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Last month we discussed symptoms of serotonin syndrome and its diagnosis by the Hunter Criteria. Let's move on to what causes serotonin syndrome.
Serotonin Syndrome - What Causes It?
- Serotonin syndrome is not an idiopathic drug reaction, but the result of excess serotonin in the nervous system.
- It is classically associated with adminstration of two serotonergic agents, but it can occur after initiation of a single agent or increasing the dose of a serotonergic agent in individuals who are particularly sensitive to serotonin.
- Although selective serotonin reuptake inhibitors (SSRIs) are most commonly implicated, there are other medications encountered in the Emergency Department that can also play a role in serotonin syndrome.
- There are also reports of serotonin syndrome occuring with methadone, trazodone, and metaxalone (Skelaxin).
- Serotonin syndrome is often under-recognized if the symptoms are not severe. Thus a thorough medication history is important in its purely clinical diagnosis.
** Stay tuned for the conclusion on management of serotonin syndrome **
References
- Nordstrom K, Vilke GM, Wilson MP. Psychiatric emergencies for clinicians: emergency department management of serotonin syndrome. J Emerg Med 2015 Oct 7 [Epub ahead of print].
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