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Serotonin syndrome

Published online by Cambridge University Press:  02 January 2018

Feargal Leonard
Affiliation:
Priority House, Hermitage Lane, Maidstone, Kent ME16 9PH
Ananth Puranik
Affiliation:
Priority House, Hermitage Lane, Maidstone, Kent ME16 9PH
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Abstract

Type
The Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2000

Sir: Mir & Taylor (Psychiatric Bulletin, December 1999, 23, 742-747) in their review of serotonin syndrome reminded us of the diagnostic criteria (Sternbach's criteria) for the diagnosis of this syndrome at a time when we had recently changed the drug therapy of a patient from trazodone to paroxetine. In this patient we saw the emergence of five symptoms listed in Sternbach's criteria (agitation, myoclonus, shivering, tremor and incoordination). We have two points to make: we noted that the most severe symptoms in this patient were nausea and vomiting. Although, it is accepted that nausea and vomiting may occur as part of the serotonin syndrome (Reference Lane and BaldwinLane & Baldwin, 1997) they are not diagnostic criteria. Gastrointestinal symptoms are well-recognised effects of increased serotoninergic activity and it is surprising that there is little emphasis on them in the literature relating to this subject. Where serotonin syndrome is a result of changing drug therapy the possibility of a discontinuation syndrome should be considered as an alternative diagnosis because of the overlap in symptomatology between the two syndromes.

References

Lane, R. & Baldwin, D. (1997) Selective serotonin reuptake inhibitor-induced serotonin syndrome: Review. Journal of Clinical Psychopharmacology, 17, 208221.Google Scholar
Rosenbaum, J. F. & Zajecka, J. (1997) Clinical management of antidepressant discontinuation: Review. Journal of Clinical Psychiatry, 58 (suppl. 7), 3740.Google Scholar
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