Serotonin Syndrome Risk – A Case Example

When I’ve had students with me, they will often ask about multiple serotonin related drugs and risk of serotonin syndrome.  A classic example of this is a patient on an SSRI and Tramadol.  This combination is used frequently in practice.

Serotonin syndrome is very serious, but extremely rare.  We should never exclude anything, but if I have a patient on Zoloft 25 mg daily and is taking a prn Ultram 50 mg once or twice a week, serotonin syndrome is not going to be the first thing on my radar to say the least.

Now take this example of a patient on Zoloft 200 mg daily and Effexor 400 mg daily.  My concern for serotonin is obviously much greater and we would need to thoroughly investigate why those high doses (and why this combination) is necessary and if we’ve had to ramp up to these doses on both medications, have they really been effective?  Given the Effexor/Zoloft combo above, my level of concern for Serotonin Syndrome risk would be much higher than simply on a low dose SSRI and Tramadol.  Side effects could also certainly be more prevalent on these higher doses.

Have you seen a case of serotonin syndrome?

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  1. Felicia

    Yes, serotonin syndrome ruined a year of my life. I am a 30 year old healthy female. My psychiatrist had me on effexor XR 150 QD and Wellbutrin SR 300 qd. She diagnosed me almost a year into our treatment with bipolar disorder! My BP and pulse was always high, couldn’t concentrate, did bad in school, always slept, was disorderly to say the least, not myself.
    I took myself off of wellbutrin first, then lamictal, and haven’t had a manic episode since.
    I have to repeat my third year of pharmacy school and she and the school refused to accept that the meds had a huge impact on me.
    I failed one class by less than 1% and the other by less than 2% . That is automatic dismissal from the school and I had to beg my way back in. I am now trying to get a private loan for this year and am finding it almost impossible.
    I share this because I wonder how prevalent this is? I see high doses of “serotonin ” drugs all the time as I work in a pharmacy.

    • Sam

      A few years ago, I was taking 6 different drugs affecting serotonin. As the naive (older)teenager that I was, I was experimenting with LSD. The Paxil I was taking in combination with the high dosage of LSD led to severe serotonin syndrome. I was having a seizure every few minutes, maybe 12 in that first two hours. After the first one my parents called EMS and I was in and out of concioussness and laying in the ER completely unaware of what was happening. I was constantly reminded I was having seizures but had no idea what that meant or who was even telling me. When it started to sregister what they were saying, I cried. The only person I could recognize was my best friend. Due to the obscene amount of seizures, I couldn’t speak, or write, or control fine movement at all. When I woke up a day and a half later in a hospital room I didn’t know where I was or what had happened and I couldn’t control my arms well at all and speaking was still off the table. I wasn’t myself for two weeks, which was a blessing in disguise because we were told I might’ve been like that permanently. I did get a teddy bear out of all of it though.

      • Kayla

        Wishing the best for you

      • Colette

        Sam, I LOVE your attitude! I’d give you another teddy bear, lol.
        So sorry you went through all that, I hope you are fully recovered. Thank you for sharing so we can all learn.

    • Olivia

      I suffered a near fatality due to Serotonin Syndrome. I was losing motor skills for weeks and unable to function in most of the world. My first red flag was anger but more like rage. I told my psychiatrist about this but he was unconcerned. The symptoms changed and became more severe. I was confused and thought it may have something to do with my brain working differently. It coincided with my starting a new project and it seemed like my brain was functioning differently. The symptoms worsened rapidly and I called an ambulance for fear of losing autonomous bodily functions. By the arrival of the ambulance I could not walk and before I made it to the ER I was in the state of consciousness known as Stupor. I did not know the exact state until later research. I was eventually unable to move or speak then I lost the ability to comprehend language. It was the most terrifying 2 hours of my life. When I came out of it I did not know my name. It took hours until I was near lucid. I begged to see a neurologist but they refused. A psychiatrist did asked me if I ever thought I was God but never my medications. They wanted to keep me another night because of an irregular heart rhythm. My state of consciousness was never discussed. It was going to happen again. I could feel my consciousness start to change. A dizziness was involved. That led me to the stupor realization. I checked myself out AMA and may have saved my life. At home I researched my symptoms and causes of Stupor and found serotonin syndrome. I was prescribed by the same psychiatrist 6 medications linked to the condition and the dosage of 2 increased just before the rage incident. I most likely would have been kept on the same drug regiment in the ER and death could have easily occurred. The diagnosis by the ER. Acute encephalopathy. Dementia basically and my state consciousness caused by possibly taking 1/4 more a pill of seroquel. I said maybe I took that but was unsure. I did not take any of the other medications prior. Thank god. I quit everything cold turkey. A patient who arrives in the state of stupor is an automatic for a review by a neurologist. I asked my psychiatrist to prescribe me a serotonin antagonist but he instead prescribed a benzo. Which can raise serotonin as well. Moron. I will never take another psych med again. The field is riddled with psychiatrists searching for something to throw a med at. My suggestion is to go to a drug interaction site and maintain a list of everything you take. Some meds may not be obvious serotonin raisers and I guarantee most psychiatrists don’t even know. Gabbapentin for example. It is so often missed that hospitals have a cover their ass term, Hospital Induced Delirium.

