Akathesia: A Tortured Restlessness

 

There are particular side effects from medicine that physicians want to know right away if you have. Akathesia is one of them. Akathesia is a sensation of inner restlessness so bad that it can actually increase the risk of suicide. People suffering from it are unable to sit still and often describe it as a creepy-crawly sensation inside of them. Akathesia treatment usually works pretty quickly. Let’s go over what is akathesia to be sure you can recognize it in the unfortunate chance that you or someone you know experiences it.



How do you get akathesia?

Akathesia is a potential side effect on medications prescribed for psychiatric illness (there are other non-psychiatric medication that can cause it too although it is less common). It is seen most frequently with antipsychotic medications but also can be caused by antidepressant medications.

 

Akathesia is dose dependent which means the risk of it can be increased by raising the dose too quickly. When starting on medication, start with a low dose and raise it slowly to minimize this risk.

What symptoms does it cause? 

What is akathesia? It is a sensation of inner restlessness so bad it can increase the risk of suicide. Don't delay akathesia treatment.

 

A person experiencing akathesia may:

 

  • Unable to sit still
  • Restlessness
  • Feel fidgety,
  • Be rocking back and forth,
  • Pacing or marching in place,
  • Be irritable and tense,
  • panicked,
  • Agitated,
  • Unable to sleep.

Akathesia Treatment:

What is akathesia? It is a sensation of inner restlessness so bad it can increase the risk of suicide. Don't delay akathesia treatment.

 

 

It is important to know akathesia goes away. This isn’t a permanent state of torture! Also, we are generally able to manage this side-effect as an outpatient although depending on individual circumstances someone may require hospitalization.



First step:

The first step in akathesia treatment is often to discontinue or reduce the medication causing the restlessness. It can take a week or so for the medication levels to be lowered in the body so other treatments often need to be used to keep people comfortable while waiting.

 

There are several quick-acting medications used to alleviate akathesia. Generally, these akathesia treatments reduce the extreme restlessness pretty rapidly. Your physician may have to raise the dose of the medication if the initial amount wasn’t enough to minimize the symptoms.

 

There are several options for akathesia treatment medications but 2 commonly used examples are:

  • A blood pressure medication called propranolol (Inderal)
  • Clonazepam (Klonopin), an anti-anxiety medication.



Akathesia: In conclusion

Don’t let akathesia go untreated. If you ever had a justifiable reason to emergency page your doctor this is one of them. If you are unable to sit still, and have extreme restlessness after starting or raising a dose of your medication, contact your physician right away. Akathesia treatment can work quickly so don’t delay.

 

Other medication side effects not to miss:

Neuroleptic Malignant Syndrome: Rare but Potentially Deadly Side Effects of Antipsychotic Medications

 

What is Serotonin Syndrome? Hint: It’s an Emergency. Know the Signs and Symptoms of Serotonin Syndrome.

 

Take psychiatric medications? Be aware of SIADH hyponatremia and SIADH symptoms

 

Will You Have Antidepressant Withdrawal Symptoms?

 

 

 

48 of the Best Resources to Help with Overcoming Anxiety (Includes Help with Anxiety for Adults and Children!)

Anxiety is a treatable condition. Depending on the intensity, some people can get better on their own and others need therapy and/or medications to help with anxiety. Either way, recovering from anxiety is possible! There are great self-help options available to assist with the treatment of anxiety which includes websites, apps, and books on overcoming anxiety.

 

I compiled a list of 48 of my favorite anxiety resources that are full of information for both adults and children. Get your list here:

 

Imagine what life would be like without anxiety. Would you do things differently?

If you got help with anxiety would you:

  • Pursue different careers or hobbies?
  • Try to get that promotion you deserve even if it requires travel and public speaking?
  • Fly in a plane or go back to school to complete your degree?
  • Drive on the highway so you can take road trips?
  • Say yes to that party at your friends’ house? Or to a work gathering?
  • Go to a store instead of ordering everything online?
  • Have some peace of mind?
  • Fall asleep easier and wake up without fear?

Overcoming Anxiety

Anxiety can be healthy and normal. It’s a motivator and is our body’s way to remind us we need to pay attention. If we are anxious about something we may try harder to be prepared. Anxiety can be a helpful tool for our success and survival.

 

But sometimes anxiety stops being helpful and starts to run the show. It becomes so powerful anxious feelings are overvalued and evidence that might contradict worry thoughts is ignored. Naturally, the tendency is to avoid the things that feel unpleasant yet once the avoidance cycle starts anxiety has the upper hand.

 

Anxiety can be a helpful signal and enhance your life, but it is a problem when it begins to rule decisions. Get help with anxiety so you can stop responding to fears and worries in ways that end up making it worse.

Treatment of Anxiety

Here is my comprehensive list of recommended treatment options for children and adults, including websites, apps, and books on overcoming anxiety. It includes 48 different resources to get you recovering from anxiety so you can take back control of your life.

 

Download this resources list to help you get started overcoming anxiety now!

 

Adventure Awaits! How to Overcome Fear of Flying Phobia.

Recently, I took an international trip with my family that required a 16-hour plane ride. Stuck in an uncomfortable middle seat for this unpleasantly long flight I had lots of time to think and reflect in order to make the most of this extended period of nothingness. One of the topics I thought about is how life would change if I had a fear of flying phobia and the trips and family adventures I would miss out on. Fear of flying is common and many of my patients talk to me about this very thing. You can learn how to overcome fear of flying phobia. There are many adventures that await you (or business trips). Don’t let the anxiety and fear that accompany this hold you back- get treatment and put the anxiety behind you.



What is a fear of flying phobia?

Fear of flying, or aviophobia, is a type of “specific phobia” involving unreasonable and out-of-proportion levels of intense, persistent, fear of specific objects, situations, activity, or people.

Taking control to manage (and avoid) anxiety

Fear of flying phobia is common. Learn how to overcome fear of flying so you don't let this interfere with your work or family any more. Adventures awaits!

Oftentimes, people with anxiety manage it by doing something that makes them feel in control. Anxiety causes such out-of-control feelings it’s a natural response to reflexively do things to feel back in control. Not all forms of “taking control” actually help us in the long run but they need to be recognized as attempts at self-soothing and anxiety management.

 

These attempts to regain control over anxious feelings may take the form of:

 

  • Obsessively organizing the house,
  • Deciding to drive backroads to avoid a bridge or highway,
  • Choosing to drink alcohol before an event to calm down,
  • Or most commonly, to avoid the anxiety-provoking event entirely.

Flying in an airplane is the ultimate loss of control.

You aren’t flying the plane (well, I hope you aren’t!) and you can’t get off if you want to. If you have a panic attack you will be “trapped” in the airplane for the duration of the flight. It’s no wonder that so many people with anxiety have a fear of flying.



