What is serotonin syndrome?
Serotonin syndrome is a serious drug reaction that can be mild or lethal. It can be caused by Cymbalta or any other medication that affects serotonin, including supplements. Serotonin is a chemical that the body produces naturally. It’s needed for the nerve cells and brain to function. But too much serotonin causes symptoms that can range from mild (such as shivering and diarrhea) to severe (such as muscle rigidity, fever and seizures). Severe serotonin syndrome can cause death. If you experience serotonin syndrome stop taking Cymbalta immediately and seek medical help.
Serotonin syndrome can happen even if you have never taken psychotropic drugs before.
Bridging to another drug can significantly increase the risk of serotonin syndrome.
Serotonin syndrome can also be caused by supplements such as 5-HTP, St John’s wort, and others. So the golden rule with any prescription drugs, non-prescription drugs, and natural supplements is to check every ingredient to learn whether it affects serotonin. Use this interactions checker for drugs: www.drugs.com Verify that supplements are free from serotonin-affecting substances by doing an internet search for each ingredient plus the word “serotonin.”
One personal experience of serotonin syndrome
“While I was on Cymbalta … I spontaneously began experiencing symptoms … involuntary muscle jerking and twitching, brain zaps and electrical shocking sensations throughout my body, low sodium levels, migraine, nausea and other GI problems, extreme pain, insomnia, horrific suicidal ideations, confusion, hallucination, mood swings, etc.” -Mreen Helm, CHW moderator
Be prepared
Make sure your doctor knows about all the medications and supplements you take. You should keep a list of your medications and supplements, together with your medical details, in a file for easy reference by you or a loved one. Consider having them on your person at all times.
Do not take more than one serotonin-related medication or increase your dose of a serotonin-related medication unless you have seriously considered the consequences and are convinced there is a need.
If you use more than one drug that affects your serotonin levels, know the symptoms of serotonin syndrome so you can watch for them.
Serotonin syndrome signs and symptoms
- Agitation or restlessness
- Insomnia
- Confusion
- Rapid heart rate and high blood pressure
- Dilated pupils
- Loss of muscle coordination or twitching muscles
- High blood pressure
- Muscle rigidity
- Heavy sweating
- Diarrhea
- Headache
- Shivering
- Goosebumps
Severe serotonin syndrome can be life threatening. Signs include:
- High fever
- Tremor
- Seizures
- Irregular heartbeat
- Unconsciousness
Treatment
The drug(s) that caused the serotonin syndrome must be stopped immediately. No drug can reverse the symptoms of serotonin syndrome. Typical supportive care includes aggressive IV fluids, monitoring, oxygen, muscle relaxants, and medications that can control heart rate and blood pressure. If these don’t work, a serotonin blocking agent may be tried.
Severe serotonin syndrome can kill!
If you suspect you have serotonin syndrome please seek medical help immediately.
The most dangerous time with serotonin-affecting drugs is when stopping, starting, changing doses up or down, or adding and taking away other drugs. Please be aware of the symptoms of serotonin syndrome! Have a crisis and safety plan in place with close, trusted family and friends.
Drugs and supplements that could potentially cause serotonin syndrome
- SSRI antidepressants, SNRI antidepressants, tricyclic antidepressants, MAOI antidepressants
- Bupropion (Zyban, Wellbutrin SR, Wellbutrin XL) and all tobacco addiction medications
- Anti-migraine medications, such as:
- carbamazepine (Tegretol, Carbatrol)
- valproic acid and triptans, which include almotriptan, naratriptan (Amerge) and sumatriptan (Imitrex, Tosymra)
- Pain medications, such as:
- codeine, fentanyl (Duragesic, Abstral)
- hydrocodone (Hysingla ER)
- meperidine (Demerol)
- oxycodone (Oxycontin, Roxicodone)
- tramadol (Ultram, ConZip)
- Mood stabilizers and antipsychotics, such as:
- lithium
- Abilify
- olanzapine
- resperidone
- haloperidol
- quetiapine
- Illicit drugs, such as:
- LSD
- ecstasy/MDMA
- cocaine
- amphetamines
- Herbal supplements, such as:
- St. John’s wort
- Ginseng, saffron, and even nutmeg
- Non-prescription cough and cold medications containing dextromethorphan.
- Anti-nausea medications, such as:
- granisetron (Sancuso, Sustol)
- metoclopramide (Reglan)
- droperidol (Inapsine)
- ondansetron (Zofran)
- Some antibiotics, such as Zyvox
- HIV medications, such as Norvir
References
https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758
https://my.clevelandclinic.org/health/diseases/17687-serotonin-syndrome