      • Claire Nelson

        Thank you for sharing your story. I had a horrific experience with SSRIs myself. I had a C-section and my doctor kept upping my Zoloft script. I ended up becoming unable to communicate, read or do math. Once I was hospitalized, the “doctors” refused to listen to me about the poisoning I was describing. They held me for 4 days refusing to give my husband and the rest of my family any details of my whereabouts. It was hands down the most traumatic experience of my life. Pfizer is evil.

        • Amber

          I was prescribed Prozac at 10mg daily for major depressive disorder. I am 44 years old in relatively good health and was a store manager of a local retail chain. I was also on probation. After 3 weeks I became extremely irritable and started to have serious muscle spasms along with rigidity. At first they thought I tore a rotator cuff and then the spasms started to travel to all other parts of my body. I was quickly referred to a local neurologist as they were so severe I could not use the affected parts for days/weeks at a time and they were affected ting multiple parts at once. This has made me unable to drive, feed myself bathe or do pretty much anything by myself and there were no days were I was not in excruciating pain for the first 5 months. (I stopped taking the prozac at week 3). I still have them but I can somewhat use the affected parts during the episodes, they are only happening once or twice a week now and only last 2 to 4 days instead of 5 to 9 so it is improving. It has been 8 months now and I am going to prison s probation doesn’t understand that it affects everything and makes me unable to do things like drive, I have lost my job and my home. Has anyone else experienced this? All MRI, cat scans everything comes back normal. The only abnormal is my sedimentation and wbc counts are through the roof .

          • Margaret

            My heart goes out to all of yous. The doctor put me on Lexapro and trazadon. I thought I was dying.I know my organs was starting to shut down my pee smelled awful I started drinking alot of water until the smell went away. I went through the withdrawal on my own and it was not easy as you know.that and trazadon is wicked never again I will question every med from now on.why on God green earth do doctors do this kind of stuff.

      • Lauren

        Thank you for posting your experience. It is very helpful.

      • Kat

        I had a seizure and ended up in icu 3 days.
        Didn’t wake up for 48 hrs

      • Karl Linder

        You are aware that you use benzodiazepines in the treatment of seratonin syndrome. You dont have the privilege to call medical personnel dumb unless you are one yourself, which by now, I’m assuming you’re not considering you’re an idiot. The benzo is not there to do anything else but keep your gaba receptors activated so that u cannot get a seizure, so pretty good call from your “incompetent” doctor. Oh yes i forgot to show my license for bullying people who think they know more than their doctors: I am one.

    • Andrew Mcdougall

      They refused to accept that the meds/syndrome had an effect on you.
      The GP that ‘diagnosed me, then refused to actually diagnose me.
      Refusing to accept the extremes of the effects.
      I hope you are ok. You likely know it takes at least 6 months to get back to ‘base level’,they don’t !

