Dr. Pagnani of Rittenhouse Psychiatric Associates discusses Serotonin Syndrome, a serious and potentially fatal condition caused by serotonin toxicity. It would be rare for someone to develop Serotonin Syndrome while taking one (or even two) psychiatric medications at FDA approved doses, without taking other Serotonergic medications, supplements or illiciit substances. With that said, patients (and even providers) may not realize that there is a large list of medications, supplements and illicit drugs that can increase serotonin levels and contribute to serotonin syndrome (including, but not limited to opiates and medications used to treat pain [meperidine, oxycodone, tramadol], antibiotics (ciprofloxacin, linezolid, isoniazid), antifungals (fluconazole), medications for headaches (triptans), antivirals (ritonavir), supplements (St. John's Wart), antinausea medications (Zofran/ ondansetron), cough medicines (dextromethorphan), antidepressants, amphetamines and stimulant medications, lithium, cocaine, ecstasy (NMDA) AND OTHERS. Classically, patients present with the triad of altered mental status, autonomic instability (tachycardia, diaphoresis [sweating], dilated pupils, increased bowel sounds, flushing) and neuromuscular abnormalities (clonus, hyperreflexia, hypertonia). There is a wide range in presentation and severity of symptoms and it is incredibly important that if a patient believes that may have serotonin syndrome, or a provider believes a patient may have serotonin syndrome, the individual is seen immediately in an ER and all potentially contributing medications, supplements, and/or drugs are stopped immediately. Supportive care must be given and medications like cyproheptadine (used in the treatment of serotonin syndrome) can be considered.

Dr. Pagnani is the founder and medical director of Rittenhouse Psychiatric Associates, an Instructor at The Johns Hopkins Hospital for the Department of Psychiatry, he supervises psychiatric residents at Jefferson Hospital, he serves on the Young Professional Board of Uplift, the Center for Grieving Children and he maintains a private practice of Psychiatry in Philadelphia where he sees patients for onetime psychiatric evaluations and second opinions. He is a licensed physician and surgeon in NJ, PA, NY, MD, DE, FL and CA and can provide consultations to individuals via HIPAA compliant Telehealth visits living in these locations.

Rittenhouse Psychiatric Associates is a private practice of psychiatry consisting of about 25 psychiatrists, psychiatric nurse practitioners and psychotherapists with physical locations in Philadelphia and Paoli, PA and serving all of PA, NJ, NY and FL virtually via HIPAA compliant telepsychiatry. Individuals seeking not only evaluations but longterm psychiatric care, can contact Rittenhouse Psychiatric Associates directly.

These videos aim to increase awareness and discussion of mental health topics and to encourage struggling individuals to schedule an appointment directly with a mental health provider. Mental health needs to be normalized, and simply speaking about mental health topics openly, is an important first step.

Dr. Pagnani and Rittenhouse Psychiatric Associates are NOT advocating for or against the use of any mentioned psychiatric medications for any specific individual. Additionally, any side effects mentioned are not a complete list of potential side effects or contraindications to taking any mentioned medications, and all risks and benefits of a medication should be discussed with an individual’s provider at an appointment, before starting, stopping or making changes to a medication regimen.

This video is INFORMATIVE ONLY NOT MEDICAL ADVICE.

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www.RittenhousePA.com
www.ChrisPagnaniMD.com