Avoiding the anxious trigger (flying)

Avoidance is usually the coping mechanism that wins with fear of flying. People with a flying phobia will do whatever they can to avoid a flight. I have patients who are willing to drive for 24 hours to make it to an event that they could have flown 3 hours to get to. And 2 days later they have to turn around and drive back. Oftentimes, they insist this doesn’t bother them but I wonder how much that is a defense because the idea of flying is UNTHINKABLE to them.

Is a flying phobia really a big deal?

Having a fear of flying phobia may sound like it wouldn’t cause many difficulties in one’s life since most people don’t need to fly often…. until you hear individuals describe how it has changed their life. I have had patients completely alter their professional trajectory out of fear they would need to travel. This includes declining promotions that they otherwise wanted because the jobs would involve distant business meetings or deciding to change careers entirely to one that will never require airplane travel.

The whole family is affected by this

Fear of flying phobia is common. Learn how to overcome fear of flying so you don't let this interfere with your work or family any more. Adventures awaits!

This phobia interferes with family life when people end up staying home from family trips that require flying. Weddings missed and distant adventures never experienced, a flying phobia can be made into a whole family affair.

 

When people do acquiesce to taking a trip, their anxiety may skyrocket and they often fret and seek reassurance from the time the trip is booked until it happens… sometimes declining to go at the last minute. It can be paralyzing for them. If a trip is booked a year in advance, without treatment a person with a flying phobia may spend the majority of the year with anticipatory anxiety worrying about this upcoming vacation.

Good news! There are excellent treatments available to overcome fear of flying:

Fear of flying phobia is common. Learn how to overcome fear of flying so you don't let this interfere with your work or family any more. Adventures awaits!

Many people seek out medication from their doctor to alleviate the terror they feel about flying. This usually takes the form of as-needed anxiety-relieving medication they can take just before getting on the flight. Although this can reduce the person’s anxiety, and be the reason they agree to fly, there are more effective preventative treatments available.



In the situation of occasional airplane travel, using an as-needed benzodiazepine is possibly reasonable (I say possibly because it depends on the particular person’s history. Benzodiazepines are not appropriate for everyone even if the situation is a reasonable one to use it for). Oftentimes, when a person knows they have a medication that will reduce anxiety, this is enough for them to agree to travel. They may never love flying, but they know they can “white-knuckle” it and get through when they need to.

 

Solely having treatment be an as-needed benzodiazepine isn’t ideal if:

 

  • A person has to travel regularly,
  • They experience high anxiety at the thought of flying,
  • Avoiding flying impacts their life negatively.

 

People can overcome this fear by doing cognitive behavioral therapy (CBT) specifically aimed at addressing their fear of flying.

How to overcome fear of flying: A great treatment option

Created by a pilot (he is also a therapist) who knows everything about airplanes, Soar is a great example of a successful program to address the fear of flying.

 

I love this program because it combines his flying expertise with specially created CBT programs to target fear of flying. He has DVD’s to listen to on your own time, and some packages include 1:1 counseling with him. He even has an emergency program called “Help Me Now” targeted to people flying the next day who need immediate intervention so they can get on a plane.

 

I have had patients terrified of flying use this program who can attest to its benefits. They now fly comfortably without the need for anxiety medication.

 

Watch these educational videos from Captain Bunn about fear of flying. They include pointers about how to get rid of it.

Fear of flying does not need to control you!

Don’t miss out on any other family vacations or work trips that are needed for your career. There are treatments available that can successfully treat flying phobia so you don’t need to avoid and worry any longer.

 

Get the help you need. Talk to your physician and/or check out the Soar program so you can eliminate this fear of flying permanently.



For additional help and information about anxiety read these articles:

Shifting Thoughts and Taking Control: Cognitive Restructuring for Anxiety Management

5 Ways to Stop a Panic Attack

The Best Resources for Anxiety

 

How Does Antabuse Work? Everything You Need to Know to Decide if Disulfiram Antabuse Treatment is Right For You

Antabuse (Disulfiram is the generic name) is a medication given to people who are struggling with alcohol addiction and need medication to support their efforts to abstain. Breaking the cycle of addiction is extremely difficult and sometimes a person needs to medically remove alcohol as an option in order to begin to recover. Disulfiram Antabuse treatment is not a cure for addiction. It discourages drinking due to the extremely unpleasant consequences (the disulfiram reaction) that happen when Antabuse and alcohol are combined. How does Antabuse work? In order to understand this, we need to take a look at how alcohol is metabolized. Antabuse interferes with this pathway and this is why you get sick if you drink alcohol while taking Antabuse.



Wondering if you have a drinking problem or at risk for withdrawal? Take a moment now to read these posts:  Do you have a drinking problem? and Alcohol Dependence and Withdrawal: Are You at Risk?

Antabuse Treatment: How alcohol is broken down

Disulfiram Antabuse is a medication for people struggling with alcohol addiction. Antabuse treatment can have unpleasant effects (called Disulfiram reaction) when Antabuse and alcohol are combined. How does Antabuse work? Read here for the full story.

Alcohol needs to be broken down into smaller parts in order to be excreted (cleared from the body). It needs chemicals (mostly supplied by the liver) to break it down. Here are the basics of how alcohol is metabolized and processed:

1st step to metabolize alcohol:

The first chemical needed in the process is called alcohol dehydrogenase. This is responsible for breaking alcohol into acetaldehyde. Acetaldehyde is a toxic metabolite and is responsible for many of the symptoms caused by a hangover.

High levels of acetaldehyde cause:

  • Nausea,
  • Vomiting,
  • Flushing,
  • Headache,
  • Low blood pressure



Because of the unpleasant effects of high levels of acetaldehyde, it needs to be broken down further in order to feel well.

2nd Step:

The next chemical in the process is aldehyde dehydrogenase which is responsible for breaking down the acetaldehyde further into acetic acid, a harmless substance that can be excreted.

How Antabuse works: Why disulfiram Antabuse makes you feel sick if you drink alcohol

Disulfiram Antabuse is a medication for people struggling with alcohol addiction. Antabuse treatment can have unpleasant effects (called Disulfiram reaction) when Antabuse and alcohol are combined. How does Antabuse work? Read here for the full story.

How does Antabuse work? Disulfiram blocks Step 2: the ability for aldehyde dehydrogenase to break down the acetaldehyde. This means acetaldehyde stays around in the system creating the unpleasant effects that happen with high acetaldehyde levels (listed above).

 

The physical effects that happen from the toxic acetaldehyde start within about 10 minutes of drinking alcohol and last for an unpleasant 1+ hours depending on the amount of alcohol consumed.

Antabuse and alcohol: What could happen during a Disulfiram reaction?

Disulfiram Antabuse is a medication for people struggling with alcohol addiction. Antabuse treatment can have unpleasant effects (called Disulfiram reaction) when Antabuse and alcohol are combined. How does Antabuse work? Read here for the full story.

Here is a good summary of what can happen when disulfiram and alcohol are combined. This is called a disulfiram reaction:

 

Disulfiram plus alcohol, even small amounts, produce flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. In severe reactions there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death.

