Serotonin Syndrome: Signs & What to Do (Oregon)
If you’re seeking medication management in Oregon, you should know the warning signs of serotonin syndrome—so you can act fast and avoid a true emergency. Celium provides psychiatric care statewide via telehealth with select in-person options.
What it is (plain English)
Certain meds, supplements, or drugs can push serotonin too high, sending your nervous system into overdrive. Symptoms often start within hours of starting/increasing a med or mixing two serotonin-raising substances.
Think: too hot, too wired, too twitchy.
What to watch for
Early or mild — call your prescriber same day
Restless, amped up, can’t sit still
Shaking or twitchy/jerky muscles (leg bouncing, jaw tremor)
Sweating, warm skin, big pupils
Fast heartbeat, higher blood pressure, headache
Nausea or diarrhea
Red flags — ER now / call 911
Fever ≥ 101.5°F (38.6°C) or drenching sweat
Muscle rigidity or repetitive jerks/twitches (clonus) you can’t control
Confusion, agitation, hallucinations, severe anxiety, or not making sense
Very fast heart rate, fainting, or seizures
When it happens
Usually hours to 24 hours after a dose increase, adding a new med, or mixing serotonergic substances.
Risk rises when prescriptions meet OTCs, supplements, or recreational drugs.
Common culprits (examples—not a full list)
Antidepressants: SSRIs/SNRIs (sertraline, fluoxetine, escitalopram, venlafaxine)
MAOIs: phenelzine, tranylcypromine, selegiline; linezolid; methylene blue
Pain/migraine/psych: tramadol, meperidine, fentanyl; triptans; lithium
OTC/herbals: dextromethorphan, St. John’s wort, ginseng
Recreational: MDMA (ecstasy/molly), cocaine—especially on top of antidepressants
Psychedelic + MAOI combos: e.g., ayahuasca (harmala MAOIs) with SSRIs/SNRIs
What to do
Mild symptoms: Hold the most recent serotonin-raising med(s). Call your prescriber or urgent care the same day.
Red flags: Call 911 / go to the ER. Say “possible serotonin syndrome.” Bring a list/photo of all meds, supplements, and substances.
Do not restart the suspected med(s) until cleared by your clinician.
Prevention = smarter medication management
Don’t mix serotonergic meds without checking first.
Tell every clinician/pharmacist about all prescriptions, OTCs, and supplements.
MAOI washouts: usually 14 days; 5 weeks after fluoxetine before starting an MAOI.
Be cautious after dose increases or when adding tramadol, linezolid, dextromethorphan, or MDMA.
We provide diagnostic evaluations, medication management, and MOUD/MAT via telehealth across Oregon.
How to get help now (medication management in Oregon: Celium Healthcare)
Self-schedule your intake (telehealth available statewide).
Check rates & in-network insurance (PacificSource, Regence, Moda, Samaritan, Adventist PPO).
Crisis? If symptoms are severe or escalating, call 911 or go to the nearest ER. Do not wait.