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Serotonin toxicity

Published online by Cambridge University Press:  13 June 2014

Sobia Nasim ,
Faraz Jabbar ,
Asfar Afridi  and
Brendan D Kelly
Sobia Nasim
Affiliation:
Connolly Norman House, 224 North Circular Road, Dublin 7, Ireland
Faraz Jabbar
Affiliation:
Connolly Norman House, 224 North Circular Road, Dublin 7, Ireland
Asfar Afridi
Affiliation:
Stewarts Hospital Services, Palmerston, Dublin, Ireland
Brendan D Kelly*
Affiliation:
Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland
*
*Correspondence Email: brendankelly35@gmail.com
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Abstract

Serotonin toxicity is a potentially life-threatening condition associated with a range of psychotropic medications, co-administration of specific combinations of agents and overdose of certain drugs. It is associated with a wide diversity of clinical signs and symptoms, including cognitive, autonomic and somatic effects, as well as serious complications, including possible death. Diagnosis is often challenging and requires a high index of suspicion. Differential diagnosis includes syndromes such as neuroleptic malignant syndrome. Management depends on the causal agent and urgency of clinical presentation. Treatment may involve discontinuing the causal agent and providing supportive measures, or emergency intervention to preserve vital functions (airway, breathing, circulation), amongst other measures. Further research is needed to clarify the incidence of serotonin toxicity, issues related to differential diagnosis, optimal management of the condition, and treatment of mood problems following serotonin toxicity.

Type
CPD
Information
Irish Journal of Psychological Medicine , Volume 28 , Issue 2 , June 2011 , pp. i - iv
Copyright
Copyright © Cambridge University Press 2011