 

The intensity of the reaction varies with each individual, but is generally proportional to the amounts of disulfiram and alcohol ingested. Mild reactions may occur in the sensitive individual when the blood alcohol concentration is increased to as little as 5 to 10 mg per 100 mL. Symptoms are fully developed at 50 mg per 100 mL, and unconsciousness usually results when the blood alcohol level reaches 125 to 150 mg.



How long does Disulfiram Antabuse stay in the body?

Disulfiram Antabuse is a medication for people struggling with alcohol addiction. Antabuse treatment can have unpleasant effects (called Disulfiram reaction) when Antabuse and alcohol are combined. How does Antabuse work? Read here for the full story.

Antabuse is quite long-acting (slow to be cleared from the body) and a reaction may occur up to 2 weeks from the last dose of the medication!

 

Until it is fully cleared a person will get sick if they drink alcohol and I highly recommend not experimenting to see if you can drink sooner. I have heard stories of patients who are able to drink after 4 days but I have also heard stories of patients who have tried this and have been sicker from the disulfiram reaction than they ever were in their life.

 

Of course, the amount of time necessary until a person can “safely” drink again does not address the issue of someone struggling with addiction resuming drinking. We all know there are adverse effects that happen with addiction too…

Potential side-effects of Antabuse:

Disulfiram Antabuse is a medication for people struggling with alcohol addiction. Antabuse treatment can have unpleasant effects (called Disulfiram reaction) when Antabuse and alcohol are combined. How does Antabuse work? Read here for the full story.

 

It is important to know this medication cannot be started within 12 hours of consuming an alcoholic beverage. Many of the below-listed side effects are more common in the first 2 weeks of therapy and then disappear. These can also be minimized by lowering the dose if necessary.

 

Side effects include:



  • skin rash,
  • acne,
  • headache,
  • drowsiness or tiredness,
  • impotence,
  • metallic taste or garlic-like taste in the mouth,
  • weakness,
  • loss of appetite,
  • upset stomach and vomiting,
  • yellowness of the skin or eyes,
  • dark urine,
  • rare liver inflammation or failure.

Antabuse treatment: It is an option to aid in recovery from alcohol addictionDisulfiram Antabuse is a medication for people struggling with alcohol addiction. Antabuse treatment can have unpleasant effects (called Disulfiram reaction) when Antabuse and alcohol are combined. How does Antabuse work? Read here for the full story.

Disulfiram Antabuse is not a cure-all for alcohol addiction but it can be a life-saving intervention that, when used along with psycho-social supports, helps support a person that is struggling to achieve abstinence from alcohol.

 

Do you know anyone that has successfully used Disulfiram Antabuse in their recovery? Have you, or anyone you know, experienced the adverse reaction of combining Antabuse and alcohol? What happened?

Please comment with any words of wisdom for people that are wondering if Disulfiram Antabuse treatment is right for them. 

 

To read more about addiction check out these posts:

 

Need help quitting Juul? Learn more about treating Juul addiction.

There is a drug called Lean in school. Have you heard of it?

7 Alternatives to AA in Recovery from Addiction

We Can Help Prevent Prescription Medication Abuse and Drug Diversion

Naloxone: The antidote for opiate overdose

 

 

 

Fall Prevention in the Elderly: Improve Sleep and Reduce Anxiety Without an Increased Risk of Falling

Preventing falls in the elderly can significantly improve quality of life. Unfortunately, falling and injury happen too frequently. Fall prevention in the elderly is the result of common sense safety planning and education regarding contributing factors that set people up to fall. Many frequently used medications increase these risks, especially sleep aids and certain anxiety medications. But insomnia and anxiety also impair quality of life and need to be treated. Learn more about the risks and safer alternatives that can help.



Why is fall prevention in the elderly so important?

Preventing falls in the elderly can significantly improve quality of life. Fall prevention in the elderly needs to include education about increased risks from sleep aids and certain anxiety medications.

Here is a quote from the National Council on Aging that sums up why it is essential to do everything we can to minimize the risk of falling. These are some scary facts!:

 

“According to the U.S. Centers for Disease Control and Prevention:

  • One in four Americans aged 65+ falls each year.
  • Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.
  • Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.
  • Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.
  • In 2015, the total cost of fall injuries was $50 billion. Medicare and Medicaid shouldered 75% of these costs.
  • The financial toll for older adult falls is expected to increase as the population ages and may reach $67.7 billion by 2020.”

Why are so many older adults prescribed medication that can increase the risk of falls?

Preventing falls in the elderly can significantly improve quality of life. Fall prevention in the elderly needs to include education about increased risks from sleep aids and certain anxiety medications.

Many medications increase the risk of falling in the elderly but oftentimes psychotropic medications are the culprit. It would be easy to say “just don’t prescribe them!” but, of course, it isn’t that simple.

Here are 3 examples of why a medication that increases fall risk gets prescribed:



1. Decreased quality of sleep: An unfortunate reality of aging is decreased quality sleep. (This article tells you why. Hint: It’s related to melatonin). Lack of sleep can feel torturous and sleep deprivation also sets people up to make clumsy or careless mistakes that they may not have made if they were more rested.

 

Naturally, people want to sleep so

they ask their physician for a sleep aid.

 

2. Anxiety: Anxiety is a common and uncomfortable condition and people understandably want to feel better as quickly as possible. Medications that work quickly to minimize anxiety increase the risk of falls in the elderly. Safer alternatives don’t work as quickly as a benzodiazepine so this makes these quick-acting medications tempting (and sometimes necessary) to use.

 

3. A person is already on the medication or was treated with it successfully in the past so they want it back: Maybe the person has tried multiple different medications and has found certain medications are the only ones that work well for their particular condition. They took the medication in the past and want it restarted or perhaps they are currently taking the medication. If the medication helps them feel better and they have no noticeable side effects they may have no motivation to come off the medication based upon theoretical risks.

Preventing falls in the elderly: Sleep aids and risk

Preventing falls in the elderly can significantly improve quality of life. Fall prevention in the elderly needs to include education about increased risks from sleep aids and certain anxiety medications.

There is a clear, established, association between certain sleep aids and increased risk for falls (and an increased risk of dementia! This risk is becoming clearer with recent data).



Here is a quote from a research article published in Sleep:

 

Compared with older adults who did not use sleep medications, those who used physician-recommended sleep medications at baseline were approximately 34% more likely to report a fall at follow-up.

These hypnotic (sleep-inducing) medications like the benzodiazepines and “Z-drugs” can all increase fall risk:

  • Xanax/ alprazolam,
  • Ativan/ lorazepam,
  • Klonopin/ clonazepam,
  • Ambien/ zolpidem,
  • Sonata/ zaleplon,
  • Lunesta/ eszopiclone.

