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UMass Chan Affiliations
Department of PsychiatryDocument Type
Journal ArticlePublication Date
2008-05-25Keywords
Antidepressive Agents, Second-GenerationAntipsychotic Agents
Anxiety Disorders
Benzodiazepines
Bupropion
Cyclohexanols
Delayed-Action Preparations
Depressive Disorder
Drug Therapy, Combination
Female
Fluoxetine
Humans
Methadone
Middle Aged
Opioid-Related Disorders
Serotonin Syndrome
Serotonin Uptake Inhibitors
Substance Abuse, Intravenous
Psychiatry
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Show full item recordAbstract
Serotonin syndrome is a potentially life-threatening adverse drug reaction caused by excessive serotonergic agonism in central and peripheral nervous system serotonergic receptors (Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005;352:1112-1120). Symptoms are characterized by a triad of neuron-excitatory features, which include (a) neuromuscular hyperactivity -- tremor, clonus, myoclonus, hyperreflexia and, in advanced stages, pyramidal rigidity; (b) autonomic hyperactivity -- diaphoresis, fever, tachycardia and tachypnea; (c) altered mental status -- agitation, excitement and, in advanced stages, confusion (Gillman PK. Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity. Br J Anaesth 2005;95:434-441). It arises when pharmacological agents increase serotonin neurotransmission at postsynaptic 5-hydroxytryptamine 1A and 5-hydroxytryptamine 2A receptors through increased serotonin synthesis, decreased serotonin metabolism, increased serotonin release, inhibition of serotonin reuptake or direct agonism of the serotonin receptors (Houlihan D. Serotonin syndrome resulting from coadministration of tramodol, venlafaxine, and mirtazapine. Ann Pharmacother 2004;38:411-413). The etiology is often the result of therapeutic drug use, intentional overdosing of serotonergic agents or complex interactions between drugs that directly or indirectly modulate the serotonin system (Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005;352:1112-1120). Due to the increasing availability of agents with serotonergic activity, physicians need to more aware of serotonin syndrome. The following case highlights the complex nature in which serotonin syndrome can arise, as well as the proper recognition and treatment of a potentially life-threatening yet easily avoidable condition.Source
Gen Hosp Psychiatry. 2008 May-Jun;30(3):284-7. Link to article on publisher's siteDOI
10.1016/j.genhosppsych.2007.09.007Permanent Link to this Item
http://hdl.handle.net/20.500.14038/45956PubMed ID
18433663Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.genhosppsych.2007.09.007