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Serotonin syndrome

From Wikipedia
serotonin syndrome
class of disease
Subclass ofadvers effect of psychopharmacological medication, rare disease with malignant hyperthermia Edit
Has causecocaine Edit
Health specialtypsychiatry Edit
Possible treatmentbenzodiazepine drug Edit
WordLift URLhttp://data.medicalrecords.com/medicalrecords/healthwise/serotonin_syndrome Edit
ICD-9-CM333.99 Edit

Serotonin syndrome (SS[1]) dey consist of a group of symptoms wey fi occur plus de use of certain serotonergic medications anaa drugs.[2] De symptoms fi range from mild to severe, wey be potentially fatal.[3][4][5] Symptoms insyd mild cases dey include high blood pressure den a fast heart rate, usually widout a fever.[5] Symptoms insyd moderate cases dey include high body temperature, agitation, overactive reflexes, tremor, sweating, dilated pupils, den diarrhea.[2][5] Insyd severe cases, body temperature fi increase to greater dan 41.1 °C (106.0 °F).[5] Complications fi include seizures den extensive muscle breakdown.[5]

Serotonin syndrome typically be caused by de use of two anaa more serotonergic medications anaa drugs.[5] Dese fi include selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-hydroxytryptophan, St. John's wort, triptans, MDMA, metoclopramide, anaa cocaine.[5] E dey occur insyd about 15% of SSRI overdoses.[6] E be a predictable consequence of excess serotonin on de central nervous system.[7] Onset of symptoms typically be within a day of de extra serotonin.[5]

Diagnosis dey base on a person ein symptoms den history of medication use.[5] Oda conditions wey fi produce similar symptoms such as neuroleptic malignant syndrome, malignant hyperthermia, anticholinergic toxicity, heat stroke, den meningitis for be ruled out.[5] As of 2013, no laboratory tests dey exist wey fi confirm de diagnosis.[5]

Initial treatment dey consist of discontinuing medications wich fi be contributing.[2] Insyd those wey be agitated, benzodiazepines fi be used.[2] If dis no be sufficient, a serotonin antagonist such as cyproheptadine fi be used.[2] Insyd those plus a high body temperature, active cooling measures fi be needed.[2] De number of cases of serotonin syndrome wey dey occur each year be unclear.[8] Plus appropriate medical intervention de risk of death be low, likely less dan 1%.[9] De high-profile case of Libby Zion, wey be generally accepted dem die from serotonin syndrome, result in changes to graduate medical school education insyd New York State.[7][10]

Signs den symptoms

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Clonus dem see insyd a person plus serotonin syndrome

De symptoms be often present as a clinical triad of abnormalities wey fi be used to assess de severity of serotonin syndrome:[7][11]

Serotonin syndrome severity assessment scale[7][11]
Severity Autonomic effects Neurological (somatic) signs Mental status Oda symptoms
mild
  • absent anaa low-grade fever
  • tachycardia
  • mydriasis
  • excessive sweating
  • shivering
  • intermittent tremor
  • akathisia
  • myoclonus
  • mild hyperreflexia
  • restlessness
  • anxiety
moderate
  • increased tachycardia
  • fever up to 41 °C
  • nausea
  • diarrhea
  • hyperactive bowel sounds
  • excessive sweating
  • vasoconstriction
  • moderate hyperreflexia
  • inducible clonus
  • ocular clonus (slow continuous eye movements)
  • myoclonus (muscle twitching)
  • easily induced startle response
  • confusion
  • agitation
  • hypervigilance
  • rhabdomyolysis
  • metabolic acidosis
  • renal failure
  • disseminated intravascular coagulopathy
severe
  • temperature higher than 41 °C (wey increased muscle tone cause)
  • increased muscle tone, wich be more severe insyd lower limbs
  • spontaneous clonus
  • intense myoclonus
  • severe hyperreflexia
  • delirium
  • coma
 as above

Causes

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Chaw medications den street drugs fi cause serotonin syndrome wen dem take dem alone at high doses anaa in combination plus oda serotonergic agents. De table below dey list sam of dese.

