The Serotonin Syndrome

The Serotonin Syndrome


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Take notice that also non SSRI anti-depressants (and even Ritalin) may interact (primary or secondary) with the serotonergic (or serotoninergic) system in the brain.

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Serotonin Syndrome
The Serotonin Syndrome is a hyperserotonergic state which is a very dangerous and a potentially fatal side effect of serotonergic enhancing drugs which can have multiple psychiatric and non-psychiatric symptoms. This is a toxic condition which requires heightened clinical awareness in order to prevent, recognize, and treat the condition promptly. Promptness is vital because, as we just mentioned, the serotonin syndrome can be fatal and death from this side effect can come very rapidly. This syndrome is a toxic hyperserotonergic state whose rate of incidence is unknown, but is on the rise. This disorder, brought on by excessive levels of serotonin, is difficult to distinguish from the neuroleptic malignant syndrome because the symptoms are so similar. The neuroleptic malignant syndrome is a serious condition brought on by the use of the neuroleptic drugs.
Source: Prozac: Panacea or Pandora? by Dr Ann Blake Tracy http://members.aol.com/atracyphd/syndrome.htm

The Serotonin Syndrome is a potentially lethal condition caused by excessive serotonergic activity and is diagnosed by the presence of at least 3 of 10 symptoms: mental status changes (confusion, hypomania), agitation, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, diarrhea, incoordination, and fever.
Source: Journal of Clinical Psychiatry

Symptoms: euphoria, drowsiness, sustained rapid eye movement, overreaction of the reflexes, rapid muscle contraction and relaxation in the ankle causing abnormal movements of the foot, clumsiness, restlessness, feeling drunk and dizzy, muscle contraction and relaxation in the jaw, sweating, intoxication, muscle twitching, rigidity, high body temperature, mental status changes were frequent (including confusion and hypomania - a "happy drunk" state), shivering, diarrhea, loss of consciousness and death.
Source: American Journal of Psychiatry, June 1991 "The Serotonin Syndrome"

A recent study (25 sept, 2004) shows us clearly that serotonin toxicity (such as the Serotonin Syndrome) can even appear rapidly in a few hours after taking a single therapeutic dose of SSRI medication. In Bio-Psychiatry it is a common thought that SSRI's are believed to have their effect by inhibiting the re-uptake of serotonin (downregulation of transporters) and thereby gradually increasing serotonin outside the tissue cell wall (extracellular) in the synaptic gap between brain cells (neurons) in the brain. In this important study, Zoloft (Lustral, sertraline) was given to monkeys for 4 weeks to establish how long it would take before Zoloft would have it's effect on serotonergic neurons and thus elevation of serotonin. In contrast with the commonly accepted SSRI theory, it was observed that serotonin levels raised NOT gradually, but rapidly and dramatically and kept on raising during these 4 weeks, an effect that can NOT be ascribed solely to a "re-uptake inhibition" of serotonin.

