The scoop on serotonin syndrome

Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders

“…Serotonin syndrome, caused by elevated brain serotonin levels, can be triggered when serotonergic medications are combined. 99 Symptoms can arise within 24 to 48 hours after combining medications and are characterized by mental status changes (confusion, agitation, anxiety); neuromuscular hyperactivity (tremors, clonus, hyperreflexia, muscle rigidity); and autonomic hyperactivity (hypertension, tachycardia, arrhythmias, tachypnea, diaphoresis, shivering, vomiting, diarrhea). Advanced symptoms include fever, seizures, arrhythmias, and unconsciousness, which can lead to fatalities.…”

Serotonin syndrome: a clinical review of current controversies

“…In the presence of a serotonergic agent and either symptom/symptom constellation: tainty about SS's exact pathophysiological mechanism has led to a controversy regarding which substances exactly can precipitate SS. For instance, it has been suggested that that severe SS "usually'' (Buckley et al, 2014;Isbister and Buckley, 2005) or "almost exclusively'' (Foong et al, 2018;Isbister and Buckley, 2005) involves monoamine oxidase inhibitors.…”

Serotonin Syndrome/Serotonin Toxicity

“…30 The most toxic combination of serotoninenhancing drugs includes MAOIs taken with SSRIs or SNRIs, or a combination of 2 MAOIs. [5][6][7][8][9] Other potentially lethal combinations may include polypharmacy with antidepressants, pain medications, OTC medications, and illicit drugs. Linezolid, a new synthetic antimicrobial, is considered to be a weak MAOI.…”

“…3,4 SEROTONIN SYNDROME Experts in the fields of psychiatry, pharmacy, and toxicology refer to these symptoms as serotonin toxicity, because the symptoms result from the toxic effects of too much serotonin. [5][6][7][8][9] The term toxicity instead of syndrome "clarifies that it is a form of poisoning, just as lithium toxicity is a form of poisoning." 6 Therefore, serotonin toxicity (ST) can develop with administration of any serotoninenhancing medication, including therapeutic use, polypharmacy, or accidental/intentional drug overdose.…”