The People's Perspective on Medicine

Serotonin Syndrome Can Be Deadly

Serotonin is a critically important neurochemical that helps control mood and is also involved in appetite, sexual behavior, sleep and learning. Millions take medications such as Prozac, Paxil, Lexapro or Zoloft that work by regulating serotonin levels in the brain.

But too much of this crucial chemical can lead to serotonin syndrome, a potentially life-threatening condition. Serotonin syndrome also seems to be a mystery. Many physicians have never heard of it and don’t think to diagnose it.

The healthy 55-year-old woman had warning signs of a migraine: tingling and numbness around her mouth and down her arm. She took Maxalt, a medication that usually stops migraines before they take hold.

This time it didn’t work and her migraine attack lasted all day. The following day when she got up the headache was still there, though not as intense. After taking her Zoloft (prescribed to reduce the frequency of her migraines) and eating breakfast, she went back to bed. Soon she was in desperate trouble. She tried to tell her husband what was wrong, but she couldn’t speak. He became alarmed and called 911.

The paramedics arrived within minutes and found her blood pressure was very high (216/160) and her arms were moving uncontrollably. At the hospital, the blood pressure was even higher, her temperature was 104 degrees and she was sweating profusely. She was unconscious and the doctors assumed she had had a stroke. Her arms and legs were thrashing so much she had to be paralyzed and put on a ventilator to do a CT scan.

The CT scan, surprisingly, showed no evidence of a stroke. Neither did a spinal tap. The neurologist considered viral encephalitis the next most likely cause.

In intensive care her tremors became so pronounced, the neurologist worried she was having a seizure. An emergency EEG showed no seizure activity. To keep her arms and legs still, the sedation was increased.

For days she remained in the ICU, unconscious. The doctors sent off cultures to determine if West Nile or herpes virus had invaded her brain. The tests were negative. Her husband was frantic.

All attempts to reduce the sedation resulted in a return of limb movement. After four days, she began to return to consciousness. The doctors still had no idea what had gone wrong.

Her husband began to wonder about a possible interaction between Maxalt and Zoloft. He contacted us and we suspected serotonin syndrome. He found a list of ten symptoms of serotonin syndrome. Three are considered enough for a diagnosis. His wife had experienced eight.

This story has a happy ending. The woman was discharged from the hospital at the end of the week in good health, under orders not to take Maxalt and Zoloft together again. Several physicians agreed that serotonin syndrome was the likely explanation, after all.

Many people take antidepressants like Zoloft, Paxil or Prozac. Serotonin syndrome may be rare, but the danger is so severe that everyone taking an SSRI antidepressant should be warned about potential interactions with migraine medicines like Imitrex or Maxalt, the pain reliever Demerol, the diet pill Meridia, the OTC cough remedy dextromethorphan, the “club drug” ecstasy or even the herb St. John’s wort. All increase serotonin. Combining such drugs could be flirting with death.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I’m going to tell you what I did to get off Tramadol after 15 years. No doctor would advise this, but I tried EVERYTHING, and I have been Tramadol free for 2 years. This was just bad luck with a silver lining for me. I had spine surgery that went wrong, and was on a high dose of morphine at the hospital for a week and then oxycodone at home for a month or two. I was so drugged at the hospital that I was rarely lucid and slept through the anxiety, sweating, early mental part of withdrawal.

I started off on a very high dosage of oxycodone at home which masked the next weeks of withdrawal. I tapered down off oxycodone quickly to avoid a new mess. By then, I was able to cope. Tramadol must have strong antidepressant/seretonin effects. The painkiller addiction side of it is nothing compared to the way it affects anxiety, temperature regulation and sleep.

I am not recommending anyone seek out surgery or other narcotics for Tramadol treatment. This is only my story. I only took 50mg of Tramadol 4 times a day, and if I missed one dose, I would sweat, fall asleep, lash out, and feel insane.

I was put on tramadol over 10 years ago for chronic pain. It was not a controlled substance at the time and it worked well for me with no side effects, or sense of feeling high. Then, suddenly 3 years ago it’s a controlled substance. My doctor never mentioned this, until I found out at the pharmacy that it’s status had changed.

I decided to stop the medication. I had been taking 150 mg a day for over 10 years. I tapered off over a period of 10 days. What was the most irritating is the return of the pain that I had originally experienced for which I was taking tramadol, plus the pain of general aging. Withdrawl symptoms were mostly sneezing, nausea, some tingling.

The FDA should’ve looked into tramadol to start with well enough to label it a controlled substance in the beginning. Because they didn’t thousands upon thousands of people became addicted. I am blessed that I didn’t have much of a withdrawal and I refuse to return to the medication just in case that minimal withdrawal was a fluke. However, now instead of paying 10 bucks for a co-pay monthly, I am paying hundreds of dollars per month for alternative pain relief such as therapeutic massage, chiropractic care, acupuncture etc.

Way too expensive for me but I really don’t have much choice. I did find that 3 to 4 g of candied ginger every day stops the nausea and helps relieve some of the pain. I feel bad for all of us that were assured by doctors and misled by the manufacturer and FDA that tramadol was so very safe. I miss being pain-free, but I’m grateful I’m not on tramadol anymore after reading what others have been through.

