Abnormally high levels of serotonin, a chemical that acts as a neurotransmitter, can cause serotonin syndrome. While supplementing your serotonin levels can decrease symptoms of depression, too much can be fatal. Serotonin syndrome can develop in people taking antidepressants called selective serotonin reuptake inhibitors, or SSRIs, which raise serotonin levels, as well as in those taking other drugs. Herbs do not help and should not be used to treat serotonin syndrome. They can, in some cases, actually increase the risk of developing it.
Causes
Elevated levels of serotonin in the brain cause serotonin syndrome. People who have a genetic lack of the cytochrome P450 2D6 enzyme, which includes 8 percent of the Caucasian population, are more likely to develop the syndrome. Certain herbs can increase the effects of drugs used to treat depression, increasing the chance of developing serotonin syndrome. St. John's wort and citrus aurantium, also called bitter orange, both have effects on the enzyme, according to an article published in the November 2006 issue of "Clinical Psychiatry News." Ginseng may also increase the risk, according to the Mayo Clinic. If you take prescription medications, especially medications to treat depression, do not take any herbal preparations without your doctor's approval.
Symptoms
Symptoms of serotonin syndrome include fever, uncontrollable muscle spasms, ataxia, agitation, confusion, hypomania, sweating, hyperactive reflexes, rapid heart rate, tremors and shivering. Symptoms are most likely to occur right after you've increased your medication dose or started a new medication. Serotinin syndrome usually occurs in people taking two or more medications that increase serotonin levels. If you've just started a new herbal medication and develop symptoms of serotonin syndrome, stop the herb immediately and notify your physician.
Treatment
Serotonin syndrome may be mild enough to clear when you stop the medication causing the disorder. In some cases, you may require hospitalization and treatment with intravenous medications such as valium to reduce agitation and muscle symptoms. You may also receive medication to decrease serotonin levels such as cyproheptadine. Herbal treatments have no benefit and should not be used to treat this disorder.
Complications
Severe serotonin syndrome causes muscle breakdown. When muscle breaks down, toxic substances released from the muscle, called myoglobin, can cause severe kidney damage, leading to a serious condition called rhabdomyolysis. Kidney damage can lead to death in serotonin syndrome. Disseminated intravascular coagulation, or DIC, a serious clotting disorder, can also develop. In severe serotonin syndrome, delirium and coma can occur; between 2 to 12 percent of patients will die, Christopher Frank, M.D., reported in the July 2008 issue of "Canadian Family Physician."
References
- MayoClinic.com: Seratonin Syndrome; February 2011
- "Clinical Psychiatry News"; Herbal Use May Affect Psychotropic Response : Serotonin Syndrome Has Been Reported in Patients Who Used Both St. John's Wort and an SSRI; November 2006
- "Canadian Family Physician"; Recognition and Treatment of Serotonin Syndrome; Christopher Frank, M.D.; July 2008
- MedlinePlus: Rhabdomyolyisis: August 2009
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