Abstract
Serotonin syndrome is a potentially life-threatening event occuring during pharmacotherapy. It is based on the hyperstimulation of the serotonin (5-HT) system, mediated through postsynaptic 5-HT1A and 5-HT2 receptors.
The typical clinical features are: alterations of the mental status (anxiety, confusion, hypomania, agitation), neurological impairments (myoclonus, hyperreflexia, tremor, ataxia), gastrointestinal symptoms (diarrhea, vomiting), cardiovascular symptoms (hypertension, tachycardia), autonomic signs (diaphoresis, fever). The most common cause of the 5-HT hyperstimulation are inappropriate drug-drug interactions.
All SSRI-type antidepressants can induce serotonin syndrome, the most risky is an interaction between SSRIs and MAOIs. The most efficious treatment is an immediate withdrawal of all 5-HT agents.
If necessary, supportive therapy and treatment with benzodiazepines can be provided. Furthermore, 5-HT blockers, such as methysergid, cyproheptadine, and propranolol may be given.
However, the most important precaution is the prophylaxis of the serotonin syndrome by a sufficient wash-out period during switching antidepressants of different class.