Serotonin Syndrome: Causes, Symptoms And Treatment
Serotonin (5-HT) is a neurotransmitter produced by the body, and It is necessary for the proper functioning of the body for various reasons since it is responsible for regulating certain physiological processes. But excess serotonin causes Serotonin syndrome a set of symptoms of varying severity that affects individuals who consume antidepressants.
Its most common cause is overdose or the interaction between medications that have the ability to increase the release of serotonin.
In this article we broadly explain what functions serotonin is responsible for regulating:
Serotonin is a chemical substance with which neurons communicate, that is, a neurotransmitter. This is synthesized from tryptophan, an essential amino acid provided through the diet because it is not manufactured by the body. Some foods that contain tryptophan are: oats, wheat, almonds, eggs or oily fish.
But although many think that serotonin is only found in the brain (acting as a neurotransmitter), the Central Nervous System (CNS) only contains 5% of 5-HT, since the small intestine produces the rest and this serotonin never reaches the brain, but rather has other functions in the body (for example, it regulates the state of contraction of the smooth muscles of blood vessels).
Although serotonergic neurons are present in smaller numbers in the brain, their functions in the CNS are very varied, since these neurons are highly branched and carry out a large number of synapses. Some of the most relevant functions of serotonin are: regulating appetite, regulating positive and negative mood states, intervening in the sensation filter (so it is related to concentration), controlling the level of body temperature, etc.
The excess stimulation of serotonin on the postsynaptic 5-HT1A and 5-HT2A receptors at the central and peripheral level has negative effects for the organism that They can be very serious and even fatal. The set of symptoms attributed to excessive activity of serotonergic neurotransmission on these receptors is known as Serotonin Syndrome, and was originally described by Oates in 1960.
In recent years, the consumption of antidepressants has become very fashionable, and this is the main cause of the increase in cases of this syndrome. Antidepressants that inhibit serotonin reuptake are the treatment of choice for depression, panic disorders, generalized anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, premenstrual diaphoretic disorder, and bulimia nervosa.
The overdose or combination of these drugs can lead an individual to suffer from Serotonin Syndrome, and since there are many medications that can cause this condition, below are the best-known pharmacological substances that are associated with Serotonin Syndrome:
Psychiatric Medications
Neurological Medications
Other medications
Symptoms of Serotonin Syndrome
The symptoms of Serotonin Syndrome begin a few hours after the overdose or the interaction between drugs that increase the presence of serotonin, and are characterized by what is known as a triad: autonomic, neuromuscular and neurological dysfunction. If it is not diagnosed in time and appropriate measures are taken, serotonergic toxicity is associated with high mortality.
The characteristic symptoms are varied and can be mild or severe. Below is the symptomatology that an individual with Serotonin Syndrome presents:
Treatment of serotonin syndrome
To treat serotonin syndrome properly, it is necessary to have a updated pharmacological history which includes over-the-counter medications or substances and phytopharmaceuticals.
Mild and moderate serotonergic toxicity can resolve within 24 hours after discontinuation of pharmacological treatment, but much depends on the half-life of the substances involved. Severe cases require immediate hospitalization and intensive care, as the patient may suffer severe hyperthermia, rhabdomyolysis or respiratory failure.
For treatment, even in mild cases, the administration of benzodiazepines is common to reduce agitation, pseudoconvulsive movements and muscle rigidity. Correct hydration, control of autonomic instability or control of fever is common as a supportive measure.
Cyproheptadine (Periactin), an H1 antagonist drug with activity on 5-HT2A in smooth muscle and with anticholinergic and antiserotoninergic properties, is beneficial, since it manages to reverse the antidepressant effects, and a single dose can block approximately 85 to 95% of serotonergic receptors.
