{"id":15841,"date":"2020-10-14T09:00:47","date_gmt":"2020-10-14T13:00:47","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=15841"},"modified":"2025-10-17T17:10:03","modified_gmt":"2025-10-17T21:10:03","slug":"serotonin-syndrome-symptoms","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/serotonin-syndrome-symptoms\/","title":{"rendered":"Learn to spot the signs of serotonin syndrome"},"content":{"rendered":"<p><span style=\"font-weight: 400;\"><a href=\"#what\">What is serotonin syndrome?<\/a> | <a href=\"#causes\">Causes<\/a> | <a href=\"#prevalence\">Prevalence<\/a> | <a href=\"#symptoms\">Symptoms<\/a> | <a href=\"#think\">What to do if you think you have it<\/a> | <a href=\"#treatment\">Treatment<\/a> | <a href=\"#last\">How long does it last?<\/a> | <a href=\"#long\">Long-term damage<\/a> | <a href=\"#avoid\">How to avoid it<\/a><\/span><\/p>\n<p><span style=\"font-weight: 400;\">Let\u2019s say you take a prescription <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/side-effects-of-antidepressants\/\"><span style=\"font-weight: 400;\">antidepressant<\/span><\/a><span style=\"font-weight: 400;\">, such as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/paxil\"><span style=\"font-weight: 400;\">Paxil<\/span><\/a><span style=\"font-weight: 400;\"> (paroxetine), every day. You feel a <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/migraine-treatment-and-medications\"><span style=\"font-weight: 400;\">migraine<\/span><\/a><span style=\"font-weight: 400;\"> coming on, so you dig through the drawer in search of an <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/imitrex\"><span style=\"font-weight: 400;\">Imitrex<\/span><\/a><span style=\"font-weight: 400;\"> (sumatriptan) tablet.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Or, another common scenario\u2014you take the antidepressant <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/cymbalta\"><span style=\"font-weight: 400;\">Cymbalta<\/span><\/a><span style=\"font-weight: 400;\"> (duloxetine), and you feel a cold and cough coming on. You reach for a bottle of <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/robitussin-peak-cold-dm\"><span style=\"font-weight: 400;\">Robitussin-DM<\/span><\/a><span style=\"font-weight: 400;\"> to treat your symptoms.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">These medication combinations seem harmless, right? Think again. These scenarios of mixing medications can cause something called serotonin syndrome, which can be life-threatening.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Serotonin is a neurotransmitter. Depression is often associated with low levels of serotonin. Many treatments for <\/span><a href=\"https:\/\/www.singlecare.com\/conditions\/depression-treatment-and-medications\"><span style=\"font-weight: 400;\">depression<\/span><\/a><span style=\"font-weight: 400;\"> help increase serotonin levels. Other medications (such as certain migraine medications, pain medications, cough suppressants, and even dietary supplements) can also increase serotonin levels.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you take a medication that increases serotonin, you may feel just fine. But, too much serotonin from a dose that is too high, or from taking two or more medicines that increase serotonin levels, can cause serotonin syndrome (SS). <\/span><\/p>\n<h2 id=\"what\">What is serotonin syndrome?<\/h2>\n<p><span style=\"font-weight: 400;\">Serotonin syndrome occurs when there is <\/span><a href=\"https:\/\/my.clevelandclinic.org\/health\/diseases\/17687-serotonin-syndrome\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">too much serotonin<\/span><\/a><span style=\"font-weight: 400;\"> in your system. How do you get too much serotonin in your body?<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Serotonin syndrome can happen when someone:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Takes more than one medicine that affects serotonin levels<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Starts or increases the dose of a medicine that increases serotonin<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Takes too much medicine that increases serotonin (accidentally or on purpose)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">When left untreated, the consequences can be severe.<\/span><\/p>\n<h2 id=\"causes\">Which medications can cause serotonin syndrome?<\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>SSRI antidepressants: <\/b><span style=\"font-weight: 400;\">SSRIs (selective serotonin reuptake inhibitors) are the most common drugs involved in serotonin syndrome. They include Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Celexa (citalopram), Lexapro (escitalopram), Luvox (fluvoxamine), and Trintellix.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>SNRI antidepressants: <\/b><span style=\"font-weight: 400;\">SNRIs (serotonin-norepinephrine reuptake inhibitors) include Cymbalta (duloxetine), Effexor (venlafaxine), and Pristiq (<a href=\"https:\/\/www.singlecare.com\/prescription\/desvenlafaxine-er\/what-is\">desvenlafaxine<\/a>).