Serotonin syndrome is a negative drug reaction that potentially poses a danger to the human body. The cause of the syndrome is believed to be the accumulation of too much serotonin in the body. Serotonin is a neurotransmitter whose production in the body is charged to the nerve cells. Its function is regulation of the following processes in the body:
- Blood flow
- Body temperature
Another important role of serotonin is making sure that the brain cells and the nerve cells are functioning properly. It’s also believed to have an impact on mood.
The build-up of too much serotonin in the body may be caused by taking different prescribed medicines together. Medications such as those that are used to treat migraine headaches, depression, and management of pain are just some of the types that could cause serotonin syndrome. Too much of this hormone could lead to a wide range of symptoms that could either be mild or severe. Some parts of the body that can be affected include the muscles and the brain among other parts.
If your new medication interferes with serotonin, it may lead to serotonin syndrome. Increasing the dosage of a certain medication that you are currently using could also lead to serotonin syndrome. The chances are higher if you use two different medications at the same time. If immediate action is not taken against the disease, it could turn out to be fatal.
Serotonin Syndrome Symptoms
Symptoms of the condition may manifest just minutes, or even hours, after increasing the dosage of an already existing medication or taking completely new medication. These symptoms include the following:
- Muscle rigidity
- Muscle spasms
- High blood pressure
- Rapid heartbeat, or tachycardia
- Dilated pupils
- Hyperreflexia, or overactive reflexes
More severe cases of the syndrome could have a different set of symptoms altogether. These include:
- Irregular heartbeat
What Causes Serotonin Syndrome?
The condition typically occurs when the body takes in nutritional supplements which lead to an increase in serotonin levels, as well as illicit drugs. For instance, taking an antidepressant after taking medication to help with a migraine will lead to an increase in serotonin levels. Certain types of prescriptions may lead to high serotonin levels. These include antivirals for HIV and AIDS treatment, antibiotics and some medications used to treat pain and nausea.
The following are examples of drugs that are associated with serotonin syndrome:
Antidepressants. The following antidepressants are associated with serotonin syndrome:
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). For example, Effexor
- Selective serotonin reuptake inhibitors (SSRIs). Examples include Zoloft and Celexa
- Monoamine oxidase inhibitors (MAOIs). Marplan and Nardil fall into this category
- Tricyclic antidepressants. Examples include amitriptyline and nortriptyline
Migraine Medications. The triptan drug category consists of certain migraine medications that are associated with serotonin syndrome.
Examples of these medications include:
- Naratriptan (Amerge)
- Sumatriptan (Imitrex)
- Almotriptan (Axert)
Illegal Drugs. Specific illegal drugs have been linked to serotonin syndrome.
They include the following:
- Ecstasy (MDMA)
Herbal Supplements. Some types of herbal supplements have also been linked with the occurrence of the serotonin syndrome. They include:
- John’s Wort
Medications for Cough and Cold. Specific types of an over-the-counter cough and cold medications whose components include dextromethorphan usually have something to do with serotonin syndrome.
These drugs include:
- Robitussin DM
Diagnosing Serotonin Syndrome
A specific laboratory test for serotonin syndrome is still nonexistent. Your doctor will, however, begin by doing a thorough review of your medical history as well as your symptoms. You should be open to your doctor if you have taken any outlawed drugs in the past few weeks or if there is any medication you are taking. This information will assist the doctor to give an accurate diagnosis.
Other several tests will also be done to check if there are anybody functions or any other vital organs that have been affected. Other conditions may also be ruled out from these tests.
There are some other conditions which have symptoms that are similar to those of serotonin syndrome. These include hormonal problems, drug overdose, and certain infections. Some conditions such as neuroleptic malignant syndrome also have similar symptoms. The neuroleptic malignant syndrome is a negative reaction to psychotic disease medications.
