Therapy

The most important measure to be taken if serotonin syndrome is suspected is to stop all medication that may cause it immediately. These include in particular antidepressants, but also certain painkillers (opioids such as tramadol, methadone, fentanyl, pethidine), drugs for nausea of the setron type (ondansetron, granisetron), the antibiotic linezolid and migraine drugs such as triptans and ergotamine. There is no medication for serotonin syndrome.

The focus is on stabilizing the circulation and breathing. Mild syndromes usually improve after 24 hours. However, it becomes problematic if the syndrome is caused by drugs that take a long time to be broken down by the body.

These include in particular the drugs trancylpromine and fluoxetine, which are also antidepressants. Serotonin syndrome can last for several days with such drugs even after they are discontinued and requires longer clinical monitoring. Under no circumstances should attempts be made to treat the fever with antipyretic drugs.

These are ineffective here, as the increased body temperature is caused by excessive muscle activity. Such patients must receive intensive medical care. Medications such as lorazepam or propanolol can be used to calm the patient and treat symptoms. In severe serotonin syndrome, the active substance cyproheptadine is also used, which acts as an antagonist on the serotonin receptor.

Duration

The duration of serotonin syndrome varies from patient to patient. Mild serotonin syndromes usually subside within 24 hours of discontinuing medication. Severe syndromes can last up to 2 weeks.

Antidepressants in particular, whose effects continue for a few days after discontinuation, cause symptoms until the effects subside completely. This can also take several days. Trancylpromine and fluoxetine in particular are important examples of such drugs. The duration of a serotonin syndrome cannot be predicted exactly and is difficult to estimate, especially when several drugs are combined.

Prognosis

A serotonin syndrome detected early usually has a good prognosis. If medication is discontinued in time and clinical monitoring is carried out, the symptoms usually subside after 24 hours. However, the prognosis for serotonin syndrome depends on the severity of the symptoms and the general condition of the person affected.

It is a potentially life-threatening condition and one of the few psychiatric emergencies. Therefore, the diagnosis of a serotonin syndrome should not be underestimated. The prognosis of those affected worsens especially if the signs are overlooked and not acted upon quickly enough. Therefore, sensitization to the syndrome is very important both for patients on antidepressant medication and for the doctors treating them.