    • Beatrice

      Yes I had the same thing happen to me. I slept for 14 hours a day. They have me more drug and of Adderall you name it I took it. Xanax doesn’t cause these symptoms and relaxes you! But addiction is a real deal with this medication. I do agree with you 100% because I took the same medicine as you…and yes same symptoms

    • Garry Madaline

      SS just landed me in a mental hospital with drug dealers junkies suicide cases and more
      First hospital I went to ask if I was agitated and I was really agitated so when they asked if I felt like hurting someone I said yes.
      Next thing I know I’m in an ambulance locked down on a stretcher and spent three nights in an acute mental hospital while they gave me more drugs that I shouldn’t have had. Worst nights of my life. They let me go without diagnosis and my psychiatrist ordered some pain drugs along with increasing my trintellix script
      The anxiety started again and then I had a short hallucination which made me think this might be SS as I had it before after surgery when I took my normal trintellix but the surgeon ordered a muscle relaxer
      Thank his my daughter who is an MD was there at my home who fixnt know what was wrong but called the surgeon and got a resident who luckily knew immediately what it was when he went over my med list. More outrageous was that I went back to the pharmacy who gave me both and I asked if a red flag came up and they said yes but it’s so uncommon a problem that they ignore it

      They opened up the Pandora’s box on mental health issues but didn’t have anything in place to deal with any of it and still don’t as I learned after my mental hospital stay. More people taking victory laps after hurting the general public

      • Pam Williams

        I too had a horrific experience I too had serotonin syndrome obviously I had no idea my brother found me unconscious and nearly dead the er called it an intentional overdose I’m just finding these things out now but I’m clearing my name I’m 64 female don’t drink or do drugs only trusted my dr wish I hadn’t and it all started with zoloft

      • Garry Madaline

        Found a packaged pill in my medicine cabinet so I checked it out cause it looked familiar. Turned out it was the anti nausea drug they give everyone after surgery. Just as a ha ha I started looking up the side effects which I’ve now learned to do and SURPRISE! it raises seratonin levels. No warning, no questions from the surgical team ..nothing. I kept hearing how rare it is but I’ve had 3 verified SS issues and at least 2 others I feel sure were also SS.
        Be careful it’s a bigger problem that being portrayed

    • Jestine

      I wasn’t directly on those but my husband was on both at one point but he mainly as always had Wellbutrin and a mix of other things like effexor and he became schizophrenic and he ultimately died from these delusions… He was not at all like that before the medication and after that he was a changed person. I know that his medications ruined our lives too .. I’m not just grieving I swear I am trying to get the bottom of this and I’m outraged because we were so happy and in love we had é beautiful kids until the medication in which started because of depression that was a huge mistake to seek help. We were both fine before all of that but he got depressed a little after a DUI he had gotten.. I wish I could’ve helped him and I wish I did the research more before he died but I didn’t ever imagine that doctors we be counter productive for a person’s life… They are there to help .. anyways I’m doing my research and getting my ducks in a row and I’m suing for mal practice or for pharma production to have to do more then just prescribe whatever to who ever they want it’s not right they should have to have all the facts and we should be told first .. they can’t force this stuff and not know all the factors first for sure.. they are messing with people’s brains that’s got to have all the facts first..for sure … I’m so sorry this had an affect on your life it did affect you just know that for sure .. it was the medication and people are wrong for not looking into it first .. I’m so glad you didn’t turn out like my husband though so thank you God for that

    • Andrew James Mcdougall

      Ive endured the horrors of serotonin syndrome as well as ‘not being believed ‘ by practitioners.
      Yes after going off meds things did improve fairly soon there after. But took more than 6 months to get back to ‘baseline’. However about a year after I’m still not able to concentrate/focus.
      From what I’ve read SS does not usually have long term effects, but I question this. Is it ‘Just’ the effects of depression, anxiety, not having a focus or routine for so long, or is it a hangover symptom from the SS? Also I often have neck pain, is this a hangover, the new meds, or me just being hyper vigilant after the SS hell?
      Wondering if anyone else feels that they have experienced long term effects of SS?
      Thanks !

      • Josie Laffrey

        I was in serotonin syndrome for nearly a year on 225mg of effexor, 300mg of wellbutrin, 100mg of trazodone, and 10mg x2 a day of adderall. Additionally, I’m a medical cannabis patient. All of these together wreaked havoc on my serotonin. I had no idea why I felt so bad until I saw a new psychiatrist who said he couldn’t treat me if I was in a coffin.
        Even after 4 months of being off most medications I do not feel the same or have ability/motivation to work/function like I did before being over prescribed. There aren’t any good answers online, but I’m definitely experiencing long term effects of having SS.

        • Andrew

          Thank you Josie, I’m sorry you have also endured this. It seems that we are just being fobbed off, the damage is real, but seems there is either little information or little research on the long term effects. But at the end of the day, practicioners seem to prioritise covering their own asses above the welfare of their patients. I can only hope that time might improve the outcome for both of us. Take care!

