How will my veterinarian treat serotonin syndrome?
The treatment of serotonin syndrome depends largely on your dog’s clinical signs. If your dog is experiencing very mild signs, your veterinarian may simply have you discontinue your dog’s medication or decrease the dose. It is important that you only change your dog’s medication under your veterinarian’s guidance, however, because suddenly stopping a serotonergic drug can result in harmful effects for your dog.
If your dog experienced a recent overdose, your veterinarian may first attempt gastrointestinal decontamination. The goal of decontamination is to clear remaining drugs from your dog’s gastrointestinal tract, to reduce drug absorption and prevent worsening effects. Your veterinarian will first induce vomiting, then give activated charcoal to bind any remaining drug in your dog’s gastrointestinal tract. After decontamination, your dog may remain hospitalized for observation and supportive care. Treatments will be administered based on your dog’s clinical signs and may include antinausea medications, antidiarrheals, muscle relaxants, or antiseizure medications. Your dog may remain hospitalized for several days, in order to allow the veterinary team to manage the ongoing effects of serotonin syndrome.
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If it is not a matter of education Patients who display unwanted behaviour are normally only presented to the practice late in their history of suffering, since behaviour is usually not associated with an illness, but solely with the animal’s circumstances and its nature. However, abnormal behaviour can be caused by a wide variety of disorders. Increased aggressiveness can, for example, be caused by pain or hormones, but also infectious diseases – think of rabies, at worst – should be considered. To differentiate, possible organic, hormonal, infectious, orthopaedic, genetic, autoimmune and allergic causes should be clarified. Furthermore, poisoning can also lead to problematic behaviour. Among the many possible causes, the most common underlying diseases in our clinical laboratory consultation are listed here. Organic diseases Liver: Patients with portosystemic shunt may be presented to the practice for the first time because of apathy. Even if the affected dogs start behaving conspicuously by showing circular movements or by having epileptiform seizures, symptoms can be significantly milder and less specific, especially in case of an intrahepatic shunt. Clinical chemistry can become challenging as not all shunt patients show changes in liver values. Frequently, an isolated increase in ALT is observed. Diagnosis should thus be made by means of a bile acid stimulation test or – if possible in-house – by measuring ammonia and also include an ultrasound scan.Kidney and bladder: Diseases affecting these organs can also lead to unwanted behaviour. If, for example, puppies show signs of uncleanliness, congenital or acquired kidney or bladder problems should be considered, too. In addition to medical imaging, a urinalysis (status/sediment and urine culture) as well as the determination of the protein-creatinine ratio (UPC) are recommended. The determination of urea, creatinine and SDMA in serum is not always effective in puppies, as the growing organism has highly variable concentrations of these substrates in serum. Adult cats may show kidney-related uncleanliness which is often misinterpreted as a behavioural problem.Hormonal imbalances Behaviour is regulated by a variety of hormones and hormonal interactions. Changes in a single hormone level can trigger profound behavioural changes.
Thyroid gland: Diseases of the thyroid gland frequently occur in dogs and cats. In dogs, both cause and symptoms differ with age.
