We searched PubMed and Google Scholar for relevant articles on serotonin toxicity, the causes, and the differential diagnoses. The objective of this update is to review the symptoms of serotonin toxicity and the causative drugs and their mechanisms of action, and to equip primary care providers with practical strategies to prevent and identify serotonin toxicity. 1, 2, 4 With the ever increasing use of antidepressants for mood and other conditions such as anxiety, pain, sleep, and menopausal hot flashes, clarity is needed to help health care professionals prevent, identify, and manage serotonin toxicity. 2 The lack of agreed-upon diagnostic criteria, inconsistencies in clinical symptoms, and clinicians who are not trained to identify it mean that case reports are published even when patients do not experience serotonin toxicity, which complicates the literature. Mild toxicity appears to be rare but is likely under-reported, unrecognized, or confused with other syndromes. Most cases do not require medication intervention, but can be managed by stopping the drug or decreasing the dose. 1– 3Ĭases of serotonin syndrome resulting in hospitalization or death are rare. 1– 3 While the most common culprits are monoamine oxidase inhibitors (MAOIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs), the list of potential contributors is long and includes often-overlooked substances such as herbals and illicit drugs. Most cases involve 2 drugs that increase serotonin in different ways or an overdose of 1 serotonin-elevating drug. 1– 3 Patients present with a combination of neuromuscular, autonomic, and mental status symptoms. Serotonin toxicity (commonly referred to as serotonin syndrome) is a potentially life-threatening drug-induced condition caused by too much serotonin in the synapses of the brain.
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