I’ve been on tramadal for 2 year and was up to 700mg a day and was cut off cold turkey by my dr. I can’t stand up from being dizzy along with all the other horrible symptoms.

I have a friend who has been taking tramadol for the last 4 months. least 8 pills a day…mot sure if they’re 50 or 100 mg…for diabetic neuropathy. Over the last 2 months, his behavior has become progressively more aggressive, abusive, insulting. While he was no sweet heart before, he is an absolute monster now. Has anyone else seen this type of reaction?

I have had dealings with SSRI’s on several levels. I can see the good it can do, and the dangers they cause if prescribed by well meaning but uninformed health providers.

I am a disabled, 20 year Army Veteran. I was in the Medical Field, as a Nurse, Para-medic Flight Nurse and a Special Forces Medic. I also worked in several E.R’s of Level 1 or 2 Trauma Centers. I too, am a disabled veteran, of over 100% service connection physical and psychological traumas. I also have a Masters as a trauma councilor.

What I have experienced, and seen in other vets with PTSD, who take these “Anti-anxiety” meds that replace, increase, facilitate or affect Serotonin in any way, can be troublesome. More so, if It is long term or the only treatment for issues for which it was prescribed. Now, for me, my psychological healing was coupled with several other treatment, such as Therapy, both 1 on 1, and groups?

Healing takes time and a doctor who is well educated and experienced in trauma and the treatment of Traumas, and/or PTSD. Playing with the brain’s chemistry should not be taken lightly, and best left to doctors who know more than drugs. Treatment is and should be “Patient” specific, and not be a one size fits all approach.

Meds alone may be fine later on, but recovery takes time and a commitment from both patient and doctor. In my case it has taken years, hard work and a support system.

I read about some problems with drug interactions with these SSRI’s and other meds, some can be very serious. Some are not known until it affects someone in a bad way. I advocate and strongly urge my patients to educate or stay informed about the meds they take, and if or how medications interact and affect their health.

As one of many vets with combat or military related injuries, the issue of PAIN is a real problem, and not taken very seriously by the V.A. I won’t get into that issue now. But how such meds are dispensed is confusing at best, and shows contempt by the VA, and labels them in a negative way.

The recent trend is towards the Non-narcotic meds. Most notably, and common one is “Tramadol aka Ultram”. I had to learn the hard way, and forgot to take my own advice. It would take pages to explain but look it up on any of the websites that educate people on medical and medicine related issues. Let me just say that Tramadol/Ultram have ingredients can have serious problems when a patient is taking any SSRI’s. Having had a very bad experience that could have ended badly, and seeing Vets going through the same. I question the VA’s commitment to us, and wonder how many suicides can be the or a trigger for the large number of suicides by vets these many years.

I hope I was able to at the least, motivated some to look into medication interactions, especially the Serotonin related meds.


How did you get rid of it? Did you experience anhedonia, muscle spasms, things like that?

I have experience many of these symptoms as well as my husband. But he also has high bloodpressure and he stays so tired and is starting to have problems with his mobility. What is going on , he is only 58 and this just isn`t him at all. We are scared and are searching for answers. CAT SCAN done came back negative.

I think I’m experiencing that serotonin very scary stuff thought I was dying, going potty at 1:30 a cramps, felt like passing out lost 2lbs just from the sweat….my doctor is clueless about this condition I’m really at wits end on what to do.

I’m turning 69 in a week or so if I make it, been on this tramodol for about 10 yrs started out using 1/4 tabs every 8 hrs back in ’04…….. all the symtoms are there but latley its getting up to 1 1/2 every eight hrs don’t know which direction to go nobody seems to know what alternatives I would have at my age.

I have been taking tramadol for 6 months I take 5 of the 50mg. As prescribed by doctors. Thinking that this was a safe alternative to a narcotic medication was completely a negative exsperiance. I want to be healed of pain not so sick that I couldn’t eat, sleep, or function. Thinking lowering the dose would help…. Not so.. I almost passed out driving. I was running fevers,shaking and couldn’t breath. So for days I didn’t take any. Which made me feel like I was having seizure which scared me very bad.

I have only one prescription left. I see that I’m going to have to wing it off…. And pray that I don’t continue these feelings. I can’t sleep and my body has lost all my muscle tone. Please let me know a easier way to get away from this medication. I thought it being a non-narcotic would be safe for my cronic pain. What other medication options do I have? I have taken so many over the counter meds that it doesn’t help and my stomach can’t take many because of feeling like I’m going to vomit or my throat and stomach are on fire….. I want relief without the side effects and sickness.

I understand how you ‘re feeling. I’ve been up since 1am, I have been on tramadol for fen years. They were prescribed to me for back, arm and nerve pain. Over the years I got up to 240 a month, sometimes more. Last week, I decided no more!! This is the 5 th day without them. I am still so out of it and can allover. Barely sleeping or being!! This has to get better. Good luck and I hope you. Kick this terrible addiction.

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