In young dogs, it is autoimmune thyroiditis which leads to behavioural changes, whereas in older dogs these changes are caused by follicular atrophy. In young dogs, anxious or aggressive behaviour with hyperactivity and severe educational problems is often associated with thyroid dysfunction. If these patients really suffer from thyroid-related behavioural problems, these are due to initial episodes of autoimmune thyroiditis with fluctuating hormone secretions. The diagnosis is confirmed by measuring the T4 and TSH levels but, above all, by determining the thyroglobulin antibodies (TgAb) as well as T3- and T4-antibodies. In older dogs, hypothyroidism is one of the most common known endocrine disorders. Some of the first changes that are observed are increasing reluctance to move and lethargy. As the function of the thyroid gland can be influenced by many other diseases, it is necessary to determine the T4 and TSH levels and to rule out other conditions in order to confirm the diagnosis. The clinical signs triggered by hyperthyroidism in older cats (weight loss, hyperactivity) often lead to a quick diagnosis. Only rarely, hyperthyroid cats are apathetic. In most cases, measuring the T4 level in serum is sufficient; in uncertain cases, TSH can be measured.Gonads/adrenal gland: Sex steroids are responsible for a complex system of behaviours. The castration of domesticated animals and, thus, the suppression of gonadal function is frequently performed and significantly influences the behaviour. Not only the reproductive ability but especially aggressive behaviour against conspecifics should be suppressed. In case of dominance problems, it is also expected that castration will make it easier to guide the dogs. If the dog or the cat continues to show sexual behaviour despite being neutered, the question arises as to whether there is still some gonadal tissue present. Determining the luteinising hormone (LH) as well as steroid hormones and particularly the measurement of the anti-Müllerian hormone (AMH) level in both male and female animals can help to answer this question. Endocrine neoplasms can also manifest themselves through behavioural change. In the early phase, this may even be the only clinical sign. Sertoli cell tumours cause male dogs to become attractive to other males and to behave more like being neutered due to increased oestrogen secretion. Granulosa cell tumours in female dogs can mimic the behaviour of a pregnant bitch with nest-building behaviour and carrying around soft toys if hormone secretion, especially progesterone, is low but constant. It is alarming for the owner that no previous heat was observed and, thus, a false pregnancy is unlikely. Endocrine active adrenal tumours lead to various behavioural changes depending on the hormonal secretion pattern. While Cushing’s syndrome, which is common in dogs, is primarily associated with increased appetite up to allotriophagia, other tumours of the adrenal cortex are rare. A rather common tumour of the adrenal medulla is the catecholamine-secreting phaeochromocytoma. The permanently elevated level of catecholamine in the blood results in increased restlessness and anxiety in patients. Determining the catecholamines normetanephrine and metanephrine in blood plasma or the normetanephrine- and metanephrine-creatinine ratio in urine helps to confirm the diagnosis.
Neurotransmitters Recently, clinical laboratory testing of dogs with behavioural problems has started to focus on the “happiness hormone” serotonin. Serotonin is a neurotransmitter whose effects in the CNS include the inhibition of fear and aggression. A lack of serotonin in the CNS therefore leads to fearful-aggressive behaviour. Although serotonin cannot cross the blood-brain barrier, low serotonin levels in the blood correlate with certain behavioural problems. This correlation has been confi rmed by our own research (see chart). Therefore, measuring serotonin in serum is recommended for dogs with fearfulaggressive behaviour. In addition to food supplementation with tryptophan, treatment can be carried out with serotonin analogues or serotonin reuptake inhibitors. A return to normal behaviour can be expected after a few weeks.Infectious causes It is the tactic of some infectious agents to manipulate their host’s behaviour with the aim of being transferred to a new host more quickly. A typical example for this is an infection with the rabies virus. Fortunately, rabies only plays a very minor role in Germany. Nevertheless, it may be a diff erential diagnosis in animals from uncontrolled imports and should be considered if dogs are aggressive. But even less dramatic and much more frequent infections can also lead to behavioural changes. Especially ectoparasites living in the fur or on the skin can lead to increased restlessness without causing massive itching at the same time. Infected hair can be sent in to identify the parasite.Poisoning The intake of foreign substances is another way in which unwanted behaviour can be triggered. Lead poisoning manifests itself in various ways with restlessness, agitation, increased barking or biting and depression. If the dog ingests nicotine through cigarette butts, it leads to agitation and