Serotonin Syndrome - A Potentially Fatal Condition from Serotonin Toxicity. Overview & Evaluation

Dr. Pagnani of Rittenhouse Psychiatric Associates discusses Serotonin Syndrome, a serious and potentially fatal condition caused by serotonin toxicity. It would be rare for someone to develop Serotonin Syndrome while taking one (or even two) psychiatric medications at FDA approved doses, without taking other Serotonergic medications, supplements or illiciit substances. With that said, patients (and even providers) may not realize that there is a large list of medications, supplements and illicit drugs that can increase serotonin levels and contribute to serotonin syndrome (including, but not limited to opiates and medications used to treat pain [meperidine, oxycodone, tramadol], antibiotics (ciprofloxacin, linezolid, isoniazid), antifungals (fluconazole), medications for headaches (triptans), antivirals (ritonavir), supplements (St. John's Wart), anti-nausea medications (Zofran/ ondansetron), cough medicines (dextromethorphan), antidepressants, amphetamines and stimulant medications, lithium, cocaine, ecstasy (NMDA) AND OTHERS. Classically, patients present with the triad of altered mental status, autonomic instability (tachycardia, diaphoresis [sweating], dilated pupils, increased bowel sounds, flushing) and neuromuscular abnormalities (clonus, hyper-reflexia, hypertonia). There is a wide range in presentation and severity of symptoms and it is incredibly important that if a patient believes that may have serotonin syndrome, or a provider believes a patient may have serotonin syndrome, the individual is seen immediately in an ER and all potentially contributing medications, supplements, and/or drugs are stopped immediately. Supportive care must be given and medications like cyproheptadine (used in the treatment of serotonin syndrome) can be considered.

Dr. Pagnani is the founder and medical director of Rittenhouse Psychiatric Associates, an Instructor at The Johns Hopkins Hospital for the Department of Psychiatry, he supervises psychiatric residents at Jefferson Hospital, he serves on the Young Professional Board of Uplift, the Center for Grieving Children and he maintains a private practice of Psychiatry in Philadelphia where he sees patients for one-time psychiatric evaluations and second opinions. He is a licensed physician and surgeon in NJ, PA, NY, MD, DE, FL and CA and can provide consultations to individuals via HIPAA compliant Telehealth visits living in these locations.

Rittenhouse Psychiatric Associates is a private practice of psychiatry consisting of about 25 psychiatrists, psychiatric nurse practitioners and psychotherapists with physical locations in Philadelphia and Paoli, PA and serving all of PA, NJ, NY and FL virtually via HIPAA compliant tele-psychiatry. Individuals seeking not only evaluations but long-term psychiatric care, can contact Rittenhouse Psychiatric Associates directly.

These videos aim to increase awareness and discussion of mental health topics and to encourage struggling individuals to schedule an appointment directly with a mental health provider. Mental health needs to be normalized, and simply speaking about mental health topics openly, is an important first step.

Dr. Pagnani and Rittenhouse Psychiatric Associates are NOT advocating for or against the use of any mentioned psychiatric medications for any specific individual. Additionally, any side effects mentioned are not a complete list of potential side effects or contraindications to taking any mentioned medications, and all risks and benefits of a medication should be discussed with an individual’s provider at an appointment, before starting, stopping or making changes to a medication regimen.

This video is INFORMATIVE ONLY - NOT MEDICAL ADVICE.

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www.RittenhousePA.com
www.ChrisPagnaniMD.com

[hassan....]

I want to share my story so that others do not make mistakes. I suffered from serotonin syndrome after two weeks of taking Prozac, and then the doctor added another medication for me, which I took, and I had a panic attack, severe fear, and confusion, and I felt like I was going to die. I went to the emergency room in the hospital and met with another psychiatrist who had no experience. I told him, unfortunately, he said: I have anxiety that is not from the medicine. He gave me another medicine, so I believed what he said and I went into a coma due to serotonin poisoning. The medicine was withdrawn from my body, but I suffered from severe depression and anxiety after that because of this incident. I continued to suffer for years, and I am now fine, much better than before, and I am still recovering without any medications. An antidepressant. When I went to a psychiatrist, he went because I had a phobia of giving lectures at university only. I am very regretful and wrong for going to a psychiatrist. I lost 3 years of my life because of that.

[jmcarp]

Is it possible to have chronic abdominal pain post serotonin syndrome? I’m about 4 weeks into recovery and still get abdominal pain and have to watch everything I eat.

[NicoleMcGregor-wy]

My doctor didn’t ask what supplements I was taking, was taking tryptophan, when I was prescribed a SSRI. Developed serotonin syndrome and it took 18 hours before I felt normal.

[lillianmarcano]

My grandson was overdosed at a facility and almost died he was in ICU for almost a month now he has PTSD he can't remember anything had to learn how to eat walk had to go to pt and it and was in blood thinner because all the blood clots in his hands and neck we went through hell he was 13 at the time now he's 15 and getting all the help that he needs nothing the same anymore now he has serotonin and nms syndrome combined he's very sensitive they ruin my grandson life he's brain damage 👈😢

[szilviakunnetoth]

If someone has mild, long-lasting (about a year and a half) mild serotonin toxicity, which unfortunately was not recognized by the doctors, how long does it take for the brain's serotonin level to recover without treatment after stopping the medication? Thank you very much for your help.

[curtisbischof]

If I take 15 mg of Mirtazapine, can I take melatonin for sleep?

[Metalhead-life]

Can someone get extremely paranoid, agitated and mean from SS?

[WatchmanofGod]

I'm curious Sir, as these individuals I see for treatment have been difficult...
Lamictal, Vimpat, Topamax. (400mg) Cymbalta RP (90mg) Trazodone(100mg) Klonopin (1mg)
I suffer from Epilepsy and see a psychiatrist as well...

[SacredOwl]

My wife is prescribed Imitrex and prozac, then they just added Tramadol. I told her do not take until she knows for sure. She also has seizures, which Tramadol can cause even in lower doses. So you think all three is a problem?

[allisonmoore]

I was on the lowest dose of Zoloft for two weeks and I experienced terrifying muscle spasms that made me fall down on the ground and lose control of my body as well as neurological trimming that lasted for days that was like Parkinson’s I was on no other medication and I am not a drug user
The doctor swore up and down it wasn’t from the Zoloft three months later I tried taking it again and experienced the same debilitating affects. This left me permanently neurologically damaged. Beware these drugs are not meant to be taken for more than a few months and also lead from studies, I read to Alzheimer’s and dementia .

[aaliyanworld]

My doctor prescribe me 60 mg duloextine at morning and clomipramine 50 mg at night. After even having 8 to 12 hours gap will they cause serotonin syndrome? If yes them how much risk . Plz reply me sir

[guymann]

Is cough medicine okay if using Sertraline?

[davidevan]

I have been on 50 mg of Desipramine for 3 years for ibs, off label use. Would adding 10mg of Paxil to this for anxiety be safe?

[Copilot]

Would it be possible to have Serotonin Syndrome for years ?

[Layingflat]

This syndrome has total destroyed my life, I lost a kidney, my health, my mind, my job, friends and family. After being off the poisons for 8 months. I feel now, there os no way back. I get any help at all in Australia.