Class Drugs wey fi induce serotonin syndrome
Antidepressants Monoamine oxidase inhibitors (MAOIs),[7] tricyclic antidepressants (TCAs),[7] SSRIs,[7] SNRIs,[7] nefazodone,[12] trazodone[12]
Opioids Dextropropoxyphene,[13] tramadol,[7] tapentadol, pethidine (meperidine),[7] fentanyl,[7] pentazocine,[7] buprenorphine[14] oxycodone,[15] hydrocodone[15]
Stimulants den entactogens MDMA,[7] MDA,[7] AMT,[16] caffeine,[17] methamphetamine,[18] lisdexamfetamine,[19] amphetamine,[20] phentermine,[13] amfepramone (diethylpropion),[13] sibutramine,[7] methylphenidate,[13] cocaine[13]
5-HT1 agonists Triptans[7][13]
Psychedelics NBOMes (e.g., 25I-NBOMe)[21]
Herbs St John's wort,[7] Syrian rue,[7] Panax ginseng,[7] nutmeg,[22] yohimbe[23]
Others Tryptophan,[7] L-DOPA, valproate,[7] buspirone,[7] lithium,[7] linezolid,[7][24] dextromethorphan,[7] 5-hydroxytryptophan,[12] chlorpheniramine,[13] risperidone,[25] olanzapine,[26] ondansetron,[7] granisetron,[7] metoclopramide,[7] ritonavir,[7] metaxalone,[7] methylene blue[27]