hyperactivity. It also frequently happens that animals take drugs if the owner does not handle the drugs carefully. Depending on the drug and dosage, behaviour can vary and range from hyperexcitability to somnolence. A single intake of poison results in a sudden change in behaviour and, at a higher dose, is usually associated with further symptoms. Genetic behavioural problems Particularly in pedigree animals, there are various genetic defects that are associated with behavioural change. These include, for example, neuronal ceroid lipofuscinosis (restlessness, aggressiveness, anxiety), acral mutilation syndrome (paw chewing), glycogen storage disease (lethargy), necrotising meningoencephalitis (disorientation, head shaking, circling), dopamine transporter polymorphism (hereditary behavioural abnormality in Malinois dogs: reduced excitability, episodic aggression) and many more. The causative mutations have already been identifi ed in numerous breeds, which is why the option of diagnosing hereditary diseases in pedigree dogs with behavioural problems should also be taken into account. Especially for dogs, we off er an extensive and constantly growing range of tests. For more information, see https://shop.labogen.com/
Primary laboratory parameters to be determined relating to the most common behavioural problems
| Cause | Laboratory tests | |
| Anxiety | thyroid gland | T4, TSH, TgAb |
| serotonin deficiency | serotonin (1) | |
| phaeochromocytoma (dog) | normetanephrine + metanephrine (2) | |
| Aggressiveness | thyroid gland | T4, TSH, TgAb (dog) |
| serotonin deficiency | serotonin (1) | |
| gonadal sex steroids | testosterone, oestradiol | |
| pain – orthopaedic – neurologic | cortisol as stress marker (measure from saliva, if required) | |
| Hyperactivity/ restlessness | thyroid gland (old cat, young dog) | T4, TSH (cat) T4, TSH, TgAb (dog) |
| phaeochromocytoma (dog) | normetanephrine + metanephrine (2) | |
| ectoparasites | parasitological analysis | |
| poisoning | heavy metal screening (3) toxin screening (4) | |
| Lack of motivation | liver (shunt) | ALT, bile acid stimulation test |
| hypothyroidism | T4/TSH | |
| Uncleanliness | kidney/bladder | urea, creatinine, SDMA (adult animals) UPC + urinalysis/urinary sediment + urine culture |
| Hypervocalisation cat | thyroid gland | T4/TSH |
| Reproductive behaviour | gonads | AMH, testosterone, oestradiol, LH |
(1) Send in cooled (possibly frozen) and protected from light (2) Frozen EDTA plasma, urine acidified with HCI to pH < 2, send in frozen and protected from light (3) EDTA whole blood (4) Only possible from urine; always state clinical history. Dr. Ruth Klein Laboklin Aktuell english
How is serotonin syndrome treated in dogs?
Treatment of serotonin syndrome consists of prompt decontamination and aggressive supportive care. Decontamination in clinically normal animals is necessary either via emesis (apomorphine at 0.02-0.06 mg/kg intravenously [IV] or intramuscularly [IM]) or gastric lavage, followed by administration of activated charcoal.
How do I check my serotonin levels ? | Mega Health Channel & Answers
Serotonin syndrome in dogs is a rare but severe condition where the body has an excess amount of the neurotransmitter serotonin from ingesting toxic levels of dog antidepressant medication.
Serotonin syndrome can be life-threatening, and any owner whose dog is prescribed behavioral modification drugs should be aware of it.
In this article, we will cover the signs of serotonin syndrome, what causes it, and what can be done to prevent it to help keep you better informed.
If your dog is taking an antidepressant or behavioral modification medication or could have been exposed to them, take careful note of these signs. If you notice them seek veterinary help.
Antidepressant medications are administered to dogs with behavioral problems such as anxiety. Many of these medications cause an increase in serotonin in the body, which is a “feel-good hormone.”
However, when serotonin levels become too high, it can become toxic and lead to serotonin syndrome.
Serotonin syndrome is usually diagnosed based on the history of ingestion of a drug or supplement that affects serotonin levels and clinical signs related to the condition. Signs of serotonin syndrome can occur within an hour of an overdose or could occur several days later.
Suppose no known history of ingestion of a drug or supplement that affects serotonin is known, then a sample of urine, blood, or stomach contents can be submitted for a toxicology report while supportive care is instigated.
Serotonin syndrome can be challenging to diagnose because signs of toxicity can vary depending on the drug ingested. If you are concerned your dog could have serotonin syndrome, check with your veterinarian that this is something they are considering, and make sure to let your veterinarian know about any medications or supplements, your pet is being given.
Unfortunately, serotonin syndrome can be life-threatening. This can occur when serotonin levels are high enough in the blood to cause seizures and coma.
Life-threatening serotonin levels in the body are very rare and usually caused by ingestion of large amounts of drugs and typically multiple different kinds.
