I was talking with a friend about people sharing changa at festivals and how so few people in those situations know about maoi's, their interaction with stimulants/ssri's and serotonin syndrome.

She asked me how to recognise serotonin syndrome and what first aid could be administered. I only know it causes high temperatures and raised blood pressure, but then so do many common stimulants. Could only suggest keeping the person cool and giving them fluids.

Any other suggestions for recognising and dealing with this kind of situation?

Serotonin syndrome is something of a gradient if I understand it. One can have some mild effects and not be too worried about risking death.

Although I don't think it's safe to treat full on, potentially lethal serotonin syndrome with a few herbal sedatives, I have found a mixture of skullcap (Scutellaria spp.) and ghost pipe (Monotropa uniflora) to be relaxing and very helpful when my mind feels inflamed. Lavender and lemon balm come to mind as good candidates, but I haven't been using them.

Sometimes I have noticed when taking syrian rue extensively over days that during certain points in the day I would feel more 'pressure' to my actions, and thus more motivated. I can see how this would play into its antidepressant effects, but sometimes it does become overbearing and a dropperful of that mixture puts me much more at ease. I can imagine in a more precipitous situation some herbal sedatives could make a big difference in how much you enjoy a serotonin party.

I'm not well-versed enough to say but pharmas like quietiapine act as serotonin antagonists, which may be able to block the effects of serotonin syndrome in theory. Also the thieno/benzo*azepines... maybe they are helpful, I have no experience with them

Cannabis might help you out in some situations, acting as an antioxidant and antiinflammatory agent... THC Prevents MDMA Neurotoxicity in Mice

Many of the symptoms of taking SSRIs like MDMA or psychedelic drugs overlap with serotonin syndrome and this makes it very difficult to identify.

The number one thing to watch out for and keep under control is body temperature. Body temperature regulation can spiral out of control and it is paramount to keep it under 105F. I have heard of people being treated in ice baths, but with this you have to worry about taking the temperature too low as well. Keeping their skin wet for evaporative cooling should be adequate in most cases.

Other than that, just try to keep them calm. Anxiety can get really bad. The art of talking someone down from a bad trip would be my primary weapon in this case, but I can imagine that sometimes a sedative or downer would be necessary.

If I were running a harm reduction team at an event, my first aid kit for SS would be a bucket of water, some rags, oratory skills, and a paramedic on standby in case this doesn't work or is not enough.

In terms of dropping temperature, using isopropyl alcohol or even ethanol instead of water works nice & fast for evaporative cooling.

Hey Kerelsk! Let's be friends! I love both of those plants very much! I think after all the rain this year the Ghost Pipe is going to have nice big flushes!

I'm not sure this would be such a great idea. This would definitely provide rapid cooling, but possibly too rapid and could throw the body into shock. Also, this can create skin issues as it will leach fats/lipids from the skin as well as other valuable chemicals. The skin is right up there with the liver in removing toxins from the body. If someone has taken a combination of drugs that is causing them serotonin syndrome, they likely need all the toxin processing they can get rather than introducing new toxins and reducing the skins effectiveness as a filter.

I'd think the most noticeable immediate factor for the person would be the headache. From an observers perspective you'd want to look for confusion, agitation, rigid movement/muscle contraction, mumbling or disorganized speech. High temperature and blood pressure, pupil dilation, and sweating are other common signs, but are also common to MDMA, so aren't as helpful in this context.

When it comes to treatment, I'd advise getting them to the medical tent asap where professionals can administer sero blockers or benzos.

Sometimes if someone is having a bad trip, the last thing they need is medical attention. That's why I suggest keeping them cool and calm them down. As long as they don't get too overheated, they will survive another day. Of course, there is a point where they will need real medical attention and that shouldn't be delayed. I used to work in the entertainment industry and specifically many raves. I have seen far too many bad trips turn worse due to paramedics and law enforcement that simply do not understand that it's just a bad trip and the subject just needs consoling.

You make a very valid point. This thread was specifically asking about serotonin syndrome which is a medical emergency, but being able to distinguish a medical emergency from a difficult experience is not always easy. This is where projects like Kosmicare and the Zendo are so important, it's really nice to have a sanctuary space to take people that is staffed with sitters/volunteers are who are trained to make that determination and know how to deal with each respective case (holding space vs immediate triage to medical care and sadly, yes even to law enforcement in certain dangerous situations).

A lot of festivals don't have these resources yet, and that is where YOU come in. We are the ones out on the ground interacting with the community. We need to be able to distinguish when someone just needs some water, a quiet place to rest, and a grounded presence to help them through a difficult experience or when someone legitimately needs medical attention. We need to be capable of recognizing these things and taking immediate action, sometimes even when we've got a headful ourselves. I'd strongly suggest anyone who is attending these festivals be familiar with your resources and how to handle emergency situations. Do you know CPR and first aid? It's a good idea to take a class. Do you know where the nearest med tent is? Do you know safe spaces to bring people having a rough time?

I wanna highlight one particular resource for those who may be involved with festival leadership. MAPS has put together a wonderful guide for setting up onsite harm reduction spaces. If your local festival doesn't already have this infrastructure in place, this is absolutely the best starting point for learning how integrate these essential services.

Stay safe out there.