    • Kat

      I had it and didn’t know!
      Until I woke up in icu

  2. Dustin

    As a teenage I had a bout of depression and seen my PCP for treatment. We started on Prozac because of it’s success rate with teens. Over the course of several weeks I became increasingly outspoken, aggitated and aggressive over minor issues that would normally warrant no reaction. I felt fine, even great, but felt like everyone was getting on my case and annoying me. My mother, with no medical education, realized the change and called the doctor. The symptoms she described suggested Serotonin Syndrome. After stopping the meds I eventually returned to normal. I don’t remember much of those weeks. Just the aggressive nature.

    • Angk

      So sorry. My heart hurts for you.
      SSRI’S can send someone with bipolar 1 or 2 into mania and psychosis. Nothing good happens when one is experiencing psychosis.

    • Toby

      Hello. This thread has been so emotional to read. And a *trigger warning* I am going to describe things in detail.

      In 2016 I took the ‘gym drug’ Clenbuterol. I was 18 and it was given to me by a school teacher who was my gym trainer at the time. It was bought on the dark web and obviously cut with something. The outcome was effectively an overdose which I now understand to be extreme serotonin syndrome. I got no medical help and didn’t go to a hospital because my mum was ashamed I had taken an illegal drug and didn’t want me to get into trouble. For around 4 days (I think) I had sever symptoms; extreme heart beat, nausea, my bladder and digestive tract were not functioning properly, I struggled to talk and lost a lot of motor skills, I had uncontrollable tremors, full body shakes and sweats. It was the most horrific experience of my life, and everyone around me thought I was going to die.

      I went to my local GP and they started me on Sertraline – big mistake. As it caused the symptoms to continue for months. I was so limp I could not walk and used a wheelchair to get around, and got to a dangerously low weight. I switched to floroxitine but that didn’t help either. From this chat I now understand why. I clearly cannot take anything that increases serotonin levels.

      Having never taken any meds before I didn’t know that not everyone felt this awful on them. I felt like I was fighting for my life everyday. A year after it happened I quit taking any meds and slowly got better. I was well enough to live a seemingly normal life.

      I still struggle with anxiety, depression and have since realised I have CPTSD, a lot of which is from this overdose experience.

      To this day (8 years later) I occasionally experience tremors, muscle weakness, sweating and heart palpitations. In times of stress, burnout or exhaustion these symptoms for worse. Prior to reading this chat I put this down to CPTSD, for example I might get cold and get a bit shaky but because of my experience it sends me into complete trauma response.

      I am working on regaining my relationship with my body (as I feel like it betrayed me) through gentle practices like stretching, dance and yoga. I try to nourish and feed it well when I can. I avoid alcohol, caffeine and high sugar foods to reduce the risk of the rush feeling. A lot of the advice for people with POTs has helped me too. Eating salty snacks and drinking water with electrolytes.

      I recently had a bit of a relapse after trying sertaline again after a bad mental health episode. Hence I am here and trying to work out wtf is wrong with me! I am going to ensure I avoid any serotonin altering drugs from now on.

      Thank you to all that shared their story. And I hope this may be useful for someone. If anyone has any tips, advice or help please please comment. Thank you.

  3. Bill

    A case I recall was a patient receiving Sertraline 200mg per day and was started on zyvox 600mg twice a day. Developed unusual symptoms of confusion, grasping at the air, hallucinations within 2 days. What was interesting was this was brought to our attention by a physical therapist who remarked that the patient was no longer making progress and was in fact getting worse. Stopped the zyvox and patient improved to baseline within one day. Good collaboration!