Your doctor may order the following tests:
- A blood culture
- A complete blood count (CBC)
- Drug screens
- Liver function tests
- Kidney function tests
- Thyroid function tests
Treatments for Serotonin Syndrome
The foundations of treatment of serotonin syndrome are diligent and extreme supportive care and recognizing the possibility of this syndrome. If you are experiencing severe or even moderate serotonergic symptoms you should be admitted to a health facility immediately. If you have hyperthermia, you should be admitted to the intensive care unit. Medications for serotonergic symptoms should be cut off immediately. Caution should also be taken to ensure that more of these medications are not administered again. The optimum output of urine is maintained by giving the patient intravenous hydration. Body functions such as blood pressure, pulse, urine output and temperature should be carefully monitored. Hyperthermia may require some aggressive cooling techniques such as ice packs, cool water sprays, ventilation and even paralysis. Muscle hyperactivity and seizure can be controlled by benzodiazepines. Hypertension may not require any form of specific treatment.
Severe and moderate serotonin syndrome has previously been managed by serotonin antagonists. The most promising drug so far is cyproheptadine. The initial dose is usually an oral ingestion of 4-8 mg. The dosage may be taken with a frequency of 2 hours. It should, however, be discontinued if no improvement is noted after 16 mg of the dose. If a response is noted, the medication may be continued in doses of up to 32 mg per day. The doses should be divided, for instance, 8 mg taken four times. Propranolol and chlorpromazine are some of the other drugs that have been mentioned in the treatment of serotonin syndrome. However, they have more severe side effects and contraindications.
Once full recovery has been achieved, you should consider the treatment of the condition which leads to the prescription of the serotonergic drug.
Complications Linked to Serotonin Syndrome
Muscle tissues can break down due to severe muscle spasms. Once the muscle tissues disintegrate, severe kidney damage may follow. Temporary paralysis of your muscles may be considered as an option to prevent further breaking down. There are medications which can be used for this. To help you breathe during this period, a respirator and breathing tube will be used.
The Long-Term Outlook for Serotonin Syndrome
The outlook for this condition is very bright with effective treatment. Once serotonin levels in the body return to normal, it is not common for the syndrome to reoccur. If the condition is not treated, however, the effects could be severe.
Prevention of serotonin syndrome is not always possible. Your doctor should be aware of the medications that you are taking. Close monitoring should be done by your doctor if you are currently taking a combination of medications that are known to cause high levels of serotonin. This monitoring is especially vital if you increase your current dosage or if you start taking a new medication.
Products that carry the risk of serotonin syndrome should have labels on them informing their users about the same. This is according to the FDA.
IBS and Serotonin
In your gut, there exists a semiautonomous nervous system referred to as the enteric nervous system. It lies inside the lining of the gastrointestinal system, all the way from the anus to the esophagus. Movement inside it is directed by innumerable nerve cells. Beside secreting enzymes such as serotonin among others, it also has the ability to execute some tasks without help from the brain. Such a task is coordination of reflexes.
The brain and the enteric nervous system affect each other. Perfect examples include having to go to the bathroom even though one just went when you are anxious or feeling those butterflies in your stomach when nervous. The two are connected to each other by neural pathways. In addition, anxiety and stress from your brain may cause IBS flare-ups in your gut.
What Does Serotonin Do?
This study reveals that serotonin, which is mainly produced in the gut, is important in the relaying of information from your gut to the brain and vice versa. Proper functioning of the gut is also dependent on serotonin.
Quite a number of aspects of the functions of your gut are affected by serotonin. They include:
- How much mucus, along with other fluids, is secreted in the intestines
- The sensitivity of your intestines to certain activities such as fullness from eating and pain
- The speed with which food moves through your system, or your bowel motility
Some nerve cells are responsible for changing your sensitivity to or the intensity of the extension of your intestines when you are full, while others are messengers that inform your brain of some feelings such as pain, nausea and bloating. For instance, many people consider themselves to be full after eating heavily but your stomach might interpret this as pain.
It is possible that people having IBS experience constipation and also have low levels of serotonin. The muscles in and around the rectum also tend to be less reactive to serotonin and their stools are more likely to be lumpy or hard. Those with a high level of serotonin and IBS usually diarrhea. Their rectums are also more reactive to serotonin and their stools are loose and watery.
How to Address Serotonin Issues?
Patients suffering from IBS have to deal with a wide range of symptoms, though not all of them are linked to the bowel. Low serotonin levels may mean that you could be more prone to a condition referred to as fibromyalgia. This condition leads to an increased sensitivity to pain in your muscles all over the body. Anxiety disorders, chronic depression and interruptions of your sleep patterns are all linked to altering of your serotonin levels.