It is essential to read medication labels carefully and follow the instructions closely. Also, keep all medicines away from your dog’s access to prevent accidental ingestion.
Suppose you know your animal has ingested an excessive number of antidepressants (for example, you find a chewed-up drug bottle), or you suspect they may have serotonin syndrome. In that case, you need to seek veterinary attention immediately.
If the medication is still in your dog’s body, the first treatment involves decontamination by removing the drug. This can occur through inducing emesis (vomiting), administering activated charcoal to prevent continued absorption of any medication in the body, and stomach pumping may be required in severe situations.
The activated charcoal will often need to be repeated every few hours, but this may be able to be continued at home in less severe cases.
Once no more drugs are being absorbed, the next step will depend on the severity of the signs.
In mild cases of GI signs only (vomiting and diarrhea), medicines can be administered to stop these, such as anti-nausea and gastric protectants.
Special drugs can be administered to stop seizures and maintain oxygenation to vital organs in more severe cases with neurological effects. Many machines will be used to monitor these animals, and careful monitoring by veterinary professionals will help to track progress. Intensive management and care is required to try to keep these animals alive.
These include trazodone, mirtazapine, and amitriptyline. They block the reuptake of serotonin and norepinephrine (noradrenaline) in presynaptic terminals. The most common side effects of toxicity seen include hyperexcitability and vomiting.
These include sertraline, fluoxetine, and citalopram. SSRIs decrease the body’s ability to uptake serotonin which causes an increase in the levels of serotonin in the body. Therefore, SSRIs are considered safer than other medications that affect serotonin levels (serotonergic drugs).
The most common signs of toxicity seen are lethargy, neurologic abnormalities, GI upset, and rapid heart rate. They are unlikely to cause death, but toxicity does require prompt and appropriate treatment.
These include selegiline and tranylcypromine. They work by inhibiting serotonin metabolism and are less commonly prescribed. Signs of toxicity include restlessness, disorientation, and seizures but this usually only occurs when MAOIs are administered with other medications such as SSRIs.
These include medications for ADHD in people such as Adderall. They are not commonly prescribed to animals, but they could be toxic if an animal ingests a human drug.
These are commonly seen in over-the-counter dietary supplements. The active ingredient is often tryptophan which is converted to serotonin rapidly in the GI tract. Signs of toxicity include neurological signs (blindness, depression, tremors, seizures) and GI signs (vomiting, diarrhea).
These supplements can be incredibly toxic if given alongside prescription medicines, so make sure to discuss any supplements with your veterinarian before giving them to your dog.
In animals with mild signs of serotonin syndrome, the prognosis is often good, with some animals only having GI upset (vomiting and diarrhea) which can be managed with medication.
In more severe cases, the prognosis can be very guarded to grave. The forecast is worse in animals that receive delayed veterinary attention or those that ingest very high medication levels. Some dogs will require many days in the hospital before they can go home.
Serotonin is a neurotransmitter in the brain (central nervous system) of humans and animals. It works to regulate pain sensation, behavior, and body temperature. Serotonin also affects platelet aggregation (necessary for clotting), gastrointestinal and respiratory functions.
Tryptophan is a precursor to serotonin, and it is synthesized into 5-hydroxytryptamine (also called serotonin) and stored in vesicles in neurons. After its release, serotonin acts on reception and undergoes reuptake through the serotonin transporter (SERT).
Elevation of serotonin levels causes serotonin syndrome. The levels of serotonin need to be ten times baseline for toxic signs to occur. An animal with a fever or in a warm environment is more likely to develop serotonin syndrome effects.
As you can see from this article, serotonin syndrome is a severe condition, but it can be avoided through careful management of antidepressant medications.
Making sure to follow label instructions closely and keeping a close eye on your dog will help limit the risks of serotonin syndrome and allow early signs of this condition to be caught to allow for rapid treatment.
Medications that affect serotonin are generally safe and should not be avoided in fear of possible side effects. However, if your veterinarian recommends an antidepressant medicine for your dog, consider it carefully and assess any potential pros and cons before deciding.