RULE:

If a medication causes sedation (it’s hard to help people fall asleep without some sedation!) it can increase fall risk. Reaction time and postural control (the ability to know where your body is in space and correct balance when it gets off center) decrease when someone is sedated.

 

For example: Think about how often falls happen when people get out of bed at night and try to walk to the bathroom. They are not only sedated but the risk is elevated in dim lights when the eyes can’t compensate for the bodies’ lack of spatial awareness.

What are the alternatives to improve sleep and anxiety?

Behavioral treatments for sleep are effective. These include maximizing sleep hygiene (for a review of what this is and how to improve sleep hygiene read this article) and dealing with sleep-related worries through cognitive behavioral therapy for insomnia (referred to as CBTi. Read more about this here). Mindfulness and relaxation exercises can help and don’t have any side effects.



If medication is necessary, there are options that have less risk than classic sleep aids.

2 medications that have less risk of falls:

1. Melatonin:

Melatonin, an over-the-counter sleep aid (Read my recommendations for dosing melatonin). This medication may have less risk however that doesn’t mean NO risk. It is still sedating and can cause morning drowsiness for some people.

2. Trazodone:

Trazodone (a really old antidepressant medication that is SO sedating people cannot tolerate it in the doses necessary to treat depression) is used pretty much exclusively for sleep now. This medication can have side effects too and also can interact with some other medications. There is more information on these facts in this article,

Alternatives for the treatment of anxiety:

For anxiety, there are treatments like psychotherapy (how therapy works is explained here), and antidepressants. Both of these options can treat anxiety without the same risk that happens with a benzodiazepine (listed above).



Fall prevention in the elderly

Insomnia and anxiety impair quality of life and need to be taken seriously. Weighing the risks and benefits of each treatment option is essential to come up with the best (safest and most effective) choice for each person. The crux of fall prevention in the elderly is to balance treating the symptoms while taking the risks seriously and minimizing them with safer alternatives whenever possible.

For more discussion on sleep and aging read this article:

Sleep and aging: What happens to our sleep and how to make it better

 

9 Facts About the Sexual Side Effects of Antidepressants: They are common!

Sexual side effects of antidepressants are common yet often people feel too embarrassed to discuss these with their doctor. To make it more complicated, a common symptom of depression is reduced interest in sexual activity. This can then be compounded by the antidepressants sexual side effects. If you are wondering about antidepressant sexual side effects, but too afraid to ask, I am writing this post for you! Here are several facts about antidepressants and sexual side effects so you can be more informed.



9 Facts about antidepressants sexual side effects:

Sexual side effects of antidepressants are common. Reduced interest in sexual activity from depression can be compounded by the antidepressants sexual side effects. If you are wondering about antidepressant sexual side effects, but too afraid to ask, this post is for you!

1. It’s common!

Antidepressants sexual side effects are common: ~40% of people report sexual side effects on antidepressants

2. Sexual side effects are not permanent:

Antidepressant sexual side effects are not permanent. Although the side effect may remain for the duration of time the antidepressant is in your system, they will go away when the medication is gone. To be clear: I do not mean they will go away the day you stop taking your antidepressant. The medication is still in your system for some time after you stop it. The time it takes to clear depends on the medicine.

3. Don’t try to skip doses to minimize sexual side effects of antidepressants.

Sexual side effects of antidepressants are common. Reduced interest in sexual activity from depression can be compounded by the antidepressants sexual side effects. If you are wondering about antidepressant sexual side effects, but too afraid to ask, this post is for you!

It is not helpful to skip the antidepressant on a day you may want to be sexually active. As I previously said, antidepressants take time to come out of ones body (weeks even) so skipping a dose on the same day will do nothing to minimize sexual side effects.

4. Antidepressants and sexual side effects vary in severity

Sexual side effects vary in severity: A person may have a mild side effect and be a little less interested in sexual intimacy, or it may take longer to have an orgasm. If the side effects are mild, many people do not see the need to alter their treatment regimen. On the other hand the side effects can be severe where a person has complete inability to get aroused (men may be unable to get an erection) or be unable to have an orgasm.



5. Sorting out depression effect vs medication side-effect:

Often people are uninterested in having sex while depressed. “I don’t want to have sex now. How will I know if I’m having this side effect?” Great question! As one’s depression is treated the interest in being sexually active may return. If the interest is there but the ability to get aroused isn’t, this could be an indication of antidepressant sexual side effects and not depression interfering with sex drive.

6. The least chance of antidepressant sexual side effects:

Sexual side effects of antidepressants are common. Reduced interest in sexual activity from depression can be compounded by the antidepressants sexual side effects. If you are wondering about antidepressant sexual side effects, but too afraid to ask, this post is for you!

Wellbutrin and Remeron have the least chance of sexual side effects although may not always be an appropriate first choice for one’s medication. There are many factors that go into the decision of which medication to start: 6 Questions You Must Ask Before Choosing an Antidepressant

7. Initial claims of low sexual side effects. Can we believe them?

It seems as if every new antidepressant that comes to market claims low sexual side effects. Although I wish this to be true, I have become a skeptic because it seems that clinically, these claims do not pan out. First off, the initial research done is usually “industry-sponsored” (meaning paid for by the company who is making the medication) and the industry knows there is a huge market for antidepressants that don’t cause sexual side effects. Studies funded by parties very interested in one particular outcome are rife with possibilities for bias.



8. Antidepressants sexual side effects may not happen on a different medication.

Just because a person gets side effects on one antidepressant it doesn’t mean they will get them on the next one even when the other antidepressant has the same risk.

9. Trying the same medication again may not cause the same sexual side effects.

If there is a reason to retry a medication that previously caused sexual side effects it is not guaranteed the side effects will happen again. I don’t know why this happens but I have seen this several times in practice.



Sexual side effects of antidepressants:

Sexual side effects of antidepressants are common. Reduced interest in sexual activity from depression can be compounded by the antidepressants sexual side effects. If you are wondering about antidepressant sexual side effects, but too afraid to ask, this post is for you!

If you are experiencing antidepressant sexual side effects bring it up with your physician. It is common and we hear it all the time. We will not be shocked!

 

Remember that the side effects will continue while taking the medication, so if it is bothering you we may need to switch to a different medication. Yes, the side effects could happen again but remember there is a ~60% chance they won’t!

Interested in reading more about treatments for depression and antidepressants?

Here are my most popular posts:

 

11 Effective Interventions for Depression

 

Will You Have Antidepressant Withdrawal Symptoms?

 

Light Therapy for Seasonal Depression: What works?

 

A Psychiatrist’s Take on Suicidal Thoughts and Suicide Prevention

 

Suicide Prevention Plan: 5 Tips to Deal With Thoughts of Suicide

 

What is Serotonin Syndrome? Hint: It’s an Emergency. Know the Signs and Symptoms of Serotonin Syndrome.