Depression is commonly treated using a group of drugs commonly referred to as selective serotonin reuptake inhibitors (SSRIs). These drugs work by increasing the availability of serotonin for use by your nerve cells. Medications for anxiety and depression may not be effective in the treatment of IBS. Research for a drug that will lead to the creation of a drug that will not cause any adverse side effects while treating serotonin syndrome is still ongoing.
Consult your doctor about emerging, as well as current, therapies that may be used to address specific serotonin syndromes. Keep in mind that you can alter your serotonin levels enough to impact positive results on your symptoms by exercising, using medications and relaxation techniques.
Mental Health and Serotonin
Your mood is usually regulated naturally by serotonin. Normal serotonin levels will have some positive effects.
You will feel:
- Less anxious
- More emotionally stable
- More focused
A study conducted in 2007 showed that people who had depression also had low serotonin levels. Deficiency in serotonin has also been associated with insomnia and anxiety.
The role of serotonin in mental health has caused some minor disagreements among researchers. Some, who conducted older studies, were doubtful about whether altering the levels of serotonin affects depression. More recent research claims that it does. For instance, in 2016 a study on mice that lacked serotonin autoreceptors was carried out. These autoreceptors inhibit serotonin secretion. The levels of serotonin in the brain was higher without the inhibitors. The results showed that these mice were less anxious and that they showed less depression-related behaviors.
Normal Ranges for Serotonin Levels
Typically, for serotonin levels in the blood to be considered normal, they have to lie within the range of 101-283 ng/ml (nanograms per millimeter). This number may differ slightly according to the measurements and the samples tested. For specific test results, consult your doctor.
Carcinoid syndrome may be indicated by high levels of serotonin in the blood.
This entails a range of symptoms linked to tumors that occur in the following areas:
- small intestine
- bronchial tubes
A test will be taken by your doctor in order to measure serotonin levels in the blood. This will help them to either diagnose serotonin syndrome or rule it out.
Treating Serotonin Deficiency
You can use medication and some natural options to increase your serotonin levels.
Low serotonin levels in your brain may lead to anxiety, sleep trouble and depression. A selective serotonin reuptake inhibitor (SSRI) will be prescribed by most doctors to handle the depression. These drugs are the most common antidepressants available.
SSRIs block reabsorption of serotonin, thereby increasing its levels in the brain. More of the chemical, thus, remains active. Zoloft and Prozac fall into the category of SSRIs.
When taking serotonin drugs, you should not take any other medication unless under the guidance of your doctor.
Natural Serotonin Boosters
The Journal of Psychiatry and Neuroscience published a paper saying that besides SSRIs, the following natural factors can also lead to increased levels of serotonin:
Exercise. Exercising regularly may have some mood-boosting effects.
Exposure to Bright Light. Seasonal depression may be treated with light therapies or exposure to sunshine. Click here to find the best collection of light therapy products.
Meditation. You can boost your serotonin levels by meditating. It helps to promote a positive attitude towards life and as well as relieving stress.
A Healthy Diet. Eat foods that will boost your levels of serotonin. They include nuts, pineapple, cheese, eggs, salmon, turkey, and tofu.
What Do SSRIs Treat?
Though SSRIs are commonly used to treat depression, they are also used to treat a wide variety of other conditions.
They may include the following:
- Panic disorder
- Obsessive-compulsive disorder (OCD)
- Premenstrual dysphoric disorder (PMDD)
- Post-traumatic stress disorder (PTSD)
- Hot flashes which are caused by menopause
SSRIs are commonly used to treat anxiety. Some specific SSRIs, including sertraline, paroxetine, and escitalopram, have been approved by the FDA (Food and Drug Administration) to treat anxiety specifically. With this, anxiety can be treated with all SSRIs, as long as they are used off-label.
How SSRIs Work?
There are many chemicals in the brain that act as messengers between brain cells. Serotonin is one of them. Due to its effect of causing a state of relaxation and well-being, it has been referred to as the “the feel-good chemical.” Before being absorbed into the bloodstream, serotonin usually circulates inside the brain.
