“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 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:
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
Tegretol, Imitrex, Maxalt, drugs for Parkinsons
All opioids: hydrocodone, oxycodone, methadone etc.)
Flexeril, possibly others
Cocaine, Ecstasy (MDMA), Methamphetamine
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 Syndrome – Overviews
Emphasis on Education
Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.
For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.
Should you wish more information regarding any of the subjects listed – or not listed – here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.
For more information, please contact Accurate Clinic.
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