 

Take psychiatric medications? Be aware of SIADH hyponatremia and SIADH symptoms

 

 

Neuroleptic Malignant Syndrome: Rare but Potentially Deadly Side Effects of Antipsychotic Medications

Neuroleptic Malignant Syndrome (NMS) is a potentially life-threatening condition that is one of the rare side effects of antipsychotic medications. It is fatal in 10% of patients. Neuroleptic Malignant Syndrome symptoms need to be recognized early to cut down on this risk of death. NMS is an unpredictable and rare condition but because of the seriousness, people who take a medication classified as an antipsychotic need to know about it and realize if it is happening. Starting Neuroleptic Malignant Syndrome treatment right away will improve the course of the syndrome. What is Neuroleptic Malignant Syndrome? Follow along to find out.

 

Do you know someone who suffers from psychosis? Download this free PDF that details 21 ways to better support someone who has psychotic thoughts and keep the communication lines open.

Guidelines on How to Help Someone with Psychosis

Enter your info below to get your FREE PDF:

What is Neuroleptic Malignant Syndrome and when does it happen?

 

Antipsychotic medications are prescribed for many different disorders including Schizophrenia, Bipolar Disorder, and to augment the effects of antidepressant medication in Major Depressive Disorder. They are called antipsychotics because that was their original purpose but many people who are not psychotic take them. After they were on the market for some time their benefits in other conditions were discovered. These drugs function by blocking the brain chemical called dopamine. NMS is caused by this dopamine blockade.



The time between taking the medications and onset of NMS symptoms varies but it is most common in the first month of treatment. People typically develop NMS within hours or days of taking the antipsychotic medication.

 

Neuroleptic Malignant Syndrome can happen after one dose of antipsychotic medication or occur randomly after years of taking a medication without any issue. NMS is not dose-dependent and can occur at doses considered therapeutic.

Risk factors for Neuroleptic Malignant Syndrome:

What is Neuroleptic Malignant Syndrome? A potentially life-threatening condition and one of the rare side effects of antipsychotic medications. Recognize Neuroleptic Malignant Syndrome symptoms and start Neuroleptic Malignant Syndrome treatment right away to cut down on this risky illness.

The incidence of NMS is rare and happens to less than 3% of people who take an antipsychotic. Some factors can increase a person’s risk such as:

 

  • Prior episode of NMS,
  • Agitation,
  • Dehydration,
  • A rapid increase in medication dose,
  • Use of the medication Lithium in combination with an antipsychotic,
  • Males are higher risk than females,
  • Younger people (less than 40 years old) are at greater risk than older,
  • Catatonia: Per Merriam-Webster dictionary catatonia is described as: psychomotor disturbance that may involve muscle rigidity, stupor or mutism, purposeless movements, negativism, echolalia, and inappropriate or unusual posturing and is associated with various medical conditions (such as schizophrenia and mood disorders)

Neuromuscular Malignant Syndrome Symptoms:

What is Neuroleptic Malignant Syndrome? A potentially life-threatening condition and one of the rare side effects of antipsychotic medications. Recognize Neuroleptic Malignant Syndrome symptoms and start Neuroleptic Malignant Syndrome treatment right away to cut down on this risky illness.

Neuroleptic Malignant Syndrome is unpredictable and cannot be missed in order to reduce the risk of death. It must be considered for anybody on antipsychotic medication who has a fever and changes in their mental status (see below). It can be confusing because the presentation of someone with NMS can vary substantially.

There are 4 groups of symptoms that patients with Neuroleptic Malignant Syndrome can present with:



1. Mental Status Changes: confusion, agitation, mutism (unable to speak), catatonia (defined above)

2. Muscular rigidity: lead pipe rigidity (severely stiff muscles- the arm may be unable to bend) which can include tremor, dystonia (an abnormality of movement or muscle tone), or dyskinesia, slowed or sluggish reflexes, trouble swallowing.

3. High body temperatures

4. Autonomic Instability- blood pressure may be unstable, heart rate fast

 

To read more in-depth details about NMS check out this article.

Neuroleptic Malignant Syndrome treatment:

 

The first step in Neuroleptic Malignant Syndrome treatment is to discontinue the medication and start supportive treatment. The symptoms generally resolve within 9-14 days of starting treatment. A person with NMS may need to be managed in the intensive care unit of a hospital.

Possible interventions include:

  • Cooling blankets to lower elevated body temperature,
  • Intravenous fluids,
  • Medications to lower blood pressure
  • Control for agitation
  • A medication that increases dopamine can be given to reverse the blockade

 

After having NMS, patients can be restarted on antipsychotic medication but it is recommended to have a 2 week period off of the medication to reduce the chance of recurrence.

It is not only caused by side-effects of antipsychotic medications: Other medications to watch for

What is Neuroleptic Malignant Syndrome? A potentially life-threatening condition and one of the rare side effects of antipsychotic medications. Recognize Neuroleptic Malignant Syndrome symptoms and start Neuroleptic Malignant Syndrome treatment right away to cut down on this risky illness.

This isn’t only the side effects of antipsychotic medications; there other medications that can cause NMS. Some medications that treat nausea and vomiting can cause it because they also block dopamine. These include:



  • Domperidone (Motilium)
  • Droperidol (Inapsine)
  • Metoclopramide (Reglan)
  • Prochlorperazine (Compazine)
  • Promethazine (Phenergan)

Neuroleptic Malignant Syndrome: Recognize it!

When Neuroleptic Malignant Syndrome is recognized and treated early and aggressively the risk of death is decreased. Just by better awareness of the condition the rate of death has dropped from ~25% in previous years to the 10% that it is currently.  Apparently, in the 1960s the rate of death from NMS was as high as 74%!

 

Make sure you (or your loved one who is on an antipsychotic) are aware of the symptoms. It is incredibly rare, and highly unlikely to be an issue, but this is a condition you don’t want to miss.

 

Check out these additional articles:

Suicide Prevention Plan: 5 Tips to Deal With Thoughts of Suicide

 

A Psychiatrist’s Take on Suicidal Thoughts and Suicide Prevention

 

3 Types of Paranoia: What does paranoia mean?

 

Keys to Coping with Bipolar Disorder

 

Bipolar 2 Disorder and Hypomania: What Everyone Should Know

 

Other potential psychiatric medication side effects:

Take psychiatric medications? Be aware of SIADH hyponatremia and SIADH symptoms

 

Akathesia: A Tortured Restlessness

 

9 Facts About the Sexual Side Effects of Antidepressants: They are common!

 

What is Serotonin Syndrome? Hint: It’s an Emergency. Know the Signs and Symptoms of Serotonin Syndrome.



 

How to Prevent Suicide: 4 Coping Strategies to Use When Thinking About Suicide

Preventing suicide takes forethought and planning, not only in the world as a whole to create better support systems and treatment, but for individuals struggling with how to deal with suicidal thoughts. Creating a plan for how to prevent suicide and manage emotions at the height of intense feelings is a lot to ask of anyone. But coming up with a plan ahead of time for how to manage distress and suicidal urges can help allow the feelings to pass. This post includes coping strategies to manage distress, problem-solving techniques to help cut down on crisis, and suggestions on how to create coping cards and a hope box to use when thinking about suicide.

