The serotonin syndrome scale: first results on validity

Abstract

As a modification of the diagnostic criteria of the serotonin syndrome proposed by Sternbach, we developed the Serotonin syndrome scale for the operationalized assessment of both the presence and the severity of the core symptoms of the serotonin syndrome. In a first study on the validity of this scale, the relationships between the serotonin syndrome score (SSS) and both the paroxetine plasma levels (n = 42) and the loudness dependence of the auditory evoked potentials (LDAEP; n = 24) were investigated in depressed patients treated with paroxetine. A strong LDAEP is supposed to indicate low central serotonergic neurotransmission, and vice versa. The SSS was positively related to paroxetine plasma levels and negatively to the LDAEP. Both results support the validity of the serotonin syndrome scale. Using a SSS > 6 as diagnostic criterion, mild serotonin syndromes were diagnosed in 5 of our 42 patients. The Serotonin syndrome scale may become a useful tool for clinicians and scientists dealing with the serotonin syndrome.

Dopamine receptor stimulation does not modulate the loudness dependence of the auditory evoked potential in humans

“…In humans, the relation between LDAEP and serotonin function has been supported by several indirect clinical studies where a stronger LDAEP has been associated with conditions characterized by low serotonin, including patients with generalized anxiety disorder , depression (Gallinat et al 2000), and 3,4-methylenedioxymethamphetamine (MDMA) users (Croft et al 2001;Tuchtenhagen et al 2000). In addition, similar studies have reported a weaker LDAEP in conditions associated with increased serotonin function such as schizophrenia and serotonin syndrome (Hegerl et al 1998).…”

The loudness dependency of the auditory evoked N1/P2-component as a predictor of the acute SSRI response in depression

“…Further support has been provided by a recent study in patients with the so-called serotonin syndrome, a serious sideeffect resulting from a high central serotonergic activity during of treatment with serotonin-agonistic substances. SSRI-treated patients with a high score in the serotonin syndrome scale (SSS) were found to have an extremely low LDAEP as compared to those with a low SSS score (Hegerl et al 1998). A study in freely moving cats clearly supported the concept of a close relationship between central serotonergic neurotransmission and the LDAEP recorded over the primary auditory cortex (Juckel et al 1997).…”

High-dose glycine inhibits the loudness dependence of the auditory evoked potential (LDAEP) in healthy humans

“…It has been proposed as a reliable non-invasive assessment of central serotonin function in humans (Hegerl and Juckel 1993;Juckel et al 1997Juckel et al , 1999Hegerl et al 2001), and a number of clinical studies have reported putative abnormalities in serotonin function using the LDAEP measure, including patients with depression (Buchsbaum and Pfefferbaum 1971) (Gallinat et al 2000), generalized anxiety disorder , methylenedioxymethamphetamine users (Tuchtenhagen et al 2000;Croft et al 2001), serotonin syndrome (Hegerl et al 1998), and schizophrenia .…”