NMS vs Serotonin Syndrome
Neuroleptic malignant syndrome (NMS) and serotonin syndrome are two different types of drug-induced conditions that are not commonly encountered in medical practice. Though they are rare, they both can become life-threatening conditions that require clinical attention. Is there a difference between NMS vs serotonin syndrome? They are both conditions caused by drug use but result in differing adverse reactions to the body.
NMS is typically caused by a lack of dopamine neurotransmitters in the brain. Serotonin syndrome is typically caused by an excessive amount of serotonin in the brain. When these naturally occurring brain chemicals are off balance, they can cause a wide variety of symptoms. Some of which can become life-threatening if not treated.
What is Neuroleptic Malignant Syndrome?
NMS is a condition characterized by a decrease in dopamine activity in the brain. It is hypothesized to be caused by blocking the dopamine D2 receptor in various areas of the brain.
The condition involves dopamine dysregulation in the basal ganglia and hypothalamus area of the brain. It can lead to dopamine deficiency and result in symptoms such as muscle rigidity, hyperthermia and autonomic instability.
NMS is often associated with the use of dopamine antagonists, which are usually antipsychotic medications. It is a rare, but life-threatening reaction that can occur with the use of almost any type of antipsychotic medication.
Antipsychotic medications are usually prescribed to treat behavioral disturbances. Such conditions include dementia, bipolar disorder, depression, eating disorders, generalized anxiety disorder, insomnia, personality disorder, OCD, PTSD, schizoaffective disorder and schizophrenia.
Risk factors for NMS
- Autonomic nervous system dysregulation. The autonomic nervous system regulates certain body processes. Functions such as blood pressure and your rate of breathing are impacted by the autonomic nervous system. When it has been compromised, it can lead to mood swings, changes in blood pressure and excessive sweating.
What is Serotonin Syndrome?
Serotonin is a naturally occurring neurochemical in the brain. It plays a role in many aspects of body functionality. It is important for nerve cells, brain function, regulating the digestive process, blood flow and breathing. A typical nerve cell in the brain and spinal cord produces serotonin to help regulate attention, mood and behavior, and even body temperature.
When there is a build-up of too much serotonin, this is called serotonin syndrome. It is a serious drug reaction that can range from mild to severe.
It most often occurs when a user is taking too many medications that impact serotonin, it can occur when your drug dosage of a certain type of medication is increased or it can occur when you begin taking a new medication altogether.
Risk factors for Serotonin Syndrome
- If you recently started taking a new drug that increases your serotonin levels
- If you increase your dosage of a medication that raises serotonin levels
- If you take more than one drug known to increase serotonin levels
- If you unknowingly take two or more drugs that lead to increased serotonin levels
- If you take herbal supplements known to increase serotonin levels
- If you use illicit drugs known to increase serotonin levels
Check Your Insurance Coverage for FREE
Find out if your insurance covers addiction treatment in minutes. We accept most insurance!
NMS vs Serotonin Syndrome
Neuroleptic Maglignant Syndrome
- NMS involves a decrease in dopamine activity in the brain.
- Drugs that can cause NMS: Typical neuroleptic medications such as Bromperidol, Chlorpromazine, Fluphenazine, Haloperidol and Loxapine. Atypical neuroleptic medications such as Aripiraxole, Clozapine, Quetiapinea and Ziprasidone.
- NSM can affect anyone taking neuroleptic medications. It is primarily associated with first-generation antipsychotics.
- About two-thirds of NMS cases are estimated to occur within the first week of starting the antipsychotic medication. However, the number of cases is decreasing with the development of newer and safer medications.
- Symptoms of NMS include high fever, irregular heartbeat, fast heart rate, rapid breathing, muscle rigidity, altered mental status, high blood pressure and autonomic nervous system dysfunction.
- Risks and dangers of NMS include dehydration, acute kidney failure, seizures, heart attack, blood clots, acute liver failure, sepsis, UTI and pulmonary embolism.
Serotonin Syndrome
- Serotonin syndrome is characterized by dangerously elevated levels of serotonin in the brain.
- Drugs that cause serotonin syndrome: SSRI antidepressants such as Prozac, Lexapro and Zoloft, SNRI antidepressants such as Pristiq, Effexor and Cymbalta, Bupropion antidepressants such as Wellbutrin, Tricyclic antidepressants and MAOIs such as Nardil or Marplan, anti-migraine medications, pain medications such as fentanyl, tramadol and other opioids, illicit drugs such a cocaine, ecstasy and amphetamines, herbal supplements, over the counter cough and cold medications and anti-nausea medications.
- Combining medications that increase levels of serotonin such as migraine medication and antidepressant medication most often causes serotonin syndrome.
- Symptoms of serotonin syndrome include agitation, insomnia, confusion, rapid heart rate, dilated pupils, loss of muscle coordination, twitching, high blood pressure, muscle rigidity, heavy sweating, diarrhea, headache, high fever tremors and unconsciousness.
- Risks and dangers of serotonin syndrome include unresponsiveness, coma and seizures.
Though both of these conditions are caused by adverse drug reactions, there are some key differences to spot. If the drug is a serotonergic of an MAOI, chances are there is a risk for serotonin syndrome. If the drug is an antipsychotic, chances are, there is a risk of NMS. If symptoms of the drug-induced reaction occur rapidly within a few hours, it is most likely serotonin syndrome. If the symptoms of the drug-induced reaction come on gradually over day to week, it is most likely NMS.
Reach out to Hotel California by the Sea
We specialize in treating addiction and other co-occurring disorders, such as PTSD. Our Admissions specialists are available to walk you through the best options for treating your addiction.
Treatment of Substance Use Disorder
Neuroleptic malignant syndrome and serotonin syndrome are two conditions that are drug-induced and can cause life-threatening dangers if not treated under medical care. NMS is a condition in which a person lacks dopamine chemicals in the brain. Serotonin syndrome is a condition in which a person has excess amounts of serotonin in the brain.
Our bodies naturally create both dopamine and serotonin in the amounts needed for our bodies to function properly. When there is an excess amount or an inadequate amount of either of these neurochemicals, it can cause an imbalance and adverse reactions in the body. These conditions are both drug-induced and can also lead to the development of a substance addiction.
Hotel California by the Sea is dedicated to helping clients understand the root cause of their addiction through medication-assisted treatments and therapeutic methods. We offer treatment at all levels of care including detox, residential, PHP and IOP. We utilize evidence-proven methods such as CBT, DBT and EMDR therapy. Hotel California by the Sea helps clients reach their goals in recovery and overcome their addiction.
References:
https://ojrd.biomedcentral.com/articles/10.1186/s13023-024-03227-5
https://my.clevelandclinic.org/health/diseases/22703-neuroleptic-malignant-syndrome
https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758