(((((Please read . . Serotonin syndrome made easier!)))))

Discussion in 'Fibromyalgia Main Forum' started by jaltair, Nov 4, 2005.

  1. jaltair

    jaltair New Member

    Confusion persists regarding this syndrome. Here is some info that is gathered and combined from different sources for my own research into serotonin syndrome. This is from my own research as an RN. I hope it will help the confusion that I see when I read what others have written.

    Since the 60's, those who enjoyed experiencing drugs and effects have intentionally placed themselves into a state of mild serotonin syndrome through use of over the counter drugs, and prescription drugs parents or others may have obtained. This is not a new phenomenon. In addition, there are more and more SSRI's prescribed. Therefore it is predicted that emergency room physicians will begin encountering the syndrome more often.

    Serotonin syndrome is not a distinct illness, but a definition for a grouping of symptoms common in a person who has taken two or more medications that increase CNS serotonin levels by different mechanisms.

    The most common drug combinations associated with serotonin syndrome involve the MAOIs, selective serotonin reuptake inhibitors (SSRIs), and the tricyclic antidepressants. The syndrome includes the following:

    Mental status changes

    Confusion (51%)
    Agitation (34%)
    Hypomania (21%)
    Anxiety (15%)
    Coma (29%)

    Cardiovascular

    Sinus tachycardia (36%)
    Hypertension (35%)
    Hypotension (15%)

    Gastrointestinal

    Nausea (23%)
    Diarrhea (8%)
    Abdominal pain (4%)
    Salivation (2%)

    Motor Abnormalities

    Myoclonus (58%)
    Hyperreflexia (52%)
    Muscle rigidity (51%)
    Restlessness (48%)
    Tremor (43%)
    Ataxia/incoordination (40%)
    Shivering (26%)
    Nystagmus (15%)
    Seizures (12%)

    Other

    Diaphoresis (45%)
    Unreactive pupils (20%)
    Tachypnea (26%)
    Hyperpyrexia (45%)

    Mild to moderately severe cases of serotonin syndrome usually resolve in 24 to 72 hours. Though most cases can be treated and resolve within a week, some patients become acutely ill and require hospitalization. In some instances patients have been admitted to the ICU and required mechanical ventilation. Mortality associated with this condition is estimated to be 11%.

    The largest number of cases reported in the literature and the most serious consequences of serotonin syndrome have resulted <b>from use of the MAOIs.</b> Monoamine oxidase (MAO) inhibitors are used to relieve certain types of mental depression. They work by blocking the action of a chemical substance known as monoamine oxidase (MAO) in the nervous system.

    Most cases were reported when an MAOI was used in conjunction with Demerol (meperidine), tryptophan, Robitussin cough syrup, etc (dextromethorphan - an ingredient in many over-the-counter products and used as a street drug), a tricyclic antidepressant, or an SSRI antidepressant. The long half-life (SSRIs) and duration of effect (irreversible MAOIs) seen with some of these medications increase the possibility of serotonin syndrome occurring several weeks after these drugs have been discontinued.

    It is important to note that serotonin syndrome has been precipitated by medications that are not usually thought of as being serotonergic. One author asserts that both Demerol (meperidine) and Coricidin, Robitussin cough syrup, etc (dextromethorphan) are "notorious for precipitating acute serotonin syndrome." (One reason for use as a street drug)

    Explanation of the different groups with examples of the drugs:

    SSRI: selective serotonin reuptake inhibitors, have only the ability to balance levels of the nerve transmitter serotonin, these include: Celexa (citalopram), Prozac (fluoxetine), Luvox (fluvoxamine), Paxil (paroxetine) and Zoloft (sertraline).

    SSNRI: have the ability to affect two neurotransmitters - serotonin and norepinephrine. Examples include: - Cymbalta (duloxetine), Effexor (venlafaxine), Cymbalta (duloxetine).

    NSRI: Milnacipran, (also known as Midalcipran) is the first in a new class of antidepressants known as Norepinephrine Serotonin Reuptake Inhibitors. It is hoped that Milnacipran will be able to affect multiple pain mechanisms in a manner similar to that seen with some tricyclic antidepressants (amitriptyline), but without the negative side effects.

    Monoamine oxidase (MAO) inhibitors include: Marplan (Isocarboxazid), Nardil (Phenelzine), Parnate (Tranylcypromine).

    It's the MAOI's that create the problem when combined with the drugs noted. MAOI's are not prescribed as much as they use to be with developement of the newer drugs that have fewer interactions with other medications and foods.

    I hope that the above helps clarify . .

    Warmly, Jeannette
  2. fivesue

    fivesue New Member

    I read this today on the net, also, and I thought it was a good article. I'm glad you posted it.

    Sue