Serotonin Syndrome

A review of the clinical presentation, etiologies, differential diagnosis, and treatment of serotonin syndrome.

A part of Strong Medicine's series on Underappreciated Diseases.

#MedEd #Toxicology #SSRI

[tatianatub]

as someone who is on SSRI's and amphetamines i am highly appreciative of serotonin syndrome and am always very careful when taking drugs

[kyleocallaghan]

Really do enjoy your material - thank you so much again for taking the time to do these.

[term]

September 18, 2022 is my second birthday. My symptoms lasted for 20 hours, I passed out countless times, I was shaking UNCONTROLLABLE, I had diarrhea, my heart wanted to jump out, but at the same time I couldn't stand on my feet. When I was conscious I prayed to God to forgive my sins if this is the time for me to leave. After everything, they told me in the emergency room that it was a panic attack, countless infusions, because I was in two hospitals. I knew it wasn't because I was passing out all day. I was on anti-depressants and migraine medication, both of which have high doses of serotonin. I thank God for a second chance, and I am afraid of the incompetence of our doctors. 18.09. is the date of my patron saint and I know who saved my life then. Since then, I've been fighting and struggling with panic attacks, but that day was not one of them.

[ConanLiuMD]

Learned all about serotonin syndrome in medical school but until you see it the first time and have it in the back of your mind, it can be hard to recognize! We recently had a cancer patient who was on citalopram, trazodone, olanzapine, and recently started on duloxetine for neuropathic pain who ended up coming in with altered mental status. Our attending noticed her hyperreflexia which kind of clinched the diagnosis. I don't typically check reflexes all that often so I definitely learned that I should add that to my repertoire.

Also regarding the EMR notifications - I totally agree that they can become so burdensome and the default is to ignore them 99% of the time. They really are important though and hopefully the EMR can continue to be improved so they become more useful rather than just bloat. That part where you discussed all the potential medication complications that can occur if we aren't careful . . . it just made me realize how scary it can be with how much potential harm we can do to patients if we aren't careful with even just a simple new medication prescription.

[Anna_kandy]

I experienced this after taking a cough and cold otc syrup. I was freaking out. It was 7 years ago. Never did again. I was a med student then and read my ass off to come up with Serotonin syndrome, and realized a lot of doctors weren't aware of it.

[mmeIodie]

I experienced it when i was in a very low point in life and took almost 30 antidepressants it was very close to me damaging my kidneys and or liver

[shovelhead]

O dear I was in A&E yesterday lost a lot of weight, breathing bad, sight much worse, uncontrollable limbs tremors, muscle wastage blood in stools, blood pressure up and down, sweats bad, headaches from hell red raw throat pins and needles arm’s legs muscles constantly moving stressed they get worse confusion memory’s not there, my tablet’s are Sertraline 100mg, Fluvoxamine 50 mg, Allopurinol 100mg, irbesartan 75 mg, Atorvastatin 40mg, Melatonin 4mg at night, Clopidogrel 75mg, they told me to go home it was drug withdrawal I feel like I am slowly dying no strength can’t figure out anything even a measuring tape live in Jersey Channel Islands U.K. I know 4 of the meds above raise Sertraline hell i am desperate.

[vadimuha]

So that's why I have dilated pupils and agitation from time to time on AD's

[ProgressiveTruthSeekers]

Can you get chills and sleepiness, without a fever? I took 5-HTP the night before.

[cassiejosephson]

I was one of the rare cases needing mechanical ventilation. I was on the vent for 9 days and even coded once. My serotonin syndrome went undiagnosed for a couple years until I lost the ability to move, speak and open my eyes. Then I became very rigid and had upper, lower and ocular clonus and lost consciousness.

[mikeythedistasteful]

I had a minor case of this when starting citalopram about a year ago. For whatever reason my previous doctor didn’t titrate my dosage up and started me on the full dose. I had taken an imitrex earlier in the morning, and had a generous amount of alcohol at a dinner party the night before, so I had Advil likely still in my system from the night before. My symptoms were fever, severe tremors, ocular clonus, diarrhea, elevated heat rate, and nausea. It was frightening, and I almost drove myself to the hospital but I was in no shape to drive so I waited it out on the couch. The next day I cut my dose in half and stayed there for about two weeks because I was afraid to go back to full dose. I since switched doctors and medication a few times and now take Prozac and I have to say it’s the best with the least amount side effects. My new doctor said it sounded like a mild case of serotonin syndrome and is very conservative with my dosing, we only adjust in small increments.

[lilscorpie]

Having gone through this several times, I have to stagger both my pain meds and anxiety meds so it doesn't happen.

[brendanhoffmann]

I suspect I might have this, I'm on 80mg Prozac, 4mg Risperidone. I was on valproate for 10 years up until september last year too... I can't sit still, can't sleep, sweating constantly... they put me on 20mg of propranolol 3 times a day it it hardly does anything. I also get bad gastro-intestinal problems. I was diagnosed with OCD and drug induced psychosis for all this...

[marisapaola]

I had this for five years. My GP gave me Effexor and tramadol, I thought I was going mad, saw many specialists, wasn't until I went to a new chemist who looked me over and told me he wasn't going to sell me these in combination. Went to my gp and she was bvwet flippent. Left me with severe tachycardia and heart failure.
Edit note.. thankyou for this post & no unfortunately, progressive heart failure, uncontrolled hypertension, and progressive tachycardia, kidney damage, COPD, acidocis. I am in my early forties and lived a very clean life.

[sunving]

Thank you very Much Dr Strong. I think the first case came to flame is from combination of Prozac and Meperidine( Pethidine) morphine derivative pain killer. I am not sure wether they are still in used but it was used widely in my time for post operative pain killer. Actually SSRI and Morphine is not a problem? Selective Monoamine oxidase inhibitor are widely use in Parkinson’s. Dextromethorphan with SSRI or other serotonergic drug drug interaction are common but not fatal to make a news. Patient can feel mild agitated or high or headache like. Patient who is on Welbutrin ( Buproion) and Dextromethorphan could double the dose of Dextromethorphan. The mild case of these phenomena happened often but the fatal case is not thank god.

[SKARTHIKSELVAN]

Thanks for your efforts in making these videos.

[tararutland]

Just recovering from this after 4 months in the milder form absolute hell 😢

[roseennin]

really appreciate the new content Dr.Strong,
God bless you for sharing your knowledge with other up and coming Drs. in the medical community

[Dan-byvj]

wow, this guy looks like Chris Parnell.thanks Dr. Spaceman

[sturmfreii]

Thank you so much for the thorough video. I am recovering from this rn and it was scarier than breaking any bone or having covid.