Serotonin syndrome

Diagnosis

A definitive diagnosis of serotonin syndrome cannot be made with a single test. Instead, your doctor will diagnose the condition by ruling out other possible causes. They will typically begin by inquiring about your symptoms, medical background, and current medications. A physical examination will also be conducted as part of the diagnostic process.

To ensure that your symptoms are indeed caused by serotonin syndrome and not another condition, your doctor may use tests to:

• Assess any medication levels you may be taking
• Look for infection signs
• Examine bodily processes that serotonin syndrome may impact.

Several conditions can produce symptoms similar to those of serotonin syndrome. Minor symptoms may arise from various causes. However, moderate and severe symptoms resembling those of serotonin syndrome could be caused by:

• An overdose of illegal substances, antidepressants, or other drugs that raise serotonin levels
• A severe reaction to particular drugs, such as antipsychotics, anesthetics, and other substances known to cause these kinds of reactions
• Damage related to drug use
• Severe alcohol withdrawal

Your doctor may request additional tests to eliminate other potential causes of your symptoms. These tests may include:

• Chest X-ray
• Blood and urine tests
• Computed Tomography (CT) scan
• Lumbar puncture

Treatment

The intensity of your symptoms will determine how you are treated for serotonin syndrome.

• If your symptoms are mild, you might only need to see a doctor and cease taking the offending medicine.
• You might need to visit the hospital if your doctor is concerned about your symptoms. To ensure that your symptoms are getting better, your doctor could ask you to spend a few hours in the hospital.
• If you have severe serotonin syndrome, you will require hospitalization for intensive care.

The following treatments could be administered to you, depending on your symptoms:

• Muscle relaxants. Benzodiazepines can help manage agitation, seizures, and muscle rigidity. Examples of these drugs are lorazepam and diazepam.
• Serotonin-production blocking agents. Medication like cyproheptadine, which blocks the production of serotonin, can be helpful if other treatments aren’t working.
• Oxygen and intravenous fluids. The oxygen levels in your blood can be maintained by breathing through a mask, while fever and dehydration can be treated with intravenous fluids.
• Drugs that control heart rate and blood pressure. These could include nitroprusside or esmolol to lower elevated blood pressure or heart rate. Your doctor may prescribe phenylephrine or epinephrine if your blood pressure is too low.
• A machine, a breathing tube, and drugs to immobilize your muscles. If you have a high temperature, you could require this treatment.

Less severe forms of serotonin syndrome usually resolve within 24 to 72 hours after discontinuing medications that elevate serotonin levels. To alleviate the effects of excess serotonin already in your system, medication may be necessary. However, symptoms induced by certain antidepressants may persist for several weeks, as these medications have a longer duration of action compared to others that can cause serotonin syndrome.