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Other antidepressants: <\/b><span style=\"font-weight: 400;\">Tricyclic antidepressant medications (amitriptyline, nortriptyline), bupropion, trazodone, MAOIs (monoamine oxidase inhibitors)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-fda-warns-about-several-safety-issues-opioid-pain-medicines-requires\" target=\"_blank\" rel=\"noopener\"><b>Opioid painkillers<\/b><\/a><b>: <\/b><span style=\"font-weight: 400;\">such as Percocet, oxycodone, OxyContin, Ultram (tramadol), Demerol (meperidine), fentanyl, Vicodin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Cough suppressants:<\/b><span style=\"font-weight: 400;\"> Any cough\/cold medication that contains dextromethorphan, such as Robitussin-DM, promethazine DM, Delsym, Mucinex-DM<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Migraine medications: <\/b><span style=\"font-weight: 400;\">Triptans such as Amerge (naratriptan), Imitrex (sumatriptan), Relpax (eletriptan), Zomig (zolmitriptan), Axert (almotriptan)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Other prescription drugs: <\/b><span style=\"font-weight: 400;\">Metoclopramide, ondansetron, linezolid<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Herbal supplements: <\/b><span style=\"font-weight: 400;\">Ginseng, St. John\u2019s Wort<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Illegal drugs: <\/b><span style=\"font-weight: 400;\">Ecstasy, LSD, cocaine<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Talk to your pharmacist before starting on a new drug to avoid these potential interactions.<\/span><\/p>\n<h2 id=\"prevalence\">How common is serotonin syndrome?<\/h2>\n<p><span style=\"font-weight: 400;\">Experts are <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482377\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">not sure<\/span><\/a><span style=\"font-weight: 400;\"> of the number of cases of serotonin syndrome. This is because mild cases may be overlooked or ignored. More severe cases may be attributed to another cause. We know that serotonin syndrome can occur in people of any age, and as antidepressant use is increasing, the cases of serotonin syndrome increase.<\/span><\/p>\n<h2 id=\"symptoms\">What are the symptoms of serotonin syndrome?<\/h2>\n<p><span style=\"font-weight: 400;\">Serotonin syndrome symptoms develop quickly after taking the precipitating medicine\u201460% of cases occur within six hours. <\/span><a href=\"https:\/\/medlineplus.gov\/ency\/article\/007272.htm\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">But symptoms may gradually get worse<\/span><\/a><span style=\"font-weight: 400;\">, becoming dangerous or life-threatening if not treated. Though most patients develop symptoms within 24 hours, there are case reports of people experiencing symptoms up to <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2464814\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">several weeks<\/span><\/a><span style=\"font-weight: 400;\"> even after discontinuing the other drug known to increase serotonin levels, especially serotonergic agents with longer half-lives, such as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/fluoxetine-hcl\"><span style=\"font-weight: 400;\">fluoxetine<\/span><\/a><span style=\"font-weight: 400;\"> (the longer the half life of a drug, the longer it lasts in your body).<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">So what are the symptoms of serotonin syndrome? They can vary from mild symptoms to life-threatening and may include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Agitation\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Anxiety\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Restlessness<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Mood changes\/changes in mental status<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Disorientation or confusion<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Loss of muscle coordination<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Sweating or shivering<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Flushed skin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Fever<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hyperthermia (overheating)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Increased heart rate or high blood pressure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nausea, vomiting, or diarrhea<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tremor\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Muscle stiffness, muscle rigidity, or muscle jerks, especially in the legs\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hyperactive reflexes<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dilated pupils<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">More severe serotonin syndrome symptoms include high fever, seizures, irregular heartbeat, and unconsciousness.<\/span> <span style=\"font-weight: 400;\">If you think you may be experiencing symptoms of serotonin syndrome, it\u2019s important to seek emergency treatment from a doctor immediately.\u00a0<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/fever-temperature\/\"><b>What body temperature is considered a fever?<\/b><\/a><\/p>\n<h2 id=\"think\">Diagnosis<\/h2>\n<p><span style=\"font-weight: 400;\">If you take a medicine that affects serotonin levels and experience any of the above symptoms, contact your doctor right away, or for more severe symptoms, seek immediate treatment in an urgent care center or emergency room. Severe cases are life-threatening and can quickly progress to death.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The healthcare provider you see can usually diagnose serotonin syndrome clinically, by evaluating your symptoms, reviewing the medicines you take (both prescription and over-the-counter), and, if necessary, conducting a physical examination. Some physicians use the <\/span><a href=\"https:\/\/www.aafp.org\/afp\/2010\/0501\/p1139.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Hunter Serotonin Toxicity Criteria<\/span><\/a><span style=\"font-weight: 400;\"> to aid in the diagnosis of serotonin syndrome and to rule out<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3865832\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\"> conditions <\/span><\/a><span style=\"font-weight: 400;\">that exhibit similar signs<\/span><span style=\"font-weight: 400;\"> such as neuroleptic malignant syndrome, malignant hyperthermia, and anticholinergic toxicity.