Hanna Nawatha

10/10/2025

🌿 World Mental Health Day 🌿

Today we are reminded that mental health is just as important as physical health.
Taking care of our mind, showing compassion to ourselves and to others, and seeking help when needed are acts of strength — not weakness.

💚 Let’s keep breaking the stigma, raising awareness, and supporting one another.
Because a healthy mind is the foundation for a healthy life.

14/09/2025

Jim Carrey’s honesty about his battle with depression broke the stigma for millions. He showed that therapy and medical support matter — and that no one should face depression alone.

What do you think about celebrities sharing their mental health struggles? Does it help reduce stigma?

23/08/2025

Much of the stress we experience stems from circumstances outside of our control. Persistently focusing on these factors often intensifies distress without offering solutions. By directing attention toward the aspects of life we can influence, we support greater emotional stability and healthier coping in day-to-day living. 🧘

Is this approach effortless? Certainly not. Will it eliminate all difficulties? No. Yet evidence shows it can meaningfully improve well-being—and is therefore well worth practicing. 🩷

21/08/2025

Drug-Induced Serotonin Syndrome:
A Neurologic Emergency

Key Points

1. Definition: A potentially life-threatening condition caused by excessive serotonergic activity in the CNS and peripheral nervous system.

2. Mechanism: Overstimulation of 5-HT1A/2A receptors due to:

◦ Increased serotonin synthesis (e.g., tryptophan)

◦ Decreased serotonin breakdown (MAOIs)

◦ Increased serotonin release (amphetamines, M**A)

◦ Direct receptor agonism (triptans, L*D)

◦ Reuptake inhibition (SSRIs, SNRIs, TCAs)

High-Risk Medications

1. Common Culprits

• Antidepressants: SSRIs (fluoxetine), SNRIs (venlafaxine), TCAs (clomipramine), MAOIs (phenelzine)

• Opioids: Tramadol, fentanyl, meperidine (pethidine)

• Migraine drugs: Triptans (sumatriptan)

• Antiemetics: Ondansetron, metoclopramide

• Recreational drugs: M**A, co***ne, L*D

2. Dangerous Combinations

• SSRI + MAOI (e.g., fluoxetine + linezolid) → absolute contraindication

• SSRI + tramadol (common in pain patients)

• SNRI + dextromethorphan (cough syrup)

Clinical Presentation

Hunter Criteria (Diagnosis Requires ≥1 of These)

• Spontaneous clonus (most specific sign)

• Inducible clonus + agitation/diaphoresis

• Ocular clonus + agitation/diaphoresis

• Hypertonia + hyperthermia (>38°C)

• Tremor + hyperreflexia

Triad of Symptoms

1. Neuromuscular: Myoclonus, hyperreflexia, rigidity

2. Autonomic: Tachycardia, hypertension, hyperthermia

3. Mental status changes: Agitation, delirium, coma

Management

1. Immediate Actions

◦ Discontinue all serotonergic drugs

◦ Supportive care: IV fluids, cooling for hyperthermia

◦ Benzodiazepines (e.g., lorazepam) for agitation/seizures

2. Severe Cases (Hyperthermia >41°C, Rigidity)

◦ Cyproheptadine (5-HT2A antagonist): 12 mg PO/NG, then 2–8 mg q6h

◦ ICU admission for intubation, paralysis, and cooling

3. Avoid

◦ Dantrolene (not effective; unlike malignant hyperthermia)

◦ Antipsychotics (may worsen hyperthermia)

Prevention

• Washout periods:

◦ 2 weeks between MAOIs and SSRIs

◦ 5 weeks for fluoxetine (long half-life)

• Check for drug interactions (e.g., St. John’s wort + SSRI)

Take-Home Message

• Suspect serotonin syndrome in any patient on serotonergic drugs with altered mental status + neuromuscular hyperactivity.

• Clonus + hyperreflexia are hallmark signs.

• When in doubt, stop the drugs and monitor.

Mnemonic: "SEROTONIN"

• Sweating

• Encephalopathy

• Rigidity

• Ocular clonus

• Tremor

• Overactive reflexes

• Nausea/vomiting

• Inducible clonus

• Neuromuscular excitation

08/08/2025

26/07/2025

While many are familiar with bipolar disorder, few have heard of — a rare, chronic mood disorder that affects around 0.4% to 1% of the population, impacting men and women equally. 🤔

Cyclothymia is marked by frequent mood shifts — from low, depressive symptoms to periods of mild euphoria or heightened energy. These emotional highs and lows are similar to those in bipolar disorder, but generally less intense and shorter in duration.

Unlike full-blown mania or major depression, cyclothymia’s symptoms can be subtle — making it harder to recognize, but still deeply disruptive to daily life if left untreated.