Serotonin syndrome( SS) after taking special drugs is a rare phenomenon. In the US, this diagnosis is received no more than 7-7.5 people per year, in our country, there is no reliable statistics at all. Many Russian doctors with this syndrome are unfamiliar, and diagnosis and adequate treatment become a real problem. Therefore, it is so important to know the causes and specific signs of this most dangerous disease, because a heavy SS can even lead to death.
Serotonin syndrome
Serotonin syndrome is the rarest reaction of the body to taking medications( usually antidepressants) or drugs that increase serotonin transmission. The same term is also called a life-threatening condition caused by intoxication from such drugs.
The reaction of the body to such "serotonin" drugs is individual, therefore the list of substances that can cause it is quite impressive. These are:
- Narcotic drugs: MDMA( ecstasy), LSD, amphetamines, opiates, etc.
- Selective serotonin reuptake inhibitors, or SSRIs( antidepressants).These include citalopram, paroxetine, fluoxetine, sertraline.
- Monoamine oxidase inhibitors, or MAOI( antidepressants).These are phenelzine, moclobemide, clorgillin, isocarboxazid, etc.
- Other antidepressants( trazodone, venlafaxine, buspirone, clomipramine, mirtazapine, etc.).
- Analgesics, narcotic and conventional( fentanyl, tramadol, meperidine, pentazocine, etc.).
Other groups of pharmacy medicines may also provoke the SS: antibiotics( ritonavir, etc.), antiemetics( metoclopramide, etc.), cough suppressants( dextromethorphan) and migraine( sumatriptan), weight loss drugs( sibutramine), etc.
Causes of
The main and only factor in the development of serotonin syndrome is the intake of a substance that directly affects the synthesis of serotonin, the "happiness hormone".
The main reasons for the occurrence of HS are:
- Negative reaction to a combination of certain drugs.
- Recreational use of drugs.
- Poisoning by drugstores( intoxication).
- Just an individual response to the drug.
Most often, SS provoke the taking of drugs and mixing 2 or more drugs. The most dangerous option is antidepressants of SSRIs + MDMA.A terrible syndrome can develop if you mix these drugs with anti-catarrhal, containing dextromethorphan, and with opioid analgesics.
It is dangerous to take antidepressants together and mood stabilizers( normotimics).On other combinations of such drugs, the physician can provide detailed information.
Symptoms of
Symptoms of serotonin syndrome often appear already in the first hours after taking drugs or drugs. In half of all patients, the reaction begins in a couple of hours, 25% in the first day, and 25% in two days. In elderly patients, the SS can develop even after three days.
Classical symptoms of SS include 3 large groups: mental disorders, vegetative signals and neuromuscular signs. The reason for such violations is the general - the wrong synthesis of serotonin.
The hormone serotonin refers to neurotransmitters - special substances that are responsible for the passage of electrical impulses along nerve cells and can affect vital functions. After synthesis, serotonin combines with receptors on nerve cells and rushes to different corners of our body, where it controls emotions, sexual desire and appetite, day regimen( sleep and wakefulness), thermoregulation. In the sphere of responsibility of the neurotransmitter is also the work of the gastrointestinal tract, muscle motor, vascular tone, etc. Any disturbance of serotonin synthesis entails the disorder of all these functions.
Changes in the psyche
These signs appear in the first place and are rapidly growing - from mild excitation to hallucinations and even coma.
About the SS speak such signals:
- little emotional excitement;
- drowsiness, apathy, a sharp decline in strength;
- the strongest joy, euphoria, the urge to run somewhere urgently and do something;
- anxiety and fear right up to the panic, a convulsive search for an exit from the room( a man rushes around the room);
- anxiety and joy abruptly change;
- confusion and delirium;
- auditory and visual hallucinations;
- is sometimes a heavy coma.
Vegetative
The first signals of the SS are often disorders of the digestive tract and other signs of autonomic dysfunction:
- nausea, followed by vomiting;
- abdominal pain, gas, diarrhea;
- excruciating headaches;
- chills or fever, up to 42ºC;
- tachycardia and rapid breathing;
- pressure jumps;
- excessive sweating and tears.
Neuromuscular disorders
Dysfunction from the neuromuscular system in MS is manifested in a variety of symptoms, from twitching of the limbs to severe seizures.
When diagnosed for serotonin syndrome unequivocally indicate:
- tremor( rhythmic twitching of limbs and body);
- involuntary and nonrhythmic contractions of individual muscles;
- numbness and trembling of hands and feet;
- nystagmus( rotation of the eyeballs);
- convulsions of the eye( unexpected rolls up and down eyes);
- traffic coordination offsets;
- fuzzy speech;
- epileptic seizures.
Diagnosis
Diagnosis of serotonin syndrome in Russian medicine is a very urgent problem. Now there are no effective methods for unambiguous statement of such a diagnosis, some doctors also do not imagine a complete clinical picture of the SS.To determine the serotonin syndrome, only 2 Western methods are used.
The Sternbach scheme
Includes three criteria on the basis of which the patient can be diagnosed with the SS:
- The patient has at least 3 symptoms from this list: hyperreflexia and arousal, chills and fever, diarrhea and intense sweating, confusion, tremor, spontaneous muscle contractionsand impaired coordination.
- No neuroleptics appeared before the appearance of suspicious signals. And if I took it as intended, I did not increase the dose.
- The disease is not exactly caused by infections, drug poisoning, withdrawal syndrome or metabolic disorders.