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Serotonin syndrome - Treatment

Alternative Names

Hyperserotonemia; Serotonergic syndrome

Treatment:

Patients with serotonin syndrome should stay in the hospital for at least 24 hours for close observation.

Treatment may include:

Benzodiazepines such as diazepam (Valium) or lorazepam (Ativan) to decrease agitation, seizure-like movements, and muscle stiffness
Cyproheptadine (Periactin), a drug that blocks serotonin production
Fluids by IV
Withdrawal of medicines that caused the syndrome

In life-threatening cases, medicines that keep your muscles still (paralyze them) and a temporary breathing tube and breathing machine will be needed to prevent further muscle damage.

Expectations (prognosis):

Patients may get slowly worse and can become severely ill if not quickly treated. Untreated serotonin syndrome can be deadly. However, with treatment, symptoms can usually go away in less than 24 hours.

Complications:

Uncontrolled muscle spasms can cause severe muscle breakdown. The products produced when the muscles break down are released into your blood and eventually go through the kidneys. This can cause severe kidney damage if not recognized and treated appropriately. With appropriate treatment, the condition is reversible.

Calling your health care provider:

Call your health care provider right away if you have symptoms of serotonin syndrome.

Reviewed last on: 7/23/2008
Jacob L. Heller, MD, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

US Food and Drug Administration. FDA Public Health Advisory: Combined Use of 5-Hydroxytryptamine Receptor Agonists (Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) May Result in Life-threatening Serotonin Syndrome. Rockville, MD: Center for Drug Evaluation and Research; July 19, 2006.

Prator BC. Serotonin syndrome. J Neurosci Nurs. 2006 Apr;38(2):102-5.

Ford MD, Clinical Toxicology. 1st ed. Philadelphia, Pa: WB Saunders; 2001:150, 522, 547, 550.

Bilden EF, Walter FG. Antidepressants. In Marx J, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006: chap 149.

Sternbach H. The Serotonin Syndrome. Am J Psychiatry. 1991: 148:705.

Parrot AC. Recreational Ecstasy/MDMA, the serotonin syndrome, and serotonergic neurotoxicity. Pharmacol Biochem Behav. 2002 Apr;71(4):837-44. Review.

Depression

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