Serotonin Syndrome: A Review of Diagnosis and Treatment
Serotonin syndrome (SS) is a potentially life-threatening condition characterized by altered mental status, autonomic instability, and neuromuscular hyperactivity resulting from excessive serotonergic activity in the central nervous system. This syndrome is caused by an interaction between drugs that increase the release of serotonin or block its reuptake, leading to an accumulation of serotonin in the synaptic cleft. The diagnosis of SS is based on the presence of the classic triad of altered mental status, autonomic instability, and neuromuscular hyperactivity. SS is a medical emergency and requires prompt diagnosis and management. This article reviews the epidemiology, diagnosis, and treatment of SS.
Epidemiology
The exact prevalence of SS is unclear, as it is underreported and can be difficult to diagnose. In hospitalized patients, the prevalence ranges from 0.02% to 0.26%. SS is more common in the elderly and in those taking multiple serotonergic medications.
Diagnosis
The diagnosis of SS is primarily based on the clinical presentation. The classic triad of altered mental status, autonomic instability, and neuromuscular hyperactivity is present in most cases, but SS can also present with only one or two of these features. In addition, other features such as myoclonus, hyperreflexia, and clonus may be present. A thorough history and physical examination should be done to assess the presence of SS.
Treatment
The mainstay of treatment for SS is discontinuation of all serotonergic medications, including over-the-counter drugs. Benzodiazepines can be used to manage the symptoms of SS, while cyproheptadine may be used to reduce serotonin levels. In severe cases, supportive care should be provided.
Conclusion
SS is a potentially life-threatening condition that is caused by an interaction between drugs that increase serotonin levels or block its reuptake. The diagnosis of SS is based on the presence of the classic triad of altered mental status, autonomic instability, and neuromuscular hyperactivity. Treatment includes discontinuation of all serotonergic medications and use of benzodiazepines and cyproheptadine to reduce serotonin levels.
References
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Haddad, P. M., & Anderson, I. M. (2007). Serotonin syndrome: A practical approach to diagnosis and treatment. CNS Drugs, 21(1), 1-12.
Lal, D., & Hainsworth, J. (2011). The serotonin syndrome. American Journal of Medicine, 124(4), 323-328.