<\/span><\/p>\n<h2 id=\"treatment\">What is the treatment for serotonin syndrome?<\/h2>\n<p><span style=\"font-weight: 400;\">Seek immediate treatment for symptoms of serotonin syndrome. Severe cases of serotonin syndrome can result in rhabdomyolysis (breakdown of muscle), myoglobinuria (muscle protein in the urine), metabolic acidosis, kidney failure, acute respiratory distress syndrome, respiratory failure, abnormal blood clotting, coma, and death<\/span><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For mild cases, your healthcare provider will likely advise you to discontinue the drug or drugs causing the reaction immediately. If you have more concerning or severe symptoms, you should be treated and monitored in the hospital. Treatment of serotonin syndrome depends on the symptoms and the severity of symptoms.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some prescription medications used to <\/span><a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/serotonin-syndrome\/diagnosis-treatment\/drc-20354764\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">treat symptoms<\/span><\/a><span style=\"font-weight: 400;\"> include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Benzodiazepines (such as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/diazepam\"><span style=\"font-weight: 400;\">diazepam<\/span><\/a><span style=\"font-weight: 400;\">) to help agitation, seizures, and stiffness<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/cyproheptadine-hcl\"><span style=\"font-weight: 400;\">Cyproheptadine<\/span><\/a><span style=\"font-weight: 400;\"> to block serotonin production<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Medications to lower your heart rate or blood pressure (or raise your blood pressure if it is too low)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">You may also need intravenous fluids for dehydration and fever, or supplemental oxygen.<\/span><\/p>\n<h2 id=\"last\">Outlook<\/h2>\n<p><span style=\"font-weight: 400;\">The length of time that you could experience serotonin syndrome varies. Those with milder forms of serotonin syndrome may feel better within one to three days. Some cases can take several weeks to go away, depending on which medication(s) caused the reaction and how long the medication(s) stay in your body.<\/span><\/p>\n<p><a href=\"https:\/\/www.aafp.org\/afp\/2010\/0501\/p1139.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">American Family Physician explains<\/span><\/a><span style=\"font-weight: 400;\"> that you <\/span><i><span style=\"font-weight: 400;\">can<\/span><\/i><span style=\"font-weight: 400;\"> recover completely from serotonin syndrome, as long as it\u2019s recognized quickly and complications are well-managed.<\/span><\/p>\n<h2 id=\"long\">Can serotonin syndrome cause long-term damage?<\/h2>\n<p><span style=\"font-weight: 400;\">The <\/span><a href=\"https:\/\/acphospitalist.org\/archives\/2013\/04\/serotonin.htm\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">good news<\/span><\/a><span style=\"font-weight: 400;\"> is that \u201cin almost all cases, if the disease is caught early, there should be no long-term side effects,\u201d according to hospitalist experts.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Because of the importance of treating serotonin syndrome early, it is critical to seek immediate treatment if you have symptoms.\u00a0<\/span><\/p>\n<h2 id=\"avoid\">Prevention<\/h2>\n<p><span style=\"font-weight: 400;\">Anyone who takes medicine that increases serotonin is at risk of serotonin syndrome.\u00a0<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">For your safety, get all of your medications at one pharmacy. This way, the pharmacist can get to know you and have your full medication list to screen for drug interactions.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you have any changes in your medication regimen, such as starting a new medication, always consult your pharmacist to make sure you are not doubling up on serotonin. They can provide you with information to help minimize your risk.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you take medications that increase serotonin, be aware of symptoms of serotonin syndrome. Seek immediate medical treatment if you have symptoms.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you need a cold\/cough medication and are already taking a drug that increases serotonin levels, check the ingredients, and avoid dextromethorphan. Your pharmacist can help you select an appropriate product.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Many different medications affect serotonin levels. A change in dosage or combination of two medicines that both increase serotonin can cause serotonin syndrome, which can be life-threatening.\u00a0<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Always check with your healthcare provider to make sure that the medications you take are compatible.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is serotonin syndrome? | Causes | Prevalence | Symptoms | What to do if you think you have it | Treatment | How long does it last? | Long-term damage | How to avoid it Let\u2019s say you take a prescription antidepressant, such as Paxil (paroxetine), every day. You feel a migraine coming on, [&hellip;]<\/p>\n","protected":false},"author":94,"featured_media":53996,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8029],"tags":[9777,788],"coauthors":[10668],"class_list":["post-15841","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-education","tag-anxiety","tag-drug-safety","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>How do you know if you have serotonin syndrome?<\/title>\n<meta name=\"description\" content=\"Serotonin syndrome is caused by mixing medications. It can be life-threatening. 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