.

Moderate serotonin syndrome is manifested by a significant increase in heart rate, increased intestinal motility, epigastric pain, increased blood pressure, fever, nystagmus, pupillary dilation, motor and mental stimulation, increased reflexes and trembling limbs.

Serotonin syndrome in the severe stage is a serious threat to human life. It is manifested by the following clinical manifestations: increased blood pressure, hyperthermia, severe tachycardia, delusional state, disorientation in time, space and personality with brightly colored emotional hallucinations, a sharp increase in muscle tone, profuse sweating, impaired consciousness. Also, coagulation disorders develop, muscle breakdown and metabolic acidosis occur. Further, dysfunction of the kidneys and liver is noted, multiorgan failure arises.

Severely treated syndrome can lead to coma. Often it leads to death. Fortunately, the malignant course of this complication is quite rare.

Treatment of serotonin syndrome

Today, to get rid of serotonic syndrome, special therapeutic measures, unfortunately, have not been developed. Modern medicine has only general recommendations regarding the treatment of the complication in question. In this case, all the recommendations are based on the description of individual cases.

The primary and main event in the treatment of serotonic syndrome is the abolition of all serotonergic drugs. This step in most patients leads to a decrease in clinical manifestations within six to twelve hours, and within a day to their complete elimination.

The second necessary step is symptomatic therapy and subsequent individual care. In more severe conditions, the administration of serotonin antagonist drugs (eg, cyproheptadine) is practiced. Detoxification therapy and a number of other activities focused on maintaining homeostasis are also needed.

In order to reduce body temperature, external cooling and Paracetamol are used. At temperatures above 40 ° C comes life threatening. Therefore, it is necessary to apply intensive cooling from the outside, the introduction of muscle relaxants aimed at preventing the occurrence of rhabdomyolysis (destruction of muscle cells) and DIC. In order to maintain blood pressure within the normal range, in hypertension, direct sympathomimetics (for example, epinephrine or norepinephrine) are used in small doses. Benzodiazepines (lorazepam) can be used to relieve muscle stiffness with serotonin syndrome.

In treating the disorder in question, drugs such as Dantrolene (a muscle relaxant based on calcium channel blockade), bromocriptine (a dopamine receptor stimulator) and Propranolol (a non-selective beta-blocker) are contraindicated due to increased patient mortality.

Due to the fact that today there are no effective methods that would allow one to determine one hundred percent serotonin syndrome, it is often difficult to prescribe adequate treatment. Therefore, doctors are forced to focus on a number of indirect data. One of the most reliable are two schemes of criteria for evaluating serotonic syndrome, but they are not equally effective.

Sternbach criteria include the following items:

- prescription of drugs from the so-called "risk group", which took place recently;

- antipsychotics were not used to treat the patient or their dosage was not increased before the attack;

- infectious diseases, signs of drug overdose, or a history of withdrawal are absent;

- the presence of at least three of the following symptoms: agitation, chills, hyperreflexia, diarrhea, fever, confusion, myoclonus, sweating, impaired coordination, tremor.

Gunther's criteria contain two points - the confirmed fact of the use of substances from the "risk group" and the presence of one of the following symptoms: induction or spontaneous muscle contraction or ocular clone, hyperthermia, excessive stimulation, hyperreflexia, trembling (if there is no pathology of the nervous system in history) .

In most cases, the considered complication does not lead to sustained deterioration in health, and the existing clinical manifestations with adequate and timely therapy pass without a trace for several days.