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References

1.Isbister, GK, Buckley, NA. The pathophysiology of serotonin toxicity in animals and humans: implications for diagnosis and treatment. Clin Neuropharmacol 2005; 28: 205–14.CrossRefGoogle ScholarPubMed
2.Boyer, EW, Shannon, M. The serotonin syndrome. N Engl J Med 2005; 352(11): 1112–20. Erratum in: N Engl J Med 2005; 356(23): 2437.CrossRefGoogle ScholarPubMed
3.Gillman, PK. The spectrum concept of serotonin toxicity. Pain Med 2004; 5 (2): 231–2.CrossRefGoogle ScholarPubMed
4.Hall, CWR, Hall, CWR, Chapman, MJ. Central serotonin syndrome: Part I–causative agents, presentation, and differential diagnosis. Clinical Geriatrics 2007; 15 (12):18–25.Google Scholar
5.Isbister, GK, Buckley, NA, Whyte, MI. Serotonin toxicity: a practical approach to diagnosis and treatment. MJA 2007; 187(6): 361–65.Google ScholarPubMed
6.Frank, C. Recognition and treatment of serotonin syndrome. Can Fam Physician 2008; 54(7): 988–92.Google ScholarPubMed
7.Koniari, I, Tsigkas, G, Apostolakis, E. Serotonin syndrome: pharmacogenomics and treatment. Interact Cardiovasc Thorac Surg 2008; 7: 657–58.CrossRefGoogle ScholarPubMed
8.Isbister, GK, Hackett, LP, Dawson, AH, et al.Moclobemide poisoning: toxicokinetics and occurrence of serotonin toxicity. Br J Clin Pharmacol 2003; 56: 441–50.CrossRefGoogle ScholarPubMed
9.Hegerl, U, Bottlender, R, Gallinat, Jet al.The serotonin syndrome scale: first results on validity. Eur Arch Psychiatry Clin Neurosci 1998; 248: 96–103.CrossRefGoogle ScholarPubMed
10.Radomski, JW, Dursun, SM, Reveley, MA, Kutcher, SP. An exploratory approach to the serotonin syndrome: an update of clinical phenomenology and revised diagnostic criteria. Med Hypotheses 1999; 55: 218–24.CrossRefGoogle Scholar
11.Birmes, P, Coppin, D, Schmitt, L, Lauque, D. Serotonin syndrome: a brief review. CMAJ 2003; 168(11): 1439–42.Google ScholarPubMed
12.Schellander, R, Donnerer, J. Antidepressants: clinically relevant drug interactions to be considered. Pharmacology 2010; 86(4): 203–15CrossRefGoogle ScholarPubMed
13.Lantz, MS, Buchalter, EN, Giambanco, V. Serotonin syndrome following the administration of tramadol with paroxetine. Int J Geriatr Psychiatry, 1998; 13(5): 343–5.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
14.Rim, CL, Gitlin, MJ. Ziprasidone, monoamine oxidase inhibitors, and the serotonin syndrome. J Clin Psychopharmacol 2010; 30(4): 470–1.CrossRefGoogle ScholarPubMed
15.Colomar Ferrá, A, Ventayol Bosch, P, Raurich, JM. Serotonin syndrome due to interaction between linezolid, tryptophan and metoclopramide. Med Intensiva 2009; 33 (7): 360–1.CrossRefGoogle ScholarPubMed
16.Packer, S, Berman, SA. Serotonin syndrome precipitated by the monoamine oxidase inhibitor linezolid. Am J Psychiatry 2007; 164 (2): 346–7CrossRefGoogle ScholarPubMed
17.Bilbao Garay, J, Mesa Plaza, N, Castilla Castellano, V, Dhimes Tejada, P. Serotonin syndrome: report of a fatal case and review of the literature. Rev Clin Esp 2002; 202 (4): 209–11.Google ScholarPubMed
18.Sun-Edelstein, C, Tepper, SJ, Shapiro, RE. Drug-induced serotonin syndrome: a review. Expert Opin Drug Saf 2008; 7 (5): 587–96.CrossRefGoogle ScholarPubMed
19.Rosebush, PI, Margetts, P, Mazurek, MF. Serotonin syndrome as a result of clomipramine monotherapy. 1999; 19 (3): 285–7.Google ScholarPubMed
20.Otte, W, Birkenhager, TK, van den Broek, WW. Fatal interaction between tranylcypromine and imipramine. Eur Psychiatry 2003; 18 (5): 264–5.CrossRefGoogle ScholarPubMed
21.Ables, AZ, Nagubilli, R. Prevention, diagnosis and management of serotonin syndrome. Am Fam Physician 2010; 81(9): 1139–1142.Google ScholarPubMed
22.Adan-Manes, J, Novalbos, J, López-Rodríguez, R, Ayuso-Mateos, JL, Abad-Santos, F. Lithium and venlafaxine interaction: a case of serotonin syndrome. J Clin Pharm Ther 2006; 31 (4): 397–400CrossRefGoogle ScholarPubMed
23.Mekler, G, Woggon, B. A case of serotonin syndrome caused by venlafaxine and lithium. Pharmacopsychiatry 1997; 30(6): 272–3CrossRefGoogle ScholarPubMed
24.Rajapakse, S, Abeynaike, L, Wickramarathne, T. Venlafaxine-associated serotonin syndrome causing severe rhabdomyolysis and acute renal failure in a patient with idiopathic Parkinson disease. J Clin Psychopharmacol 2010; 30(5): 620–2.CrossRefGoogle Scholar