 

Suicide prevention hotline: 800-273-8255

 

Read more about my take on suicidal thoughts and preventing suicide here: A Psychiatrist’s Take on Suicidal Thoughts and Suicide Prevention



1. Prevent suicide by learning distress tolerance:

Preventing suicide takes planning about how to deal with suicidal thoughts. Suggestions on how to manage when thinking about suicide, how to prevent suicide and ease distress.

Suicidal impulses are often brief, intense urges lasting minutes to hours. Trying to come up with how to manage these waves of intense suicidal feelings the moment they are occurring is a challenge. Having a go-to list of coping strategies is a helpful tool in getting thru a wave of suicidal urges unharmed.

 

Even for people that are chronically suicidal, there are often moments of increased intensity for the suicidal feelings. Using these distress tolerance skills can help reduce risk.

How to prevent suicide: 10 Coping strategies to manage distress

Each individual may find different things soothing but I encourage you to come up with a variety of options so there are more to choose from at the moment you need them:



  • Deep breathing: Use an app like Breathe2Relax or other mindfulness apps that can walk a person through a breathing relaxation exercise. Find one you like and have it ready on your phone.
  • Phone apps such as Stress Free Now
  • Aromatherapy: Pick a scent you like and carry it with you. I don’t believe aromatherapy cures all things like some claims out there but I do think it smells good! Taking a moment to focus on an enjoyable scent can be grounding.
  • Exercise: I particularly like high-intensity bursts of exercise that can match the intensity of the emotion. Exhaust yourself by doing rapid jumping jacks, pushups, running quicker than is comfortable, burpees, a punching bag…there are many options available. If this level of exercise is not possible, find other exercises that are doable such as going for a walk.
  • Take a warm bath
  • Music: Crank it up or play it softly. Music can be a great distraction.
  • Pet: There is nothing more grounding than spending some time petting or playing with your animal. Animals are always in the moment and can help us get back to the here-and-now by following their lead.
  • Nature: Being out in nature is calming and grounding. It sometimes helps us to see the world is bigger than this moment.
  • Do a word game or puzzle
  • Any other distraction you can think of!

 

2. Using Coping Cards when thinking about suicide:

Preventing suicide takes planning about how to deal with suicidal thoughts. Suggestions on how to manage when thinking about suicide, how to prevent suicide and ease distress.

During a wave of intense distress and suicidal feelings, thoughts become distorted and people are often unable to come up with solutions at that moment.

 

The pattern of thinking during a crisis is often pretty consistent. Many people have predictable thoughts that happen when they feel distressed:

 

  • “I’ll never get better”,
  • “I’ll always feel this way”,
  • “My life will never change”,
  • “I’ve made no improvement”



It can be helpful to list these thoughts on a notecard and write out a matching response on the other side:

 

  • “I’ve made it through times when I felt hopeless before”,
  • “I do not always feel this way”
  • “The last many times I felt this bad I was happy I didn’t harm myself the next day because I felt better”

 

Carry these card with you (or take a picture on your phone to access them) for the moments you may start to struggle and forget that distress and suicidal urges will pass.

3. Preventing suicide with a Hope Box:

Preventing suicide takes planning about how to deal with suicidal thoughts. Suggestions on how to manage when thinking about suicide, how to prevent suicide and ease distress.

A hope box is just like what it sounds: a box full of reminders of hope and reasons why you are choosing to live. Life-saving information is stored in this box so when a person is in crises and can’t recall their coping skills or reasons for living, they can access this box and see the information in one place.

 

I first heard about hope boxes while researching mental health apps and discovered Virtual Hope Box. This is a free app that adapts the physical hope box (which obviously would be challenging to carry around) into a virtual space so it is always there, ready to access on your phone. It includes options like: Distract me, Inspire me, Relax me, and Coping tools.

Things to include in the coping box:

 

  • Coping cards that you made with alternative thoughts to counteract the challenging ones that usually come up in a crisis,
  • Emergency numbers: both numbers for crises lines but also numbers for your support system (family, friends, therapists…whoever you need to call for help)
  • Reminders of coping strategies to use and distress tolerance skills (see the list above for ideas of coping strategies)
  • Lists of reasons to live
  • Pictures of loved ones: family, friends, and pets,
  • Letters from loved ones,
  • Sentimental objects or gifts
  • Reminders of past successes
  • A pleasurable aromatherapy scent to distract you
  • A treat you would enjoy like a piece of gum or a hard candy



Create both a virtual and a physical box. Going thru the physical box can be grounding in itself- physically touching the items and sorting through the box can serve as a distraction while waiting for the distress to pass.

4. Problem-solving skills:

Suicide is an attempt to solve a problem. Be it a harmful attempt, it is an attempt nonetheless. Although this may sound overly simplistic, improving problem-solving skills can help people see other options besides suicide.

 

The goal of these problem-solving techniques is not necessarily so that a person can solve everything in the heat of the moment. The hope is that improving problem-solving capabilities will cut down on moments of crisis by being proactively better able to think through challenges. Problem-solving techniques are one part of the formula to manage distress and suicidal ideation.

A lesson from the business world:

Problem-solving skills are commonly used in business to successfully resolve obstacles and are also needed in general life. Recommendations in business management rely upon breaking down the problem in order to better understand it and come up with a solution. These steps help take some of the emotions that can cloud thinking out of it.



5 Problem-solving steps to walk through:

 

  • Define the problem.
  • Determine the causes.
  • Generate ideas.
  • Select the best solution.
  • Take action.

Get a therapist to help walk through problem-solving:

Many people are unable to do this problem-solving process on their own, especially when it comes to emotionally charged topics. These are great skills to practice with the help of a therapist who can walk through it with you.

 

The Suicide Prevention Resource Center discusses the evidenced-based treatment called Problem-Solving Therapy (PST):

 

In general, PST involves the following seven stages: (1) selecting and defining the problem, (2) establishing realistic and achievable goals for problem resolution, (3) generating alternative solutions, (4) implementing decision-making guidelines, (5) evaluation and choosing solutions, (6) implementing the preferred solutions, and (7) evaluating the outcome. A primary focus is learning and practicing PST skills, which are centered around empowering patients to learn to solve problems on their own.

How to deal with suicidal thoughts

I hope you have found these 4 ideas helpful. Take the time to get started making a list of distress tolerance coping strategies, writing out coping cards, and making your hope box. Do this ahead of time, when you are not feeling in crisis, to be better prepared with tools for management of suicidal urges and distress.

Are there other strategies that should be included in this post? Comment on what has helped you or a loved one so others can benefit.

