Serotonin Syndrome (serotonin toxicity) Serotonergic Syndrome

Serotonin syndrome

Serotonin syndrome also referred to as serotonin toxicity, is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is seen with therapeutic medication use, inadvertent interactions between drugs, and intentional self-poisoning.

Serotonin syndrome may involve a spectrum of clinical findings, which often include mental status changes, autonomic hyperactivity, and neuromuscular abnormalities

The selective serotonin reuptake inhibitors (SSRIs) are perhaps the most commonly implicated group of medications associated with serotonin syndrome. Notably, SSRIs are less commonly associated with causing severe serotonin syndrome compared with medications that inhibit monoamine oxidase (MAO).

The diagnosis of serotonin syndrome is made solely on clinical grounds. Therefore, a detailed history and thorough physical and neurologic examinations are essential.

Serotonin syndrome encompasses a spectrum of disease where the intensity of clinical findings is thought to reflect the degree of serotonergic activity.

Mental status changes can include anxiety, restlessness, disorientation, and agitated delirium.. Patients may startle easily. Autonomic manifestations can include diaphoresis, tachycardia, hyperthermia, hypertension, vomiting, and diarrhea.

Neuromuscular hyperactivity can manifest as tremor, myoclonus, hyperreflexia, and bilateral Babinski sign. Hyperreflexia and clonus are particularly common; these findings, as well as rigidity, are more often pronounced in the lower extremities.

In severe cases, muscle rigidity may mask myoclonus and hyperreflexia. While uncommon, fatal cases of serotonin syndrome are associated with hyperthermia and seizure, the latter of which is often a preterminal event

Physical examination — Typical vital sign abnormalities include tachycardia and hypertension, but severe cases may develop hyperthermia and dramatic swings in pulse and blood pressure. Dilated pupils, Tremor, Akathisia, Deep tendon hyperreflexia, Inducible or spontaneous muscle clonus, Muscle rigidity & Bilateral Babinski signs.

The differential diagnosis of serotonin syndrome includes neuroleptic malignant syndrome (NMS), anticholinergic toxicity, malignant hyperthermia, intoxication from sympathomimetic agents, sedative-hypnotic withdrawal, meningitis, and encephalitis.

Serotonin syndrome is a clinical diagnosis; serum serotonin concentrations do not correlate with clinical findings, and no laboratory test confirms the diagnosis

Five principles are central to the management of serotonin syndrome:

1. Discontinuation of all serotonergic agents

2. Supportive care aimed at normalization of vital signs

3. Sedation with benzodiazepines

4. Administration of serotonin antagonists

5. Assessment of the need to resume use of causative serotonergic agents after resolution of symptoms

Antidote - Cyproheptadine is available in 4 mg tablets or 2 mg/5 mL syrup. When administered as an antidote for serotonin syndrome, an initial dose of 12 mg is recommended, followed by 2 mg every two hours until clinical response is seen. Cyproheptadine is only available in an oral form, but it may be crushed and given through a nasogastric or orogastric tube.

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system due to serotonergic agent therapeutic use, inadvertent interactions between drugs, and intentional self-poisoning

[hassan....]

I suffered from serotonin syndrome after two weeks of taking Prozac, and then the doctor added another medication to me, which I took, and I had a panic attack, severe fear, and confusion, and I felt like I was going to die. I went to the emergency room in the hospital and met with another psychiatrist who had no experience. I told him, unfortunately, he told me that you have anxiety that is not from the medication, and he gave me another medication. So I believed his words and went into a coma due to serotonin poisoning. The medication was withdrawn from my body, but I suffered severe depression and anxiety after that because of this incident. I continued to suffer for years, and I am now fine, much better than before, and I am still recovering without antidepressant medication. When I went to a psychiatrist, he went because I have a phobia of... Providing lectures at the university only..I am very regretful and wrong for going to a psychiatrist. I lost 3 years of my life because of that.

[suganyaraja]

Thank you sir . For your great work.. which immensely help us..

[aram]

I accidentally took an antidepressant pill, 100mg Setralin. and knowing that I am not depressed, I felt dizzy, difficult to concentrate, and nauseous, but after 24 hours I was littlebit better but now, after four days, I still feel tired and lack of concentration.😢

[entertainmenteducavlogs]

Sir is cariprazine effective for foreign particle goes sensation into eye sensation. And when it goes into eyes then I believe that there is some particle in my eyes with sensation thereafter I splash large amount of water into the eyes in order to remove the particle. Is it the symptom of OCD or schizophrenia?and insect crawling as well . And
Many a times delusion agression is there with my neighbour because Sometimes I believe that he produces sound intentionally to hurt me..Plzz tell sir.
I shall be very grateful to you
Is it the symptom of OCD or schizophrenia?
And will cariprazine treat this effectively??
Please reply sir I shall be very grateful to you. I love your videos.

[Kyriakiisp]

Can zoloft 150mg and latuda 18, 5 leads to serotonin syndrome? I dont take anything else as meds