Low levels of serotonin have been linked to depression. Low levels of other brain chemicals may also lead to depression. They include dopamine and norepinephrine. SSRIs function by inhibiting absorption of serotonin from the brain and into the bloodstream. This consequently leads to high serotonin levels in the brain and hence brings relief from depression.
It is important to note that SSRIs have no effect on the production of serotonin in the body. All they do is make sure that what is left is used more effectively.
The effectiveness of SSRIs is similar across this particular group of drugs. However, they vary slightly in some factors such as what they are used to treat, their dosage and their side effects.
Since SSRIs boast of fewer side effects, doctors will usually recommend them before any other antidepressants. What this means is that SSRIs are safer than other antidepressants.
“Generally speaking, these are very safe drugs,” says Danny Carlat, MD, referring to selective serotonin reuptake inhibitors. He works as an associate at the Tufts University School of Medicine as a Clinical Professor of Psychiatry. “It’s quite hard for patients to cause any health problems to themselves by taking SSRIs even though they do have some minor side effects,” Danny continues to say.
Even with this, some certain classes of people, that is children and pregnant women, should take caution when using SSRIs.
For Children. Back in 2004, a black box warning was added to drug labels for SSRIs. The warning stated that the use of SSRIs in children and adolescents leads to an increased risk of suicidal tendencies and thoughts. Further research has, however, revealed that the benefits associated with these antidepressant medications outweigh, by far, the associated risks.
For Pregnant Women. Pregnant women, who take SSRIs risk their children being born with some defects, especially lung and heart problems. The risks of untreated depression and those of treatment with SSRIs must be compared by moms-to-be and their doctors. Untreated depression can also impact pregnancies negatively. For example, depressed women may not seek the prenatal care that is needed during pregnancy.
Switching the SSRI may also be an option to consider among some pregnant women. This helps them to treat their depression while treating depression at the same time. This is because different drugs f the SSRI class have different side effects. For instance, brain disorders, breathing difficulties and fatal heart defects in newborn babies have been associated with paroxetine (Paxil). Citalopram (Celexa) and fluoxetine (Prozac), on the other hand, do not have such serious side effects. Doctors of women who use paroxetine (Paxil) might recommend that they switch to them once they become pregnant.
Foods That Will Boost Your Serotonin Levels
Research on this sensitive topic has revealed that taking a diet that is low in tryptophan causes the levels of serotonin in the brain to drop.
The following 7 foods will help with this problem:
Eggs. Recent research suggests that the levels of tryptophan in your blood plasma can be boosted significantly by eggs. Here’s a tip from a pro: the yolk is a must-eat! Eggs are very rich in tyrosine and tryptophan, biotin, omega-3 fatty acids, choline and a load of other nutrients that contribute to the antioxidant properties of eggs as well as other health benefits that they carry.
Cheese. Cheese also contains significant levels of tryptophan. I would recommend mac and cheese. This is a combination of cheddar cheese and milk and eggs, which also contain high levels of tryptophan.
Pineapples. Pineapples are a good source of a protein referred to as bromelain. This protein helps to suppress coughs and reduce the side effects associated with chemotherapy, according to recent research. For this, I would recommend a recipe for pina colada chicken. Just mix chicken with pineapples and coconut and enjoy a delicious meal.
Tofu. Another rich source of tryptophan is any soy product. Tofu can step in for any protein in any recipe. This makes it a great source of tryptophan for both vegans and vegetarians. For a great boost of calcium, some tofu is usually calcium-set.
Salmon. I’m quite sure you have already suggested this to yourself; salmon is also a rich source of tryptophan. Well, you’re right. Going wrong with salmon is also not easy. In this category, a smoked salmon frittata is my recommendation. All you need to do is combine salmon with eggs and milk. Salmon is also associated with a variety of other benefits such as lowering blood pressure and balancing cholesterol. It is also a rich source of omega-3 fatty acids.
Nuts and Seeds. Pick your favorite and enjoy as much as you can. All nuts and seeds are rich sources of tryptophan. Research has stated that eating a handful of nuts daily lowers your risk of contracting some conditions such as heart disease, cancer, and respiratory problems. In addition, they are great sources of vitamins, antioxidants, and fiber. Oatmeal cookies and no-bake peanut butter will do for dessert.
