07-07-2025
Herbal medication, food supplements can cause serotonin syndrome
Humans need to produce serotonin since it has an impact on both the body and the brain. A neurotransmitter and hormone, serotonin is crucial for blood clotting, digestion, mood management, sleep, and overall well-being.
However, often we are unaware that too much serotonin causes serotonin syndrome, with symptoms that can range from mild to severe. If the condition is not identified and treated, it can be life-threatening. If it is identified, it can be easily treated and cured.
"Serotonin syndrome is a condition that occurs when the serotonin levels are high in the body. It can happen following the consumption of medicines which contain serotonin, like some antidepressants, painkillers, etc. It can also happen following the consumption of some herbal medications and food supplements," said Dr Arun B Nair, professor of psychiatry at Government Medical College, Thiruvananthapuram.
According to Dr TR John, senior consultant in psychiatry at Aster Medcity, Kochi, single medicines or chemicals do not usually cause serotonin syndrome unless the person is genetically vulnerable. Antidepressants, antimigraine medications, drugs of abuse, opioids, nutraceuticals, etc. can cause serotonin syndrome. Thus, the patient should communicate with the doctor if he or she is taking any other medicines," he said.
The initial symptoms of serotonin syndrome include a feeling of nervousness; some abdominal discomfort, which includes nausea, diarrhoea, tremors of the body parts, vomiting, and dilated pupils.
"But as the condition advances and becomes moderate, there will be a feeling of restlessness, anxiety, a subjective sense of agitation, and problems with muscles and involuntary contractions. In severe cases, muscles will also be rigid. There will be profuse sweating and shivering. There will be abnormal movements of the eyes," added Dr Arun.
In severe stages, there can be disorientation, altered consciousness, and an increase in heart rate, body temperature, and blood pressure.
"There can be fainting episodes, sudden falls, and rarely, seizures. Usually, it is a very rare condition, but it can happen in a few hours when a person is taking medicine or food supplement which contain serotonin. Usually, the reason is the consumption of more than one medicine which has serotonin content or more than one medicine which increases the serotonin levels," Dr Arun said.
"Awareness about the symptoms, which usually involves nervousness, discomfort, nausea, diarrhoea, and tremors, can help. If there is a history or family vulnerability, notice agitation, anxiety, and other early symptoms and seek help from a healthcare provider," Dr John said. He added that the syndrome can be caused when we change medicine, start a new medicine, change the dosage, or add a second medicine. Substance abuse, while on medications, can also cause Serotonin Syndrome.
Early identification and treatment are crucial in curing the condition. "In mild cases, stop taking the drug, which is likely to produce serotonin. Usually, within one to three days, the symptoms will completely go away. In moderate cases, it is better to observe the patient at the hospital for 24 hours. In severe cases, the patient will have to be placed in the ICU. Certain medications and IV fluids are used to improve the heart rate and blood pressure," Dr Arun added.
"We need to be careful about moderate and severe cases. In these cases, hospitalisation is required. In severe cases, the patient will need ICU care and can develop long-term complications if not treated aggressively. Medications, IV fluids, and supportive care should be given in such cases," added Dr John.
