Doctors' Answers to "Frequently Asked Questions" - Serotonin Syndrome

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Serotonin Syndrome [posted 12/10/98]
Question: I have Hypertension, Angina, and Depression. When a Psychiatrist tried to give me a serotonin based drug I had the following severe side effects: heavily coated white tongue lots of mucous in throat and mouth blood pressure, pulse, and heart rate increased to very high levels. I went to the ER where the Dr. took me off of drug, and eventually I lost most of the side effects. Because I kept having problems with hypertension I was referred to a Cardiovascular Specialist and he along with Procardio XL, Atenolol, put me on Paxil. Then I noticed the previous symptoms coming back: heavily coated tongue, increase in bp, pulse, and heart rate, sore mouth, sore tongue, along with the following additional symptoms: toxicity throughout entire body, blurred vision, throat inside felt like it was closing or swollen, gums swollen and inflamed, teeth extremely sensitive, tongue did develop some lesions with mucous, constipation to no bowel movement cold feeling in the extremities tremors of the hands and arms extreme pain in the upper back and abdomen body would automatically go into panicky feeling. I did have to be taken to the ER on several occasions,  I was kept in the hospital for one day until I passed all blood tests and treadmill, and x-rays for potential heart attack. The third time I was released with the doctor giving me potassium tablets. I have been bedridden from June of this year until September. I have recently been able to get back to trying to take up my sporting activity that I enjoy. My husband and I came up with a way of fasting to rinse out the drug (Paxil) that I had been taking for 3 months from my system, but found after months the symptoms kept coming back accompanied by this heavy fatigue (which should have been included in the previous symptoms). I began to feel like a hypochondriac when trying to explain to my doctor the things that were going wrong with me. He had blood and urine lab tests run of which he gave me a copy. He seemed to feel that from them I did not have a serotonin problem. But, from what I could read of the lab tests, they looked inconclusive to me. Should I go see a Neurologist and have them run tests on me to be sure? And would any Neurologist understand serotonin neurotransmitters and how the chemical drug serotonin would affect a person?  Of the symptoms remaining is the pain in the back and abdomen. I take Darvocet for that and Klonopin (which I had stopped taking) I started taking it again and between the fasting and that, it seems to be the only thing that has gotten me back on my feet.

Answer: Have you checked serotonin levels in the blood? Also, I strongly doubt that the SRI drugs would have residual effects for months. I suspect there is something else going on which is undiagnosed.

Serotonin Syndrome
Question: What is serotonin syndrome? What medications may cause this syndrome and is it dose related?

Answer: Serotonin syndrome refers to the excessive release of serotonin. This is occasionally seen in a type of secretory tumor called a carcinoid tumor and produces diarrhea, flushing, wheezing and abdominal pain. No specific foods produce this type of syndrome in the absence of a carcinoid tumor. Sometimes people treated with monoamine oxidase inhibitors for depression are said to have "serotonin syndrome". This results from taking certain foods after being treated with MAO inhibitor for a period of time. These foods include chicken livers, pickled herring, cheese, yogurt, sour cream, beer, wine, broad beans, figs, bananas, avocados, active yeast, soy sauce, chocolate and excessive caffeine. Drugs which produce this syndrome include cold decongestants and any stimulants.



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