CASE REPORTS / REVIEWS / ARTICLES
2004
02/00
Case/Review Serotonin Syndrome and the use of SSRI's
2003
05/27
Case/Review Serotonin Syndrome: a brief review -case 1 fluoxetine
2003
05/06
Case/Review Serotonin Syndrome induced by Remeron/Remergil (Mirtazapine)
2003
05/00
Case/Review Effexor more likely to cause Serotonin Toxicity in patient at risk seizure/suicide
2003
05/00
Case/Review Fatal Serotonin Syndrome after treatment with linezolid and Celexa/Cipramil
2003
02/00
Case/Review Serotonin Syndrome Induced by Low-Dose Effexor (venlafaxine)
2002
09/00
Case/Review Neuroleptic Withdrawal vs Serotonergic Syndrome in 8-year-old child on fluoxetine
2002
04/00
Case/Review Case of a patient with Fluoxetine & Selegiline induced Fatal Serotonin Syndrome
2002
04/00
Case/Review Severe Serotonin Syndrome induced by Mirtazapine monotherapy
2002
03/04
Case/Review Serotonin Toxicity with therapeutic doses of dexamphetamine and venlafaxine
2002
02/00
Case/Review Serotonin Syndrome present. as Hypotonic Coma & Apnea (fluoxetine & citalopram)
2001
10/00
Case/Review Serotonin Syndrome induced by Fluvoxamine and Mirtazapine
2001
09/00
Case/Review Neonatal paroxetine withdrawal syndrome or actually serotonin syndrome?
2001
03/00
Case/Review A Fatal Case of Serotonin Syndrome after moclobemide-citalopram intoxication
2000
05/00
Case/Review SSRI-antidepressants can result in Toxicity and Death through serotonergic excess
2000
04/00
Case/Review Venlafaxine-induced Serotonin Syndrome with relapse following amitriptyline
2000
03/00
Case/Review Serotonin Syndrome during fluoxetine-poisoning in a patient taking moclobemide
2000
02/00
Case/Review Case Report: Serotonin Syndrome with Serzone and Prozac
2000
01/22
Case/Review Neuroleptic Malignant Syndrome with Effexor (venlafaxine)
1999
09/00
Case/Review Serotonin syndrome associated to the use of paroxetine. Case report
1999
07/00
Case/Review Serotonin syndrome secondary to the use of sertraline and metoclopramide
1999
07/08
Case/Review Serotonin syndrome in a child associated with erythromycin and sertraline
1998
00/00
Case/Review Antidepressant drugs: disturbing and potentially dangerous adverse effects
1998
09/00
Case/Review Extrapyramidal Adverse Effects associated with Zoloft/Lustral
1998
09/00
Case/Review Serotonin Syndrome due to venlafaxine overdose
1998
07/00
Case/Review Serotonin Syndrome induced by transitioning from phenelzine to venlafaxine
1998
07/08
Case/Review Serotonin Syndrome with Effexor and other SSRI-antidepressants
1998
04/00
Case/Review Serotonin Syndrome induced by venlafaxine and fluoxetine
1997
01/00
Case/Review Serotonin Syndrome following a single dose of Effexor (venlafaxine)
1996
10/00
Case/Review Movement disorders associated with Selective Serotonin Reuptake Inhibitors
1996
07/12
Case/Review Isolated Effexor (venlafaxine)-overdose-induced Serotonin Syndrome
1995
07/08
Case/Review Serotonin Syndrome in a patient given fluoxetine and lithium
1994
11/00
Case/Review Prozac/Sarafem (fluoxetine)-induced Serotonin Syndrome in 48-year-old man
1994
11/00
Case/Review Serotonin Syndrome with Paxil/Seroxat, an OTC cold remedy, and vascular disease
1990
09/15
Case/Review Neuroleptic Malignant Syndrome with Prozac/Sarafem (fluoxetine)

(SSRI/SSNRI) Antidepressants
Antidepressant
Side-Effects
Buspirone: Buspar or Neurosine
Antidepressant
Side-Effects
Citalopram: Celexa or Cipramil
Antidepressant
Side-Effects
Escitalopram: Cipralex or Lexapro
Antidepressant
Side-Effects
Duloxetine: Cymbalta
Antidepressant
Side-Effects
Venlafaxine: Effexor or Efexor
Antidepressant
Side-Effects
Paroxetine: Paxil, Seroxat, Aropax or Pexeva
Antidepressant
Side-Effects
Fluoxetine: Prozac or Sarafem
Antidepressant
Side-Effects
Mirtazapine: Remeron or Remergil
Antidepressant
Side-Effects
Nefazodone: Serzone or Dutonin
Antidepressant
Side-Effects
Trazodone: Trazodone or Desyrel
Antidepressant
Side-Effects
Bupropion: Wellbutrin or Zyban
Antidepressant
Side-Effects
Sertraline: Zoloft or Lustral
Antidepressant
Side-Effects
ALL SSRI's: SSRI & SSNRI Antidepressants

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