    • Johnny

      The baselines , they are a general scale , fits all. All baselines are just general guesses , the only way our personal baselines can be known , is if they were recorded at our peak health levels .. just like hormones.. what’s normal for one, may be totally out to lunch for another

  4. andy Deel

    I have been taking 200 mg of sertraline for the last 12 years. Because of events in my life that caused me to have chronic anxiety in 2011 that has continued to the present day I also taking 1 mg of clonazepam 3 times a day which was changed to Xanax 0.5 mg 3 times a day. Last year my PCP added Duloxetine 30 mg once a day then insisted I see a Psychiatrist to start managing my medication, which I did. She kept me on my regular meds but she raised my Duloxetine from 30 mg a day to 120 mg a day. I had no Idea that the problems I was about to have during the next year would have anything to do with Serotonin Syndrome. I have never heard of such a thing until my Psychiatrist suddenly retired and I was contacted by a therapist to see if I wanted to continue my sessions with her. She wanted to go over my medication list and when we did she was clearly upset and immediately informed me of how to slowly come off the Duloxetine. That’s when I learned of Serotonin Syndrome. However she did not question me on any possible problems I may have had during that past year so I have been left to research for myself. I am a 61 yr. old male and I didn’t complain much because of my age and my general skeletal health problems I already have. But I have been through a lot more than I ever should have with the different symptoms that some I still am experiencing. So confused right now on how to move forward with my health. I am changing my PCP for many reasons but what’s next.

    • Kayla

      Thank you for sharing your story. Self Advocacy is a skill a lot of us need.

  5. Tori Hill

    I was put on Prozac about 2 years ago, I started out at 20 mg I think, and made my way up to 60. I stopped taking it, I didn’t give it time to work. Then, feeling bad one day a few months later I decide to pick it back up, but started where’s I left off. 60 mg of Prozac was way to much to not build back up to and I took one dose. My whole body started to tingle as if it was “asleep” like when you sit on your foot or something. Everything from my head to toe, even my lips, tingled for weeks non-stop. So even now, 2 years later, I cannot take any kind of SSRI without tingling for weeks. Even birth control, and big fluctuations in my hormones make me tingle. Idk if it will ever go away and no doctor has much to tell me about it.

    • Martha

      I’m not a professional, but some types of tingling can be treated by a med called Neurontin. I won’t want to take it to tolerate other meds, but for thr hormone fluctuations that just happen, maybe your doctor would consider it with you? It helps me with similar symptoms from other causes.

      • Annetta

        Neurontin increases serotonin, so one needs to be careful taking it with SSRIs, as that can cause serotonin syndrome.

    • Sherri

      I had recently started 10mg of lorazepam and have had reactions since day 1. My body is numb and I feel like I am high. My mouth is dry and I have absolutely no energy, I cannot walk around my house. Today took the cake. I was in group, and felt a sudden wave a nausea and ran to the bathroom. Had cold sweats, couldn’t breath, my heart felt like it was racing, barely could walk, and felt this way for about 4 hours after. Even now, 8 hours after I cannot keep my eyes open. Needless to say, I am done taking it

      • Melissa Toni Ortiz

        Hi Sherri,

        I recently started taking citalopram, as I told my doctor that I felt like I needed something for my anxiety. I felt okay the first day, and then the second day I had the same symptoms that you had except I had about 5-6 major panic attacks. It was so severe that I called the emergency services twice and headed to the emergency room and was blown off by the doctors and nurses. They just assumed that I “couldn’t handle” the side effects from SSRIs. I took 10 mg both days and still had the worse side effects I ever felt. It’s been almost three weeks and I’m still having side effects. I hope I can return to normal soon.

        • Trinity

          Did it improve? I took Lexapro for 4 days and no I’ve been diagnosed with Supraventricular Tachycardia. I’ve never had to go to the ER until 4 weeks ago after taking it. High blood pressure which I never had before the medicine and high pulse

          • Sally

            I had the same thing happen after restarting Celexa. I woke up with a pulse of 180 and after several days of that was at the ER twice. No one believe it was because of the Celexa. My doctor insisted I try lexapro even though I tried to explain my concern. I took it today and my heart rate went to 154 and it also caused high BP which I never have. I’m done with these meds—- I can’t afford to continue to go to the ER. I’m hoping to find a way to control my anxiety without the meds and pray this all stops. My heart goes out to everyone having these experiences.

        • Not so sunny

          Two days ago my PCP prescribed me 40mg of celexa. I also take Suboxone, I took the celexa and instantly went into serotonin syndrome. Worst experience of my life, the ER after like I was allergic to celexa, tried to commit suidide or drug seeking. My SUD Dr finally called them and I got some relief, but this has really ruined my life. I still feel terrible. One dose!! I almost died.

