Sertoninesyndroom

Serotonin Syndrome: Symptoms and Causes

Geschreven door: Ebrina van der Bijl

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Leesduur: 7 min

Did you know that too much serotonin in your body can cause serious symptoms? This phenomenon is known as serotonin syndrome (also called serotonin toxicity ). It can be caused by the use of certain medications and drugs.

The symptoms sometimes resemble other conditions, meaning the syndrome often goes unnoticed, with potentially dangerous consequences.

In this article you will read what serotonin syndrome exactly is, what the cause is, which signals you should not miss and of course: How you can prevent it.

Serotonin syndrome is caused by an excess of serotonin, often from antidepressants or drugs such as MDMA, and can cause severe symptoms.

Symptoms: confusion, rapid heart rate, fever, muscle tremors, sweating; recognition is difficult, medical attention is crucial in case of symptoms.

Treatment involves stopping serotonin-enhancing drugs; it can be prevented by carefully coordinating medication use and being alert to signals.

Table of contents
What is serotonin syndrome? Causes of serotonin syndrome 1. Medications (antidepressants) 2. Drugs 3. Other causes These are the most noticeable symptoms of serotonin syndrome Why is serotonin syndrome sometimes so difficult to recognize? How dangerous is serotonin syndrome? Treatment and recovery How do you prevent serotonin syndrome? Tips to prevent serotonin syndrome at a party

What is Serotonin Syndrome?

Serotonin syndrome is a rare but serious reaction that occurs when there is too much serotonin in the body .

Serotonin is a neurotransmitter, a chemical in your brain that plays a key role in regulating mood and emotions. It's often called the "happiness hormone" because it contributes to a sense of well-being and relaxation.

But too much serotonin can lead to overstimulation of the nervous system , which causes various symptoms. I'll tell you more about this later.

First I would like to explain to you what the causes are.

Causes of serotonin syndrome

Serotonin syndrome is caused by an excessively high concentration of serotonin in the brain. But how exactly does this happen?

Although there are several causes, the syndrome usually occurs as a side effect of certain medications or drug use.

1. Medicines (antidepressants)

Some medications, such as antidepressants , increase serotonin levels in your body. This can lead to an overload of serotonin. This can occur, for example, in:

  • SSRIs (Selective Serotonin Reuptake Inhibitors) - These drugs ensure that serotonin remains active for longer than normal
  • MAOIs (Monoamine Oxidase Inhibitors) - Stop the breakdown of serotonin

In addition, the antibiotic linezolid is also known to increase serotonin levels.

Together with antidepressants or other serotonin-increasing medications, this increases the risk of serotonin syndrome, especially when used in combination or at high doses. (1)

Good to know : Medications that actually lower serotonin, such as some antipsychotics, do not pose a risk of serotonin syndrome. Suddenly stopping serotonin-boosting medications also usually does not cause serotonin syndrome, as is sometimes thought. However, it can cause other symptoms.

2. Drugs

Recreational drugs such as ecstasy (MDMA) stimulate the release of serotonin and reduce its reuptake. At high doses, this can cause serotonin syndrome. (2)

The risk increases when drugs such as ecstasy are combined with serotonin-increasing medications.

Drugs such as amphetamine and cocaine can also contribute to the development of the syndrome.

3. Other causes

Medications and drugs are the most common causes of serotonin syndrome, especially when combined.

Rarer are situations where an overactive serotonin system due to other medical conditions causes the syndrome.

Some serotonin supplements , especially when combined with medications that increase serotonin levels, can increase the risk of serotonin syndrome. Therefore, always consult your doctor before taking supplements.

These are the most noticeable symptoms of serotonin syndrome

Serotonin syndrome can be difficult to recognize because the symptoms often vary and usually develop suddenly. Therefore, it's especially important to be familiar with these symptoms so you can recognize them early.

The most common signs are:

  • Confusion or difficulty concentrating
  • Feeling very restless or very tense
  • Fast heart rate and high blood pressure
  • Sweating a lot
  • Getting chills or a fever
  • Nausea, vomiting or diarrhea
  • Muscle tremors or shaking
  • Stiff muscles or cramps
  • Fast or strong reflexes (such as an extra strong knee-jerk reflex) (3)

These symptoms can range from mild to severe and often develop quickly , usually within a few hours to a day after a change in serotonin levels, for example, by starting a new medication, increasing a dosage, or combining multiple serotonin-boosting medications.

Note : If you experience several of these symptoms simultaneously, especially after taking medications that affect serotonin levels, seek medical attention quickly. By recognizing the syndrome early, you and your doctor can find the right solution together and prevent it from getting worse.

Why is serotonin syndrome sometimes so difficult to recognize?

Serotonin syndrome can sometimes be difficult to diagnose, even for doctors. This is mainly because its progression varies so much from person to person. Although several methods have been devised to diagnose it, no method seems perfect.

