Serotonin Syndrome

Excerpt

Serotonin syndrome (serotonin toxicity) is a serious and potentially life-threatening condition that results from excessive serotonergic activity throughout the central nervous system. Serotonin is a neurotransmitter that regulates mood, behavior, and other physiological functions. The neurotransmitter is produced naturally in the body and can also be found in certain medications, illicit substances, and supplements. Serotonin syndrome may be a consequence of therapeutic medication use, accidental interactions between medications and recreational drugs, or an intentional overdose. The clinical severity of serotonin syndrome varies broadly, as some cases are relatively mild while others are fatal. Symptoms classically include altered mental status, autonomic dysfunction, and neuromuscular excitation.

The diagnosis of serotonin syndrome is clinical, which provides challenges in rapid and accurate diagnosis. Several criteria exist for this clinical diagnosis, but the Hunter criteria are generally the most broadly used. Healthcare professionals must take a detailed medical history and assess the patient's medication regimen to arrive at an accurate diagnosis. Treatment for serotonin syndrome involves discontinuing the offending medications and providing supportive care.

Mild cases are under-recognized, while severe cases generally require hospitalization. Drugs to counteract serotonin toxicity may be administered in severe cases. Serotonin syndrome generally precipitates within 1 day of a serotonergic change, either from the addition of a medication, change in dose, or use of other substances. Preventing serotonin syndrome involves careful monitoring of medication use, avoiding the concurrent use of multiple serotonin-increasing drugs, and consulting with healthcare professionals if concerns about drug interactions are apparent.