25.Parker, V, Wong, AH, Boon, HS. Seeman, MV. Adverse reactions to St John's Wort. Can J Psychiatry 2001; 46(1): 77–9.CrossRefGoogle ScholarPubMed
26.Kelly, BD. St John's wort for depression: what's the evidence? Hospital Medicine 2001; 62(5): 274–6CrossRefGoogle ScholarPubMed
27.Thorpe, EL, Pizon, AF, Lynch, MJ, Boyer, J. Bupropion induced serotonin syndrome: a case report. J Med Toxicol 2010; 6(2): 168–71.CrossRefGoogle ScholarPubMed
28.Oates, JA, Sjostrand, U. Neurologic effects of tryptophan in patients receiving a monoamine oxidase inhibitor. Neurology 1960, 10: 1076–8.CrossRefGoogle ScholarPubMed
29.Silins, E, Copeland, J, Dillon, P. Qualitative review of serotonin syndrome, ecstasy (MDMA) and the use of other serotonergic substances: hierarchy of risk. Aust N Z J Psychiatry 2007; 41(8): 649–55.CrossRefGoogle ScholarPubMed
30.Gnanadesigan, N, Espinoza, RT, Smith, R, Israel, M, Reuben, DB. Interaction of serotonergic antidepressants and opioid analgesics: is serotonin syndrome going undetected? J Am Med Dir Assoc 2005; 6(4): 265–9.CrossRefGoogle ScholarPubMed
31.Guo, SL, Wu, TJ, Liu, CC, Ng, CC, Chien, CC, Sun, HI. Meperidine-induced serotonin syndrome in a susceptible patient. Br J Anaesth 2009; 103(3): 369–70CrossRefGoogle Scholar
32.Kirschner, R, Donovan, JW. Serotonin syndrome precipitated by fentanyl during procedural sedation. J Emerg Med 2010; 38(4): 477–80.CrossRefGoogle ScholarPubMed
33.Martinez, TT, Martinez, DN. A case of serotonin syndrome associated with methadone overdose. Proc West Pharmacol Soc 2008; 51: 42–4Google ScholarPubMed
34.Lee, J, Franz, L, Goforth, HW. Serotonin syndrome in a chronic-pain patient receiving concurrent methadone, ciprofloxacin, and venlafaxine. Psychosomatics 2009; 50(6): 638–9.CrossRefGoogle Scholar
35.Kinoshita, H, Ohkubo, T, Yasuda, M, Yakushiji, F. Serotonin syndrome induced by dextromethorphan (Medicon) administrated at the conventional dose. Geriatr Gerontol Int 2011; 11(1): 121–2.CrossRefGoogle ScholarPubMed
36.Sternbach, H. The serotonin syndrome. Am J Psychiatry 1991; 148 (6): 705–13.Google ScholarPubMed
37.Dunkley, EJ, Isbister, GK, Sibbritt, D, Dawson, AH, Whyte, IM. The Hunter serotonin toxicity criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM 2003; 96(9): 635–42.CrossRefGoogle ScholarPubMed
38.Van Sweden, B, Mellerio, F. Toxic ictal delirium. Biol Psychiatry 1989; 25: 449–58.CrossRefGoogle ScholarPubMed
39.Alnwick, GM. Misdiagnosis of serotonin syndrome as fibromyalgia and the role of physical therapists. Phys Ther 2008; 88(6): 757–65.CrossRefGoogle ScholarPubMed
40.Gillman, PK. The serotonin syndrome and its treatment. J Psychopharmacol 1999; 13(1): 100–9.CrossRefGoogle ScholarPubMed
41.Graudins, A, Stearman, A, Chan, B. Treatment of the serotonin syndrome with cyproheptadine. J Emerg Med 1998; 16(4): 615–9.CrossRefGoogle ScholarPubMed
42.Boddy, R, Ali, R, Dowsett, R. Use of sublingual olanzapine in serotonin syndrome. J Toxicol Clin Toxicol 2004; 42(5): 725.Google Scholar
43.Duggal, HS, Fetchko, J. Serotonin syndrome and atypical antipsychotics. Am J Psychiatry 2002; 159 (4): 672–3.CrossRefGoogle ScholarPubMed
44.Watson, WA, Litovitz, TL, Rodgers, GC Jr, Klein-Schwartz, W, Youniss, JRose, SRet al. 2002 Annual report of the American association of poison control centers toxic exposure surveillance system. Am J Emerg Med. 2003; 21(5): 353–421.CrossRefGoogle Scholar
45.Canadian Coalition for Seniors Mental Health. Canadian Coalition for Seniors Mental Health guidelines on depression. Toronto, ON: Canadian Coalition for Seniors Mental Health; 2006. Available: www.ccsmh.ca.Google Scholar
46.Pilgrim, J L, Gerostamoulos, D, Drummer, Olaf H. Deaths involving serotonergic drugs. Forensic Sci Int 2010; 198(1–3): 110–7.CrossRefGoogle ScholarPubMed
47.Isbister, GK, Bowe, SJ, Dawson, A, Whyte, IM. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. J Toxicol Clin Toxicol 2004; 42: 277–85.CrossRefGoogle ScholarPubMed
48.Mackay, FJ, Dunn, NR, Mann, RD. Antidepressants and the serotonin syndrome in general practice. Br J Gen Pract 1999; 49 (448): 871–4.Google ScholarPubMed