Serotonin Syndrome Versus NMS Similarities
Over the past few decades, attention has been drawn to two uncommon but potentially fatal adverse responses to psychiatric drugs: serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS). These two drug-induced illnesses have certain clinical traits or presentations in common. Due to variations in their administration and therapy, it is imperative to distinguish between these significant illnesses. It’s crucial to spread knowledge of the similarities and differences in how they show themselves.
Although it can sometimes happen after starting a single serotonergic medication, SS typically develops from concurrently using several serotonergic medicines. Serotonin syndrome may also be triggered by drug interactions that cause the central nervous system (CNS) to produce too much serotonin.
There is a range of theories on how SS functions. Serotonin levels may increase due to medications that cause a rise in release, decreased uptake or metabolism of serotonin, or excess serotonin precursors or agonists. Several medications and drug classes have been linked to occurrences of SS, including TCAs, SSRIs, SNRIs, MAOIs, triptans, nefazodone, buspirone, mirtazapine, carbamazepine, tramadol, linezolid, MDMA (ecstasy), dextromethorphan, St. John’s wort, lithium, methadone, cocaine, levodopa, reserpine, and amphetamines. The frequency of SS resulting from using these agents is mainly unknown.
The use of neuroleptic agents precipitates NMS. The incidence of NMS varies with a range of 0.02–2.4% in patients being treated with neuroleptics. These agents include dopamine antagonists such as antipsychotics and antiemetics. Also, abrupt withdrawal of dopamine agonists, for instance, those used in managing Parkinson’s disease, may produce signs and symptoms correlating with NMS. Interestingly, NMS does not necessarily correspond with high doses of antipsychotics, as it can also occur with lower doses.
Neuroleptic Malignant Syndrome Vs Serotonin Syndrome Risk Factors
The solitary risk factor identified in SS is the concurrent use of serotonergic agents. A list of agents associated with SS can be found in the table below within the article. The individual risk with each serotonergic medication listed in the table is mainly unknown.
However, avoiding the concomitant use of multiple serotonin-enhancing medications can help minimize the risk of developing SS. Talarico et al presented two cases of SS due to drug interactions involving citalopram with two CYP 2D6 inhibitors, cimetidine, and topiramate. Each patient’s symptoms resolved within a week of discontinuing the offending agents.
Another risk for SS may be with illicit drugs, mainly when used in patients concurrently taking a serotonin-enhancing drug. One case, reported by Joksovic, showed that “bath salts,” a synthetic derivative of cathinone, induced a state of serotonin toxicity. Cathinone is a naturally occurring psychostimulant. These synthetic cathinones are believed to enhance the release of monoamines and block their reuptake, resulting in symptoms consistent with SS.
Additionally, the use of cocaine in patients taking antidepressants, specifically SSRIs, was found to be one of the most common causes of serotonin toxicity. MDMA used concomitantly with other drugs has been connected with many fatalities. MDMA exerts its effects by increasing neurotransmitters in the CNS, serotonin, norepinephrine, and dopamine. Combining MDMA with other serotonin-modifying agents increases the risk of fatalities due to serotonin toxicity.
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Serotonin Syndrome Versus NMS
Serotonin Syndrome Overview
Serotonin syndrome is a severe and potentially life-threatening condition that occurs when there is too much serotonin in the body. Serotonin is a natural chemical that helps regulate mood, attention, body temperature, and other functions. Some medications and drugs can increase serotonin levels, especially when combined with other serotonergic agents.
Symptoms of serotonin syndrome can vary from mild to severe and include agitation, confusion, rapid heart rate, high blood pressure, muscle twitching, rigidity, sweating, diarrhea, shivering, and dilated pupils. In severe cases, serotonin syndrome can cause fever, seizures, irregular heartbeat, unconsciousness, and death. Serotonin syndrome can be treated by stopping the medications that cause it and taking drugs that block serotonin.
Serotonin Syndrome Symptoms
- Agitation or restlessness.
- Rapid heart rate and high blood pressure.
- Dilated pupils.
- Loss of muscle coordination or twitching muscles.
- Muscle rigidity.
- Heavy sweating.
- Goose bumps.
Neuroleptic Malignant Syndrome Overview
Neuroleptic malignant syndrome (NMS) is a rare and life-threatening condition that occurs when someone takes certain medications that affect the brain, such as antipsychotics or antiemetics. Symptoms of NMS include very high fever, confusion, rigid muscles, and rapid heartbeat. NMS can cause serious complications such as muscle breakdown, kidney failure, seizures, or death.
