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Causes
By Mayo Clinic staffNerve cells in your brain and spinal cord (central nervous system) produce serotonin that helps regulate your attention, behavior and body temperature. Other nerve cells in your body, primarily in your intestines, also produce serotonin. In these other areas, serotonin plays a role in regulating your digestive process, blood flow and breathing. Too much serotonin can cause serotonin syndrome.
In some cases, serotonin syndrome can be caused by taking just one drug that increases serotonin levels, but it occurs most often when you combine certain medications. For example, serotonin syndrome may occur if you take an antidepressant along with a migraine medication. A common cause of serotonin syndrome is intentional overdose of antidepressant medications.
A number of over-the-counter and prescription drugs can lead to serotonin syndrome, especially antidepressants. Illicit drugs and dietary supplements also can cause the condition. These drugs and supplements include but aren't limited to:
- Serotonin reuptake inhibitors (SSRIs), antidepressants such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine, paroxetine (Paxil) and sertraline (Zoloft)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs), antidepressants such as trazodone and venlafaxine (Effexor)
- Bupropion, an antidepressant and tobacco-addiction medication (Wellbutrin, Zyban)
- Monoamine oxidase inhibitors (MAOIs), antidepressants such as isocarboxazid (Marplan) and phenelzine (Nardil)
- Anti-migraine medications such as almotriptan (Axert), naratriptan (Amerge), sumatriptan (Imitrex) and zolmitriptan (Zomig)
- Pain medications such as fentanyl (Sublimaze), meperidine (Demerol), pentazocine, (Talwin) and tramadol (Ultram)
- Lithium (Eskalith, Lithobid), a mood stabilizer
- Illicit drugs, including LSD, Ecstasy, cocaine and amphetamines
- Herbal supplements, including St. John's wort and ginseng
- Over-the-counter cough and cold medications containing dextromethorphan (Robitussin DM, Sudal DM)
- Anti-nausea medications such as granisetron (Kytril), metoclopramide (Reglan) and ondansetron (Zofran)
- Linezolid (Zyvox), an antibiotic
- Ritonavir (Norvir), an anti-retroviral medication used to treat HIV/AIDS
- Moore DP. Serotonin syndrome. In: Moore DP. Moore & Jefferson: Handbook of Medical Psychiatry. 2nd ed. Philadelphia Pa.: Mosby; 2004. http://www.mdconsult.com/das/book/body/113440701-3/0/1243/148.html#4-u1.0-B0-323-02911-6..50148-2_1373. Accessed Dec. 10, 2008.
- Bilden EF, et al. Antidepressants. In: Marx JA: Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia Pa.: Elsevier; 2006. http://www.mdconsult.com/das/book/body/113410207-5/0/1365/463.html#4-u1.0-B0-323-02845-4..50154-2--cesec45_7826. Accessed Dec. 10, 2008.
- Boyer EW, et al. Serotonin syndrome. New England Journal of Medicine. 2005;352:1112.
- Combined use of 5-hydroxytryptamine receptor agonists (triptans), selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephrine reuptake inhibitors (SNRIs) may result in life-threatening serotonin syndrome. US Food and Drug Administration. http://www.fda.gov/Cder/Drug/advisory/SSRI_SS200607.htm. Accessed Dec. 10, 2008.
- Zeping H, et al. Herb-drug interactions. Drugs. 2005;65:1239.
- Chyka PA, et al. Dextromethorphan poisoning: An evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology. 2007;45:662.
- Argwal P. Serotonin syndrome. In: Ferri's Clinical Advisor 2009. Philadelphia, Pa.: Mosby Elsevier; 2009. http://www.mdconsult.com/das/book/body/113440701-3/0/1701/541.html#4-u1.0-B978-0-323-04134-8..50022-7--subchapter15_11410. Accessed Dec. 10, 2008
