Serotonin Syndrome

Serotonin syndrome describes a condition in which an excess of serotonin occurs in the central and peripheral nervous system. This is triggered by the intake and combination of more than one serotonergic drug or psychoactive substance. The signs of serotonin syndrome can be as follows: Diarrhea, fever, increased heart rate, palpitations, high blood pressure, increase in body temperature, sweating, confusion, tremors and muscle twitching, involuntary and prolonged muscle spasms, seizures, acute kidney damage. Serotonin syndrome can be fatal in severe cases.

The symptoms subside after about 24 hours. If medication or psychoactive substances with a longer half-life or long duration of action have been taken, the side effects may last longer.

Serotonergic drugs or serotonergic psychoactive substances are substances that enhance the effect of serotonin. I.e. mood, performance enhancement, pain perception, sexual behavior, appetite, sleep and it also influences emotional processes such as anxiety or aggression (social behavior).

Substances with an increased release of serotonin include stimulants such as amphetamine, methamphetamine, MDMA or cocaine, various antidepressants such as tricyclics (amitriptyline, doxepin, etc.), SSRIs (citalopram, sertraline, etc.), serotonin-norepinephrine reuptake inhibitors (trazodone, bupropion, etc.), monoaminooxidase inhibitors (isocarboxazide, phenelzine, etc.), opioids (e.g. oxycodone, fentanyl, tramadol, etc.), etc.).), monoamine oxidase inhibitors (isocarboxazide, phenelzine, etc.), opioids (e.g. oxycodone, fentanyl, tramadol, etc.), psychedelics (LSD), 5-hydroxytryptamine (5 -HT1) agonists (triptans), herbs (nutmeg, St. John's wort, etc.) and other active substances such as lithium, dextromethorphan, metoclopramide. The list is not exhaustive.

Not all psychoactive substances increase the risk of serotonin syndrome to the same extent. There are substances that have a stronger effect on the serotonergic system. For example, MDMA, amphetamine and methamphetamine in combination with other serotonergic substances carry a higher risk and are considerably more dangerous than cocaine, LSD or psilocybin, for example. It also varies greatly from person to person. There are generally more sensitive people for whom substance use is more likely to trigger serotonin syndrome. This depends on the biological characteristics of the individual.

The mixed use of serotonergic substances in particular is therefore associated with an additional risk. It therefore makes sense to ask yourself before consumption what added value the combination of several substances brings and whether the consumption experience is worth the risk.

If you have any questions about the use of medication and high-risk combinations of substances, always ask the doctor who prescribed the medication. They will provide information about the possible risks. They are bound to secrecy with every question (even if it concerns illegal psychoactive substances).