      • Rave

        Lorazepam, or Ativan, is a semi potent benzodiazepine. It actually has nothing to do with serotonin and in fact Ativan is sometimes given for SS.
        Additionally, 10mg of Ativan a day is WAY over the max FDA dose of 6mg/day and most max out at 4mg/day. I’m guessing you meant 1mg. Regardless this is obviously not the benzo for you, I’d suggest stopping it.

        • Garry Madaline

          Are you saying that lorazepam is a low SS risk compared to Valium.
          Just looking for clarification
          May I ask how you came to that conclusion as I am dealing with the aftermath of SS that was misdiagnosed st Mayo. Clinic and I ended up in a behavioral hospital for 2 days with the meth addicts and psycpayhs

  6. Cindy Smith

    I was diagnosed with serotonin syndrome in 2013. Sense then my doctor has been trying to keep me away from certain drugs. But every now and then I still have tremors and can’t sleep is there anything I can do to prevent this. I don’t want to be put on any more medications. But I not sure whats causing this

    • Alex


      Are you still having tremors? I had seritonin syndrome back in January with horrible tremors and jerking. It’s definitely gotten better, but even now I still struggle to fall asleep because of the jerking. There’s nothing online saying how long these symptoms can last!

  7. Leigh Ramirez

    I was put on sertraline in the beginning of February. It immediately made me feel sick—headache and stomach problems. The headaches got worse and so I started having to take migraine medication and I had tramadol to take for the pain. I had told my doctor that I had a history of migraines, and that I had these medications but rarely took them as I had been migraine free for almost 3 years. I was unaware of the dangers of taking these medications together and had emailed my doc about my headaches. I was told to increase my dose of sertraline. I ended up with serotonin syndrome, in complete terror. I was in so much pain, constant seizures, hallucinations, extreme paranoia, uncontrollable tremors and the headaches became so unbearable I often only thought of slicing my throat if I could think of anything besides the pain.
    I was so terrified and I couldn’t trust any doctor. I am about 2 months since my last dose of sertraline and I am finally starting to feel like myself again. My anxiety is worse than it ever was before I started taking this poison, I now have spells of vertigo, my thyroid is still not functioning properly, my short term memory is getting better but was awful, cognitive recall of words had become very difficult especially with my second language, and I have had daily intrusive thoughts about harming myself. I wish I could go back in time and has never had taken this poison. It has made my life very difficult but I am getting though it. I pray no one ever had to go through what I have.

    • Mary Gold

      Have you had your thyroid checked , via a blood test
      To see if you are overthyroid or underthyroid
      Some of the symptoms you mention are associated with abnormal thyroid function.

    • John

      How are you now? I hope you are better

  8. Christian Domey

    I took fluoxetine which was prescribed by a psychiatrist. I took this drug for 5 days and I nearly died. The sensation from my body, the unsteady state of my body, profuse sweating with serious hotness, my eyes were with pains and blurry vision, racing heartbeat, high bp, confusion, and can’t feel for food. I’m in my 4th day and only God knows when this symptoms will go away totally.
    I actually thought I was sick of some unusual sickness. God help me in this.

  9. Tana C Brooks

    I nearly died of Serotonin Syndrome 2 weeks ago today. Many prescribed drugs led to it. I’m upset at doctors, pharmacies, etc, right now and will fight to make changes regarding Serotonin Syndrome awareness. My fear is: what are the long term effects, how long will they go on for me, etc. I’m still quite sick and scared. I’m educating my doctors instead of them educating me!

    • Yvonne

      Hi Tana,

      I am just coming to the realization that I have been given a combination of medication that can cause Serotonin Syndrome. How could doctors and pharmacists not know this and continue prescribing this combo? I have been taking the same medication for 4 years, we expect doctors to be educated in stuff like this, however it is the opposite, and you’re right…we are left to educate them. I am now worried what kind of long term affects this will have.

    • Amber A

      I would like to help do this. I can’t believe so few people know about it. I’ve been blown off as having anxiety attacks and been treated horribly. Is it a political issue, medical board, where does one start?

    • Fabian

      I hope you are doing better. I wish you all the best.