References

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  1. ↑ Scotton, William J; Hill, Lisa J; Williams, Adrian C; Barnes, Nicholas M (2019). "Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions". International Journal of Tryptophan Research. 12 1178646919873925. SAGE Publications: 117864691987392. doi:10.1177/1178646919873925. ISSN 1178-6469. PMC 6734608. PMID 31523132.
  2. 1 2 3 4 5 6 Ferri, Fred F. (2016). Ferri's Clinical Advisor 2017: 5 Books in 1 (in English). Elsevier Health Sciences. pp. 1154–1155. ISBN 978-0-323-44838-3.
  3. ↑ New, Andrea M.; Nelson, Sarah; Leung, Jonathan G. (2015-10-01). Alexander, Earnest; Susla, Gregory M. (eds.). "Psychiatric Emergencies in the Intensive Care Unit". AACN Advanced Critical Care (in English). 26 (4): 285–293. doi:10.4037/NCI.0000000000000104. ISSN 1559-7768. PMID 26484986.
  4. ↑ Boyer EW , Shannon M . The serotonin syndrome . N Engl J Med. 2005 ; 352 ( 11 ): 1112-1120
  5. 1 2 3 4 5 6 7 8 9 10 11 Volpi-Abadie J, Kaye AM, Kaye AD (2013). "Serotonin syndrome". The Ochsner Journal. 13 (4): 533–40. PMC 3865832. PMID 24358002.
  6. ↑ Domino, Frank J.; Baldor, Robert A. (2013). The 5-Minute Clinical Consult 2014 (in English). Lippincott Williams & Wilkins. p. 1124. ISBN 978-1-4511-8850-9.
  7. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Boyer EW, Shannon M (March 2005). "The serotonin syndrome" (PDF). The New England Journal of Medicine. 352 (11): 1112–1120. doi:10.1056/NEJMra041867. PMID 15784664. Archived (PDF) from the original on 2013-06-18.
  8. ↑ Domino, Frank J.; Baldor, Robert A. (2013). The 5-Minute Clinical Consult 2014 (in English). Lippincott Williams & Wilkins. p. 1124. ISBN 978-1-4511-8850-9.
  9. ↑ Friedman, Joseph H. (2015). Medication-Induced Movement Disorders (in English). Cambridge University Press. p. 51. ISBN 978-1-107-06600-7.
  10. ↑ Brensilver JM, Smith L, Lyttle CS (September 1998). "Impact of the Libby Zion case on graduate medical education in internal medicine". The Mount Sinai Journal of Medicine, New York. 65 (4): 296–300. PMID 9757752.
  11. 1 2 Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM (September 2003). "The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity". QJM. 96 (9): 635–642. doi:10.1093/qjmed/hcg109. PMID 12925718.
  12. 1 2 3 Ener RA, Meglathery SB, Van Decker WA, Gallagher RM (March 2003). "Serotonin syndrome and other serotonergic disorders". Pain Medicine. 4 (1): 63–74. doi:10.1046/j.1526-4637.2003.03005.x. PMID 12873279.
  13. 1 2 3 4 5 6 7 "Prescribing Practice Review 32: Managing depression in primary care" (PDF). National Prescribing Service Limited. 2005. Archived from the original (PDF) on 27 July 2011. Retrieved 16 July 2006.
  14. ↑ Isenberg D, Wong SC, Curtis JA (September 2008). "Serotonin syndrome triggered by a single dose of suboxone". American Journal of Emergency Medicine. 26 (7): 840.e3–5. doi:10.1016/j.ajem.2008.01.039. PMID 18774063.
  15. 1 2 Gnanadesigan N, Espinoza RT, Smith RL (June 2005). "The serotonin syndrome". New England Journal of Medicine. 352 (23): 2454–2456. doi:10.1056/NEJM200506093522320. PMID 15948273.
  16. ↑ Alpha-methyltryptamine (AMT) – Critical Review Report (PDF) (Report). World Health Organisation – Expert Committee on Drug Dependence (published 2014-06-20). 20 June 2014. Retrieved 2019-11-18.
  17. ↑ Taylor, Marygrace (2009-05-12). "Does the Caffeine in Your Coffee, Tea, or Soft Drinks Interfere With Antidepressants?". HealthCentral. Retrieved 2024-06-30.
  18. ↑ Schep LJ, Slaughter RJ, Beasley DM (August 2010). "The clinical toxicology of metamfetamine". Clinical Toxicology. 48 (7): 675–694. doi:10.3109/15563650.2010.516752. PMID 20849327. S2CID 42588722.
  19. ↑ "Vyvanse (Lisdexamfetamine Dimesylate) Drug Information: Side Effects and Drug Interactions – Prescribing Information". RxList.com (in English). Archived from the original on 2017-03-25. Retrieved 2017-03-22.
  20. ↑ "Adderall (Amphetamine, Dextroamphetamine Mixed Salts) Drug Information: Side Effects and Drug Interactions – Prescribing Information". RxList (in English). Archived from the original on 2017-03-23. Retrieved 2017-03-22.
  21. ↑ Thomas K (2024). Toxicology and Pharmacological Interactions of Classic Psychedelics. Current Topics in Behavioral Neurosciences. Berlin, Heidelberg: Springer Berlin Heidelberg. doi:10.1007/7854_2024_508. PMID 39042251. Retrieved 14 May 2025.
  22. ↑ Braun U, Kalbhen DA (October 1973). "Evidence for the Biogenic Formation of Amphetamine Derivatives from Components of Nutmeg". Pharmacology. 9 (5): 312–316. doi:10.1159/000136402. PMID 4737998.
  23. ↑ "Erowid Yohimbe Vaults: Notes on Yohimbine by William White, 1994". Erowid.org. Archived from the original on 2013-01-26. Retrieved 2013-01-28.
  24. ↑ Steinberg M, Morin AK (January 2007). "Mild serotonin syndrome associated with concurrent linezolid and fluoxetine". American Journal of Health-System Pharmacy. 64 (1): 59–62. doi:10.2146/ajhp060227. PMID 17189581.
  25. ↑ Karki SD, Masood GR (2003). "Combination risperidone and SSRI-induced serotonin syndrome". Annals of Pharmacotherapy. 37 (3): 388–391. doi:10.1345/aph.1C228. PMID 12639169. S2CID 36677580.
  26. ↑ Verre M, Bossio F, Mammone A, et al. (2008). "Serotonin syndrome caused by olanzapine and clomipramine". Minerva Anestesiologica. 74 (1–2): 41–45. PMID 18004234. Archived from the original on 2009-01-08.
  27. ↑ Ramsay RR, Dunford C, Gillman PK (2007). "Methylene blue and serotonin toxicity: inhibition of monoamine oxidase A (MAO A) confirms a theoretical prediction". Br J Pharmacol. 152 (6): 946–51. doi:10.1038/sj.bjp.0707430. PMC 2078225. PMID 17721552.
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