Serotonin Syndrome


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“It takes but one positive thought when given a chance to survive and thrive to overpower an entire army of negative thoughts.”

– Robert H. Schuller


Serotonin Syndrome

Serotonin Syndrome is a rare emergency that can be associated with taking opioids and several types of medications commonly used for pain management as well as for anxiety and/or depression. It is most commonly seen when combinations of these medications are used or when excessive amounts of one or a combination of them are ingested.


Serotonin syndrome can cause agitation, confusion, fever, and seizures, and it can be lethal if undetected or untreated. Patients who take antidepressants (SSRIs, SNRIs, St. John’s Wort, monoamine oxidase inhibitors), lithium, or HIV medications are at increased risk of serotonin syndrome. In addition, patients who take opioids chronically are at increased risk of serotonin syndrome if medications such as fentanyl or meperidine (Demerol) are needed in emergency or surgical care settings.


The symptoms of Serotonin Syndrome can be very nonspecific and may initially be overlooked or underappreciated unless viewed with an informed perspective. The hallmark symptoms are confusion, fever, cold sweats and muscle rigidity, worse in the legs. Common symptoms associated with this syndrome also include skin flushing, shaking, decreased responsiveness, diarrhea and sometimes incontinence.


While the Serotonin Syndrome does respond to treatment, it is a potentially life- threatening condition and as such early treatment is important. Since early recognition is important to obtain treatment, inform your family members and those around you to not hesitate to call 911 should you develop these symptoms. Risk of developing these symptoms are greatest particularly if associated with a recent increase in dosage or addition of a new medication.


The list of medications that might precipitate a Serotonin Syndrome is growing but generally is limited certain categories as noted below:

Drugs at Risk for Serotonin Syndrome:

Psychiatric Meds

Tricyclic Antidepressants: Amitryptiline (Elavil), Doxepin (Silenor)

Selective Serotonin Uptake Inhibitors (SSRIs): (Lexapro, Paxil, Zoloft, Prozac, Celexa)

Serotonin/Norepinephrine Uptake Inhibitors (SNRIs): Cymbalta, Effexor

Others: Trazodone, Wellbutrin, Lithium, Ritalin, Adderal


Neurologic Medications

Tegretol, Imitrex, Maxalt, drugs for Parkinsons



All opioids:  hydrocodone, oxycodone, methadone etc.)


Muscle Relaxers

 Flexeril, possibly others


Illicit drugs

Cocaine, Ecstasy (MDMA), Methamphetamine


Other Medications

Linezolid (Zyvox)


OTC CAM Supplements

Caffeine, St Johns Wort, 5-HTP, tryptophan


Again, this condition is uncommon and it is not likely that you will develop these symptoms. Just be aware of the possibility and be cautious when you increase the dose of a medication above or add a new medication, even when directed to do so by your physician.


If you suspect this condition, stop your medications and call your doctor or call 911.



Serotonin SyndromeOverviews


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