Great book to read about how to deal with suicidal thoughts:

Here are other articles about suicidal thoughts, feelings, and prevention: 

 

 

 

 

 

 

 

 

 

 

 

 

 

*These 2 books I recommended happen to be affiliate links but they are great books I would recommend to family. An affiliate link means the website gets a small commission on any sales at NO cost to you. Thank you for helping to support this website.**

 

 

15 Interesting Facts About Alcohol: How Does Alcohol Work?

How does alcohol work in the body? Read these 15 interesting facts about alcohol to learn how it is absorbed and processed, how strong is a drink, how much is too much alcohol and when it becomes dangerous, and how long is alcohol in your system.

Drinking alcohol is ubiquitous in society but how does alcohol work in the body? Many people don’t know what it does or how it causes intoxication. Read these 15 interesting facts about alcohol to learn how it is absorbed and processed, how strong is a drink, how much is too much alcohol and when it becomes dangerous, how long is alcohol in your system, and how it can affect the liver.



1. Where is alcohol absorbed?

25% of alcohol is absorbed in the stomach in the first 5-10 minutes after consuming a drink. The rest of the 75% is absorbed in the small intestine. Even after you stop drinking, alcohol continues to be absorbed in the stomach and intestine and gets released into the bloodstream.

2. What affects the absorption of alcohol?

How does alcohol work in the body? Read these 15 interesting facts about alcohol to learn how it is absorbed and processed, how strong is a drink, how much is too much alcohol and when it becomes dangerous, and how long is alcohol in your system.

 

Unlike food, which can take hours to digest, alcohol is absorbed quickly by the body. Absorption is affected by food, speed of consumption, type of beverage (the concentration of alcohol in that drink), and variations in a persons gut absorption.

3. How fast until the alcohol reaches its max level?

The peak level of alcohol in the blood is reached in 30-90 minutes after ingestion

4. What is considered “one drink” with different types of alcohol?

How does alcohol work in the body? Read these 15 interesting facts about alcohol to learn how it is absorbed and processed, how strong is a drink, how much is too much alcohol and when it becomes dangerous, and how long is alcohol in your system.

Many times people are not aware of what actually constitutes ONE drink. They may report they have only one drink each night but the amount of alcohol consumed is much greater than that. It is important to be able to judge this and a useful experiment is to actually measure out what you like to drink so you know what it really equals. Without awareness, it becomes difficult to judge how much is too much alcohol for your body.

 



 

These drinks all have an equivalent amount of alcohol and are considered one drink:

  • 1.5 oz Whiskey shot or 80-proof hard liquor = ~40% alcohol
  • 5oz Wine (148mL) = ~12% alcohol
  • 8-9oz (237-266mL) = ~7% alcohol
  • 3oz Sherry = ~20% alcohol
  • 12oz or 1 can of beer = ~5% alcohol

5. Why do women respond differently to alcohol?

How does alcohol work in the body? Read these 15 interesting facts about alcohol to learn how it is absorbed and processed, how strong is a drink, how much is too much alcohol and when it becomes dangerous, and how long is alcohol in your system.

Women don’t have as much of the enzyme that breaks alcohol down in the stomach which is one reason they feel the effects of alcohol at lower amounts.

6. How much is too much alcohol? When can you die from alcohol intoxication?

A lethal dose of alcohol is generally over 500mg/dL but alcohol can be fatal at 300mg/dL if it is ingested rapidly and the person isn’t tolerant of the effects.

7. What is considered binge drinking?

How does alcohol work in the body? Read these 15 interesting facts about alcohol to learn how it is absorbed and processed, how strong is a drink, how much is too much alcohol and when it becomes dangerous, and how long is alcohol in your system.

 

Binge drinking is determined by the amount and speed of drinking and differs between men and women.

 

For men, a binge is when 5 or more alcoholic drinks are consumed within 2 hours.

 

For women, binge drinking is when 4 or more drinks are consumed within 2 hours.



8. How does alcohol get out of our body?

90% of alcohol is broken down by the liver. This is the way it gets cleared from your body.

9. How long is alcohol in your system?

How does alcohol work in the body? Read these 15 interesting facts about alcohol to learn how it is absorbed and processed, how strong is a drink, how much is too much alcohol and when it becomes dangerous, and how long is alcohol in your system.

Normal alcohol metabolism occurs at a rate of 15-20dL per hour. In people dependent on alcohol, the metabolism can be faster and go up to 30dL per hour. A normal sized person will metabolize approximately 1 drink per hour.

10. How does alcohol work? When does a person get impaired by alcohol?

At .05% blood alcohol level (BAL) reflexes are impaired (for example stepping on the brakes will be slowed while driving).

 

Here is a link to a fantastic chart that details impairment at different levels of blood alcohol content (BAC) that is used by law enforcement to define intoxication and estimates impairment.



11. How hard is it to get impaired by alcohol?

To get 0.1% BAL it takes an average sized person (~170 lb male) 4.5 drinks per hour.

12. How much is too much alcohol? Alcohol poisoning is dangerous!

How does alcohol work in the body? Read these 15 interesting facts about alcohol to learn how it is absorbed and processed, how strong is a drink, how much is too much alcohol and when it becomes dangerous, and how long is alcohol in your system.

This is a very dangerous situation that can happen when someone drinks large amounts in a short amount of time. This often occurs accidentally and a major cause of it is from binge drinking.

 

Alcohol poisoning can affect:

 

  • Breathing: Breathing can become slow (less than 8 breaths per minute), irregular (gap of more than 10 seconds between breaths). With reduced breathing, a person can look pale or blue-tinged.
  • Heart rate
  • Lower body temperature
  • Reduced gag reflex: A gag reflex protects us from choking and if it is reduced it makes vomiting very dangerous.
  • Level of consciousness: A person may be confused, passed out, and/or unable to be awakened.

 

Alcohol poisoning can cause seizures and lead to coma and death. It is an emergency!

If a person is unconscious or can’t be woken up after consuming alcohol they are at risk of dying! Get help immediately.



13. How is alcohol related to liver damage?

Because alcohol relies on the liver to be processed, with regular drinking the liver has to work harder and can be damaged by the demands placed on it.

14. How do we know if the liver is being damaged?

How does alcohol work in the body? Read these 15 interesting facts about alcohol to learn how it is absorbed and processed, how strong is a drink, how much is too much alcohol and when it becomes dangerous, and how long is alcohol in your system.

The liver produces substances called enzymes. When it is working too hard these enzymes can become elevated. We know this by checking blood labs. There is one enzyme that generally goes up higher than the other when people are causing damage to their liver with alcohol.



15. Is liver damage permanent?

These changes in liver enzyme levels are often reversible if a person stops drinking, but it depends on the damage that has already been done. Cirrhosis, permanent scarring of the liver, can happen with continued damage to the liver from alcohol.

Are there any other interesting facts you would like to know about alcohol? Put your questions in the comments and I will try to get you an answer. 

To learn more about alcohol read my other posts:

 

The Truth About Alcohol and Sleep

Alcohol Use Disorder: Do you have a drinking problem?