NMS requires immediate medical attention and treatment, which involves stopping the offending medication and cooling the body. NMS can occur with any antipsychotic medication, but it is more common with high-potency ones, such as haloperidol. NMS can also occur with antiemetic medications, such as metoclopramide.
Neuroleptic Malignant Syndrome Symptoms
- Very high fever (>38 °C or >100.4 °F).
- Confusion or altered consciousness.
- Rigid muscles or muscle spasms.
- Rapid heartbeat and variable blood pressure.
- Excessive sweating.
- Dilated pupils.
- Trouble swallowing.
- Irregular heartbeat.
- Rapid breathing.
- Muscle breakdown.
- Kidney failure.
NMS Vs Serotonin Syndrome Statistics
Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are both severe but rare conditions that can occur due to the use or withdrawal of certain medications that affect the brain. Both conditions can cause similar symptoms, such as fever, confusion, muscle rigidity, and autonomic instability. However, they have different causes, risk factors, and treatments. In this section, we will compare the statistics of NMS and SS, such as their incidence, prevalence, mortality, and morbidity rates. We will also discuss the factors that influence these statistics, such as the type of medication, the dose, the duration of use, and other medical conditions.
There were 26,733 exposures to SSRIs reported in 2004, of which 7.5 percent involved serotonin syndrome.
Source: Toxic Exposure Surveillance System
0.02 to 2.4%
The incidence of NMS varies with a range of 0.02 to 2.4 percent in patients being treated with neuroleptics.
Source: Strawn JR, Keck PE Jr, Caroff SN. Neuroleptic malignant syndrome.
5 and 11.6%
The mortality rate of NMS is between 5 and 11.6 percent, while the mortality rate of SS is less than 1 percent.
Source: Birmes P, Coppin D, Schmitt L, Lauque D. Serotonin syndrome: a brief review.
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Main Differences Between Serotonin Syndrome Vs NMS
Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are both rare but potentially life-threatening conditions that can occur due to the use or withdrawal of certain medications that affect the brain. However, they have different causes, clinical features, and time courses.
NMS is usually triggered by using dopamine antagonists, such as antipsychotics or antiemetics, or the abrupt withdrawal of dopamine agonists, such as those used for Parkinson’s disease. NMS reduces dopamine activity in the brain, leading to muscle rigidity, fever, altered mental status, and autonomic instability.
NMS typically develops over days to weeks after exposure to the causative agent. SS is usually caused by using serotonin agonists, such as antidepressants, triptans, or recreational drugs, or excess serotonin precursors, such as tryptophan or St. John’s wort.
SS increases serotonin activity in the brain, leading to neuromuscular hyperreactivity, such as tremors, hyperreflexia, myoclonus, fever, altered mental status, and autonomic instability. SS typically develops over 24 hours after exposure to the causative agent. Both conditions require prompt recognition and treatment to prevent severe complications and death.
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Popular Serotonin Syndrome Versus NMS FAQs
Serotonin Syndrome Vs NMS, Which is More Dangerous?
NMS and SS are dangerous conditions that can cause severe complications and death if not treated promptly. However, some sources suggest that NMS has a higher mortality rate than SS, which may indicate it is more dangerous. For example, one source states that the mortality rate of NMS is between 5 and 11.6 percent, while the mortality rate of SS is less than 1 percent.
Another source states that the mortality rate of NMS ranges from 10 to 20 percent, while the mortality rate of SS ranges from 2 to 12 percent. However, these statistics may vary depending on each condition’s definition, diagnosis, and treatment. Therefore, it is vital to recognize the signs and symptoms of both NMS and SS and seek medical attention right away if they occur.
Neuroleptic Malignant Syndrome Vs Serotonin Syndrome Vs Malignant Hyperthermia
Neuroleptic malignant syndrome (NMS), serotonin syndrome (SS), and malignant hyperthermia (MH) are all rare but potentially life-threatening conditions that can cause hyperthermia and muscle rigidity, among other symptoms. However, they have different causes, clinical features, and treatments that require differentiation.
NMS is usually triggered by the use or withdrawal of medications that affect dopamine activity in the brain, such as antipsychotics or antiemetics. NMS reduces dopamine activity in the brain, leading to muscle rigidity, fever, altered mental status, and autonomic instability. NMS typically develops over days to weeks after exposure to the causative agent. SS is usually caused by the use or withdrawal of medications that affect serotonin activity in the brain, such as antidepressants, triptans, or recreational drugs.