Turkey. Ever wondered why all Thanksgiving meals are usually followed by a large turkey? Well, it’s quite simple; turkey is simply one large ‘ball’ of tryptophan.
Serotonin and Diet
The common word is that you can boost the levels of serotonin in your blood by simply eating tryptophan-rich foods. But, is it true?
Tryptophan is found in the foods that we eat. However, serotonin is not. Huge amounts of this important amino acid are found in foods that are rich in riboflavin, vitamin B-6, iron, and protein. Keep in mind that eating these foods will not boost serotonin levels on their own. However, there’s a kind of a shortcut to this; carbs.
Carbs stimulate more release of insulin in the body, which further promotes absorption of amino acids, leaving tryptophan in the blood. You might get a boost in tryptophan levels if you mix carbs with foods that are high in tryptophan.
Since there exists stiff competition between the tryptophan found in foods and other amino acids for absorption, the effect that this tryptophan will have on your serotonin levels may not be much. This is different from tryptophan supplements. They contain tryptophan which has been purified. They also do not have any effect on the levels of serotonin. Tryptophan supplements should not be taken without authorization from your doctor.
Though there is no competition between them and supplements, the foods in the list above are high in tryptophan. If you want to keep away from supplements but still boost your serotonin levels, you need to eat them more often. Make sure to serve them along healthy carbohydrates such as whole-grained bread, rice, and oatmeal.
Other Ways to Boost Serotonin
Besides foods and supplements, there are other ways that one can boost their levels of serotonin. They include:
Regular Exercise. Research that was recently conducted in the United Kingdome revealed that exercising regularly may have some positive effects on depression.
Sunshine. Research has, once again, shown a direct link between blood serotonin levels and exposure to bright light. If you want to boost your mood and also to rest better at night, try to incorporate a lunchtime walk in your daily routine.
Positivity. In their beautiful song, the Spice Girls sang that “All you need is positivity.” I couldn’t agree more. Research has revealed that interacting with people around you and with life in general with a positive attitude can have a significant impact on your serotonin levels.
Gut Bacteria. Healthy gut bacteria have a vital role to play in determining the levels of serotonin through the axis of the gut to the brain, according to research. A high-fiber diet will help to fuel the bacteria. Supplemental probiotics might be of help as well.
How to Prepare for Your Appointment
Given that serotonin syndrome may, in some cases, be a life-threatening condition, you should seek immediate medical attention if you notice that your symptoms are worsening.
If your symptoms are not as severe, it’s okay to begin by seeing a general medical practitioner or just the family doctor. Below is some important information that will guide you on how to prepare for your appointment. It will also help you to be aware of what you can expect from your doctor.
- Once the appointment has been set, make sure to ask if you need to do anything. It could be ceasing current medication or maybe supplements.
- Note all the symptoms you could be experiencing, even if they are not related to your appointment.
- Note the key personal experiences you have gone through in recent times.
- Make a comprehensive list of all vitamins, supplements, and medications that you are taking.
- Since it may not be possible to catch everything that the doctor says, take a close friend or family member along.
- Make a list of all the questions that you want to ask.
Are You in Danger of Serotonin Syndrome?
Chances are very low. Tricyclic depressants for migraine prevention are usually quite low. Medications such as oral triptan and Sumatriptan have also not been shown to have any correlation with serotonin syndrome.
The cause of the confusion in the matter is because there are different types of serotonin receptors. Further, it’s not common for all medications to interact with the same types of receptors. The FDA issued an alert saying that a combination of triptans and SSRIs may lead to serotonin syndrome.
It is not likely for serotonin syndrome to occur if you are using a triptan and an antidepressant. That is unless your dosage is increased or changed. The risk is higher when the more medications are added, such as anti-nausea or antibiotics.
If you experience symptoms similar to those of serotonin syndrome, go to the emergency room immediately or call your doctor. Taking lots of water can also help. If the symptoms are vague or mild, then it’s probably not serotonin syndrome.
What If I’m Being Treated for Depression?
For those who suffer from migraines, it is not uncommon to have mood disorders. You can take an SNRI or SSRI to manage the pain or depression. Immediate withdrawal from antidepressants may lead to severe withdrawal symptoms. If any concerns arise, contact the prescribing physician. For future purposes, all medications you take should be recorded.