Alcohol Dependence and Withdrawal: Are You at Risk?

7 Alternatives to AA in Recovery from Addiction

 

What is Serotonin Syndrome? Hint: It’s an Emergency. Know the Signs and Symptoms of Serotonin Syndrome.

What is serotonin syndrome?
https://www.pinterest.com/pin/656399714420704571

Serotonin syndrome is an emergency and can be fatal in extreme cases. It is important to recognize serotonin syndrome symptoms when they are happening because if medications are stopped early most cases remain mild. So what is serotonin syndrome? Let’s review the signs and symptoms of serotonin syndrome so it isn’t missed but also so people have an accurate idea of what it is and don’t worry they have it when they don’t. I will also go over what causes serotonin syndrome to help make more informed decisions about medication.



Recognizing the signs and symptoms of serotonin syndrome:

What is serotonin syndrome? It's important to recognize serotonin syndrome symptoms because it is an emergency. Know the signs and symptoms of serotonin syndrome and what causes serotonin syndrome.

Recently, I had a patient be told they had serotonin syndrome because they were on an antidepressant and had an occasional lip twitch. They had no other serotonin syndrome symptoms supporting this diagnosis. The stress created for this person was completely unnecessary as they did not at all have it…and if they did, they should have been told to immediately stop the offending antidepressant. Instead, they were left on it and were completely stressed for 2 weeks until they saw me.

 

Because of this unfortunate experience, I thought it was a good time to review what is serotonin syndrome and how to recognize it.

Is serotonin syndrome common?

What is serotonin syndrome? It's important to recognize serotonin syndrome symptoms because it is an emergency. Know the signs and symptoms of serotonin syndrome and what causes serotonin syndrome.

In my 19 years since medical school, I have only seen one case of serotonin syndrome despite treating many people in the hospital who have overdosed on antidepressant medication. The person I saw had overdosed on multiple different antidepressants and was admitted to the medical unit for stabilization. Days later, I saw them when they were transferred to the inpatient psychiatry unit.



By the time I met them, the serotonin syndrome symptoms were reduced but still significant and obvious. I’ll never forget their impressive reflexes- with a light brush to the knee (not even the usual tap) the patient’s leg would involuntarily kick up to the ceiling. They were restless (specifically had akathesia), highly anxious, shivering, and tremulous. This was not a subtle presentation like the occasional lip twitch my recent patient just had.

What causes serotonin syndrome? Let’s review what is serotonin syndrome and the more common causes.

What is serotonin syndrome? It's important to recognize serotonin syndrome symptoms because it is an emergency. Know the signs and symptoms of serotonin syndrome and what causes serotonin syndrome.

First off, let me acknowledge serotonin syndrome is tricky because it is both predictable and unpredictable (see next paragraph), and the syndrome can range from mild to fatal. There is no particular laboratory test to diagnose it.

 

Serotonin syndrome is predictable because it is caused by excessive serotonin in the body… However, it is unpredictable because it is unclear who it’ll happen too. It can occur to someone taking their first dose of an antidepressant or be caused by combining multiple different medications that increase serotonin.



Oftentimes it happens when someone on a stable medication unknowingly takes a medication that interacts with it (such as cold medicines containing dextromethorphan, St. John’s Wort, certain migraine medication, various antibiotics, cocaine, etc). These interactions can cause an increase in serotonin.

 

Antidepressants, especially SSRI’s, are the most common medications involved in serotonin syndrome but any medication or substance that affects serotonin metabolism or regulation can cause toxicity. Many of the medications that cause it, although not all, treat psychiatric conditions.

Serotonin syndrome symptoms:

What is serotonin syndrome? It's important to recognize serotonin syndrome symptoms because it is an emergency. Know the signs and symptoms of serotonin syndrome and what causes serotonin syndrome.

Generally, serotonin syndrome presents within 24 hours of starting a medication or changing a therapy that causes increased serotonin. The person will have a mild, moderate, or severe serotonin syndrome dependent on which symptoms they have.

 

There are 3 different groups of serotonin syndrome symptoms that people can have:

 

1. Altered Mental Status: anxiety, agitation, disorientation, restlessness.

2. Autonomic Instability: high blood pressure, fast heart rate, irregular heart rate, fast breathing, increased body temperature, sweating, shivering, flushed skin, vomiting, diarrhea.

3. Changes in neuromuscular tone: tremors, clonus (a muscle spasm with recurrent and often rhythmic contractions), exaggerated reflexes, muscle rigidity, incoordination.



Examples of symptom severity:

A mild presentation could include mild to no temperature, fast heart rate, sweating, shivering, tremor, restlessness, anxiety, with mildly elevated reflexes.

 

A patient with a severe presentation may have a high fever, seizures, confusion, irregular heartbeat, or be unconscious.

 

This article has a great table showing the differences between a mild, moderate and severe presentation of serotonin syndrome.

Treatment

What is serotonin syndrome? It's important to recognize serotonin syndrome symptoms because it is an emergency. Know the signs and symptoms of serotonin syndrome and what causes serotonin syndrome.

Treatment is guided by the severity of the signs and symptoms of serotonin syndrome but always starts with immediately discontinuing the antidepressant.

 

If the symptoms are mild the syndrome generally resolves within 24 hours and the treatment is considered “supportive” (for example giving oxygen, IV fluids, medications to control agitation, etc).



For people that have more severe symptoms, they may need a medication that can reverse the excess serotonin (called cyproheptadine) or more intensive treatment to control body temperature and relax rigidity.

Signs and symptoms of serotonin syndrome

If you are concerned you may have signs or symptoms of serotonin syndrome call your physician immediately to inquire.

 

To limit your risk of getting serotonin syndrome pay attention to medication interactions. Just because something is over-the-counter (OTC) does not mean it is safe to take with an antidepressant. If you are in the pharmacy about to pick up an OTC medication check with the pharmacist first or call your physician. Sometimes, even when there is an interaction, we decide to go ahead and have a person take it because the benefits outweigh the risks (for example, people with migraines often need to take their triptans even though they interact with the antidepressant). Make informed choices on the medications you take and let your physician help talk you through the pros and cons.

 

Remember, even with a mild case of serotonin syndrome, there are several symptoms that happen. If you know what to look for it will make identification quicker so there is a better chance the symptoms will remain mild.

 

Read more about the treatment of depression and prevention of suicide:

11 Effective Interventions for Depression

 

A Psychiatrist’s Take on Suicidal Thoughts and Suicide Prevention

 

Suicide Prevention Plan: 5 Tips to Deal With Thoughts of Suicide

 

Other medication side effects to watch out for:

Take psychiatric medications? Be aware of SIADH hyponatremia and SIADH symptoms

 

Akathesia: A Tortured Restlessness

 

9 Facts About the Sexual Side Effects of Antidepressants: They are common!

 

Neuroleptic Malignant Syndrome: Rare but Potentially Deadly Side Effects of Antipsychotic Medications