Serotonin syndrome may result anytime a person has too much
serotonin in their
nervous system for any reason. It can easily be provoked by
prescription drugs: the user may be taking two such drugs that add up to a dangerously high level, she may have taken an inappropriately high dose of one or both, or she may have mixed a prescription drug with another serotonin-enhancing
substance. Some people just have a bad reaction to a specific drug; I know one person who experienced
disorientation and
mania as a result of taking a
SSRI weight-loss drug prescribed by her doctor. Even
innocuous-seeming
herbal medicines may raise serotonin levels, and this is especially bad because many people don't think to tell their doctor that they're taking
5-HTP or
St. John's Wort when he's prescribing them
prozac.
So it's probably best not to dismiss these
symptoms if the individual doesn't report being on any
suspicious drugs. A prompt call to the doctor or the
ER is in order if they become severe.
First aid is probably limited to providing reassurance and maintaining
hydration.
On the other hand, serotonin syndrome is not a
unitary phenomenon that usually ends in
coma. Users of
MDMA will recognize many of these symptoms as signs of some substandard
X, but certainly nothing to freak out over. MDMA is probably a special case because it's designed to create a high level of serotonin
temporarily, whereas SSRIs and other drugs are intended to have longer
half-lives. With antidepressants and the like, the user's serotonin levels will slowly rise into the danger zone, and take their time going down as well.
If the individual has taken MDMA and nothing else, the proper response to moderate symptom levels is palliative care. Make
sure that he is drinking sufficient water and is able to cool off adequately. High levles of serotonin disrupt the body's temperature regulation, and most MDMA-related deaths have actually been caused by overheating and dehydration (states to which most
raves are sadly conducive).
Of course, you
should call for medical help if he becomes uncoordinated, loses consciousness, or develops a
fever-like temperature that won't go down.