Serotonin Syndrome

Question 1

hSerotonin Syndrome is caused by?

Answer 1

antidepressants- excess serotonin

Question 2

Serotonin syndrome symptoms (2)

Answer 2

hyperreflexia and myoclonic jerks

Question 3

Treatment for Serotonin Syndrome?

Answer 3

DC offending agent and can administer Cyproheptadine- first-generation antihistamine with additional anticholinergic, antiserotonergic**, and local anesthetic properties.

Question 4

Drug combinations for Serotonin syndrome (3)

Answer 4

SSRI/TCA/MAOIs/SNRI
SSRIs & MAOIs
Multiple SSRIs

Question 5

If you are switching from SSRI to MAOis wait how long

Answer 5

2 weeks

Question 6

Switching from Prozac to MAOI wait

Answer 6

5-6 weeks b/c Prozac has a longer half life

Question 7

When switching from MAOI back to Prozac wait

Answer 7

2 weeks

Question 8

The standard period to wait is how long for medication change?

Answer 8

5 half-lives between cessation of previous drug and introduction of new drug before making the change

Question 9

Serotonin discontinuation syndrome? (9)

Answer 9

decrease serotonin syndrome (presents like withdrawal)
flu like symptoms
fatigue
lethargy
myalgia achiness
decreased concentraiton
N&V
ataxia unsteady gait
impaired memory
agitation

Question 10

Why do patients get flu like symptoms during serotonin discontinuation syndrome?

Answer 10

due to the cholinergic rebound especially with TCAs

Question 11

F.I.N.I.S.H SSRI/SNRI discontinuation syndrome in adults

Answer 11

Flu-like symptoms-fatigue muscle aches, headache, diarrhea
Insomnia-vivid or disturbing dreams
Nausea
Imbalance- dizziness, lightheadedness, vertigo
Sensory disturbance- Parathesia, electric shock, sensation, visual disturbance
Hyper arousal- Anxiety, agitation

Question 12

Serotonin discontinuation syndrome

Answer 12

onset 24-72 + resolution 1-4 days
incidence is 20-40% who have been treated at least 6 weeks

Question 13

what is the difference in symptoms relating to muscles from NMS and SS?

Answer 13

NMS- muscle rigidity
SS- hyperreflexia

Question 14

St johns worth impairs glucose tolerance by

Answer 14

reducing insulin response

Question 15

if you are switching from one antidepressant class to another which can increase serotonin levels you want to wait how long

Answer 15

two weeks
because you want the SSRI to DEGENERATE** (broken down, metabolized, and excreted)

if you see the answer with regenerate (most likely it is incorrect)

in practice you slowly taper down while slowly introducing another class

Question 16

client on Triptan (headaches/migraines) medications with depression what to be careful of and avoid prescribing?

Answer 16

avoid prescribing SSRIs, SNRIs can increase serotonin levels consider other classes of anti depressants that wont increase serotonin levels such as WELLBUTRIN

Question 17

Does Wellbutrin increase serotonin levels

Answer 17

no