SS increases serotonin activity in the brain, leading to neuromuscular hyperreactivity, such as tremors, hyperreflexia, myoclonus, fever, altered mental status, and autonomic instability. SS typically develops over 24 hours after exposure to the causative agent. In genetically susceptible individuals, MH is usually caused by exposure to inhalational anesthetics or succinylcholine. MH involves a skeletal muscle ryanodine receptor mutation that causes excessive calcium release and muscle contraction.
MH typically develops within minutes to hours of exposure to the triggering agent. The treatment of NMS and SS involves stopping the offending medication and giving supportive care, such as fluids, cooling, and benzodiazepines. The treatment of MH involves stopping the triggering agent and giving dantrolene, a drug that inhibits calcium release from the sarcoplasmic reticulum. These conditions require prompt recognition and intervention to prevent severe complications and death.
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We Level Up Fort Lauderdale Florida Serotonin Syndrome Versus NMS
At We Level Up Fort Lauderdale, Florida, we understand that serotonin syndrome and NMS are severe and potentially life-threatening conditions that can occur due to the use or withdrawal of certain medications that affect the brain. These conditions can cause symptoms such as fever, confusion, muscle rigidity, and autonomic instability, which require immediate medical attention and treatment. That’s why we offer the following services for our clients who may be at risk of developing serotonin syndrome or NMS:
- A comprehensive assessment of the client’s medical history, medication use, and substance use to identify any potential triggers or interactions that may cause serotonin syndrome or NMS.
- Close monitoring of the client’s vital signs, mental status, and neuromuscular function to detect any signs or symptoms of serotonin syndrome or NMS.
- Rapid intervention and referral to a hospital if serotonin syndrome or NMS is suspected or confirmed, including stopping the offending medication and providing supportive care.
- A follow-up and coordination of care with the hospital staff and the client’s primary care provider to ensure a safe and smooth transition and recovery.
- A medication review and adjustment with the client’s psychiatrist or prescriber to prevent any recurrence of serotonin syndrome or NMS.
- A psychoeducation and counseling session with the client and their family to explain the causes, risks, and prevention of serotonin syndrome or NMS.
- A relapse prevention plan and aftercare program to help the client maintain their sobriety and mental health.
At We Level Up Fort Lauderdale, Florida, we are committed to providing our clients with the best possible care and support for their physical and mental well-being. If you or someone you love is struggling with substance use or mental health issues that may put you at risk of developing serotonin syndrome or NMS, please contact us today. We are here to help you level up your life.
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Search We Level Up FL Serotonin Syndrome Versus NMS Resources
- MedlinePlus – “Serotonin syndrome”: https://medlineplus.gov/ency/article/007272.htm
- NCBI Bookshelf – “Neuroleptic Malignant Syndrome – StatPearls”: https://www.ncbi.nlm.nih.gov/books/NBK482282/
- National Institute of Neurological Disorders and Stroke – “Neuroleptic Malignant Syndrome”: https://www.ninds.nih.gov/health-information/disorders/neuroleptic-malignant-syndrome
- FDA – “FDA Drug Safety Communication: Abnormal heart rhythms associated with high doses of Celexa (citalopram hydrobromide)”: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-abnormal-heart-rhythms-associated-high-doses-celexa-citalopram
- CDC – “Notes from the Field: Serotonin Syndrome After Ingestion of “Bath Salts” Containing 3,4-Methylenedioxypyrovalerone — Michigan, November 2011 | MMWR”: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a1.htm
- National Institute of Mental Health – “Mental Health Medications”: https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml
- SAMHSA – “SAMHSA’s National Helpline – 1-800-662-HELP (4357)”: https://www.samhsa.gov/find-help/national-helpline
- National Institute on Drug Abuse – “MDMA (Ecstasy/Molly) DrugFacts”: https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly
- VA Pharmacy Benefits Management Services – “Criteria for Use of Serotonin Syndrome Risk Assessment Tool in the VA Health Care System”: https://www.va.gov/PBM/clinicalguidance/criteriaforuse/SerotoninSyndromeCriteriaforUse.pdf
- ClinicalTrials.gov – “Dantrolene in the Treatment of Serotonin Syndrome – Full Text View”: https://www.clinicaltrials.gov/ct2/show/NCT00004323