Serotonin Syndrome -- somewhat OT but important for practitioners to know about

[Rosemary C. Hyde, Ph.D.]

I've had some recent experience with Serotonin syndrome, and have realized that although the name is known, health care providers, from psychopharmacologists through GPs, nurse practitioners, body workers, ... no one is prepared to recognize it clinically.

It can happen to anyone taking serotonin uptake inhibitors and can be life threatening (the heart spasms, and suddenly and unexpectedly stops beating).

Generally, the dose of the main SSRI or SNRI is appropriate. But there are other prescription or over the counter medications that interact with the SNRI or are excreted through the same pathway, causing the amount of Serotonin in the person's system to rise (it's not "uptaken," so remains in the system.). This can be as simple as taking an over the counter cough syrup containing dextromethorphan along with an SSRI. (Zoloft, Paxil, Cymbalta, Remeron are a few examples -- anti-anxiety agents and anti-depressants). I don't think they've discovered all the meds that can begin to cause this reaction. And there are no label warnings about potential interactions with SSRIs.

Early clinical signs include muscles that are chronically tense or board-like, tremulousness, irritability, peripheral edema and easy breathlessness with no evidence of heart disease or electrolyte abnormalities.

At a more advanced state, the person starts experiencing terrible muscle pain with clonic spasms from very slight causes or tiny injuries. These can be either/both internal and external -- pyloric spasm, for instance, creating a temporary GI obstruction causing unretractable vomiting for hours or days, then letting up.

The pain level is severe by this time from the spasms -- severe enough that the person will end up in the Emergency Room, only to be told that there's nothing wrong with them.

Massage therapists and body workers will encounter people in earlier stages of this syndrome, with lots of cramping musculoskeletal pain. We homeopaths may encounter these people, also, complaining of muscle pain, stiff muscles, and often GI problems, vomiting, reflux, easy fullness with regurgitation of food just eaten, a feeling that food isn't going down, vomiting of food eaten hours before or the previous day.

It's important, because of the threat of sudden death, for health care workers to be aware of this syndrome which is possible in any patient who's taking anti-depressants or SSRI-type anti-anxiety agents (e.g. Klonipin, Imipramine...).

I'm passing this along because I've seen someone close to death from it after it had built up for almost two years of painful episodes. In this case, 8 different doctors in two totally different parts of the US who were prescribing the medications not only were not recognizing it, but kept prescribing more drugs of this class and making it worse. I can think of two previous patients who had come for similar symptoms, but before I was aware of this possibility, so we didn't get to the bottom of their problems.
If symptoms of this type are markedly ameliorated by a Benzodiazepine, which is a class of medicines not generally recognized or used as anti-spasmodics, that's diagnostic for serotonin syndrome.

Cuprum-met and Nux-v were both somewhat helpful for these symptoms at different times for these patients, but of course more recently I finally realized that the medication interactions were the maintaining cause of the suffering. I imagine that Ornithogalum umbellatum would also have been a possibility, or Rhus-tox, with the correct modalities. The medications take weeks to build up to full strength in the person's system, so generally the patient won't make a connection between starting to take the medications and starting to experience the symptoms.

Warmly, Rosemary

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[Glenda Wilks]

Thank you Rosemary,

Cheers
Glenda