The Hunter criteria are a well-known way to diagnose the syndrome. They focus primarily on typical signs such as muscle twitching, fever, and changes in how someone feels or behaves.

Yet it remains difficult because many symptoms can also occur with other illnesses. Moreover, the course of the disease is different for everyone: For some, symptoms develop quickly, for others more slowly, and not everyone develops a fever (one of the common symptoms).

This sometimes makes it difficult to distinguish it from similar conditions, such as neuroleptic malignant syndrome . (4)

In short : Recognizing serotonin syndrome requires experience and vigilance. Therefore, if in doubt, it's always important to consult a doctor promptly.

How dangerous is serotonin syndrome?

Serotonin syndrome can range from mild to life-threatening . In mild cases, symptoms usually disappear quickly after discontinuing the offending medication.

But without treatment, symptoms can quickly worsen and lead to serious complications, such as high fever, heart rhythm disturbances, and even organ failure.

Therefore, it is important to recognize the syndrome early and seek prompt medical help to prevent serious consequences.

Treatment and recovery

Serotonin syndrome is usually treatable , provided it is recognized early . Symptoms often disappear within 24 to 72 hours after the offending medication is stopped.

The speed of recovery depends on how quickly the diagnosis is made and what treatment is given. Severe cases can take longer and require hospitalization.

The most important step in treatment is stopping the medications or drugs that cause serotonin syndrome. Afterward, the patient usually receives supportive care to manage symptoms, such as medications for muscle spasms or fever.

In severe cases, doctors may prescribe medications that block the effects of serotonin, such as cyproheptadine . Sometimes, intensive care may be necessary if dangerous complications arise.

How do you prevent serotonin syndrome?

The best course of action, of course, is to prevent serotonin syndrome. Therefore, it's important to be mindful of medications and other substances that can affect your serotonin levels.

  1. Never take any medications or supplements on your own without first discussing them with your doctor, especially if you are already taking serotonin-boosting medications
  2. Keep a clear overview of all medications and supplements you use and always discuss new combinations with a doctor or pharmacist
  3. Be extra careful with recreational drugs such as ecstasy (MDMA), amphetamines and cocaine, as these can also increase serotonin levels and increase the risk of serotonin syndrome, especially when combined with medications
  4. Pay close attention to symptoms when starting a new medication, changing dosages, or taking drugs
  5. Seek immediate medical attention if you think you have serotonin syndrome ; early detection prevents serious problems

Tips to Prevent Serotonin Syndrome at a Party

If you choose to use MDMA or similar substances at a party, it is important to take good care of yourself.

Party drug use can lead to temporary serotonin syndrome with symptoms such as overheating and confusion , especially in crowded and warm environments. Therefore, be aware of these risks.

These tips will help you enjoy your meal more safely and reduce the risk of serotonin syndrome.

  1. Drink plenty of water, but not too much – about 250 to 500 ml of water per hour is ideal. Drinking too much water can be dangerous, so avoid overhydration.
  2. Take regular breaks - Go to a quiet, cool place every now and then to cool down and relax.
  3. Avoid combining drugs - Do not use other stimulants or medications that increase serotonin levels.
  4. Pay close attention to your body temperature. Stay out of overheated, crowded areas and dress lightly.
  5. Be alert for symptoms such as confusion, rapid heartbeat, excessive sweating, or muscle twitching. Seek immediate help if you notice these.
  6. Make sure there is someone with you - Who can help if things go wrong.
Ebrina van der Bijl - Natural Performance

Ebrina van der Bijl

Ebrina is a nutritionist with a deep commitment to healthy eating and a sustainable lifestyle, based in beautiful Portugal. Her passion for natural and organic products is at the heart of her work. With a background in Nutrition & Dietetics and experience in product development and writing, she translates complex scientific information into practical advice for a balanced lifestyle.

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Sources used

  1. SanFilippo, S., Turgeon, J., Michaud, V., Nahass, R.G., & Brunetti, L. (2023). The Association of Serotonin Toxicity with Combination Linezolid–Serotonergic Agent Therapy: A Systematic Review and Meta-Analysis. Pharmacy, 11(6), 182. https://doi.org/10.3390/pharmacy11060182
  2. Parrott, A. (2002). Recreational Ecstasy/MDMA, the serotonin syndrome, and serotonergic neurotoxicity. Pharmacology Biochemistry And Behavior, 71(4), 837–844. https://doi.org/10.1016/s0091-3057(01)00711-0
  3. Simon, L.V., Torrico, T.J., & Keenaghan, M. (2024b, March 2). Serotonin syndrome. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482377/
  4. Werneke, U., Jamshidi, F., Taylor, D. M., & Ott, M. (2016). Conundrums in neurology: diagnosing serotonin syndrome – a meta-analysis of cases. BMC Neurology, 16(1). https://doi.org/10.1186/s12883-016-0616-1

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