  10. Dana

    My son had allergic reactions to things ever since he was an infant. When my son was a teenager, he got into drugs. We did not know for sure which ones or at what level at that time, but once we knew, we scrambled to get him into rehab for 30 days. Once he was done with rehab and came home, he had a prescription for Prozac and one other medication that I can’t recall, a mood stabilizer (this was 16 years ago.) He went back to High School, and seemed to do ok for about a week. Then I was contacted by the school because something was wrong and I raced over to find him mumbling and grinding his teeth, shivering, and unable to walk. I contacted his doctor who told me to bring him over immediately. By the time we got there, only minutes later, he was posturing and seizing. The doctor took a blood sample and administered a shot, then admitted him to the hospital for 2 days. I was beside myself, just sure that he had relapsed with an illegal drug. But nope, the blood work came back clean and the doctor said it was serotonin reuptake syndrome, and that since my son was apparently so sensitive that he should not take any SSRIs. He has had some mental health difficulties since then, but has never been back on mental health meds. He says that he doesn’t remember much about it, just that he was terrified and couldn’t speak or get his muscles to move. Hell of a way to learn that this was even a possibility

  11. Michael J Browy

    I suddenly started losing control of my body when I am stressed or overheated. I just realized that literally ALL the medications I am prescribed can cause serotonin syndrome including a Buprenorphine transdermal patch which is VERY susceptible to heat. My wife has seen me go into this state and described it like I had late stage Parkinson’s! My treatment luckily saved me by applying cool damp compressed to my head and neck. I was unable to walk because my legs felt like lead, I had severe tremors and couldn’t control my hands or speak. My speech was unintelligible. I explained what happens to my doctor and we never discussed heat induced serotonin syndrome due to my medication regimen! That is my self diagnosis and while my medications help immensely with my diagnosis of major depressive disorder with panic/anxiety disorder I now know that I cannot be exposed to high temperatures for extended periods of time.

  12. Carissa

    Serotonin syndrome ruined my life. My psychiatrist recommended me to take venlafaxine (Effexor) and buspirone I took those together in the morning time. He started me on the venlafaxine 75mg and buspirone 10mg I explained to him I was having high heart rates and was extremely tired from it and his solution was to up it to 150mg. Three days later I was stopped by a train waiting for it to pass luckily had my vehicle in park, I became unconscious only to wake up with police surrounded my vehicle… they took my children out of my custody accusing me of being on drugs even though I explained I do not do drugs and recently had my medication upped for them to arrest me and am now fighting for my children and freedom because the dr did not listen to my side effects… this is the worst thing to experience I lost my kids my job and my license until my tox report comes back… it’s hard to trust a dr after what happened… now I’m sick can’t sleep ever and have severe headaches that I can’t get rid of..

  13. Maria Arevalo

    Hi I just started taking a low dose of prozac yesterday morning at about 4 am this I woke up feeling like my brain was coming out of my head if that makesany sense I also started shivering and vey cold and my anxiety is awful right now I ve known my psychiatrist for a long time and he is a wonderful person I asked him please to make sure that he prescribed me something safe so I do not blame the psychiatrist they try the best they do not know what gonna make us sick my son on prozac for many years and does very wrll with it

    my question is if anyone out that can help me to tell me if this is serotonin syndrome or just a side effect from the Prozac that will go away I’m really sick I need to take something and I don’t want to stop it if it’s going to help if someone could please help me..

  14. Kristen Johnson

    I had a weird side effect to Amitriptyline, but now I am curious if it was serotonin syndrome.. I was put on Amitriptyline by my neurologist for migraines and I took other psych meds prescribed by psych resident too.. I started becoming more angry/ raging wanting to break things when I was upset. (The logic I break it, I have to rebuy it wasn’t there anymore) I was having abnormal headaches for me, I would be fine one minute the next it was a sharp piercing pain and I was throwing up. It would go away in 5-10 minutes.. I could feel my brain separate from my skull, which was really weird and a sensation I never had before.. I kept trying to go to the ER and tell them something was wrong, but they would tell me I had boarderline and to take my meds.. Most times I never saw the psych on duty, just sent home. It went on for about 6 months before I overdosed on Amitriptyline.. When they never gave it back to me I felt better back to my normal.. Most people don’t believe when I explain what happened.. I figured it out by not being put back on the med..



  1. Drugs That Cause Hyperthermia - Can You Name Them? - Med Ed 101 - […] Serotonin toxicity (syndrome) caused by serotonin reuptake inhibitors, monoamine oxidase inhibitors, dextromethorphan, tramadol, tapentadol, linezolid, SNRI’s, and St. Johns…

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Written By Eric Christianson

March 29, 2015

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