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Serotonin syndrome

Published online by Cambridge University Press:  02 January 2018

Shameem Mir  and
David Taylor
David Taylor*
Affiliation:
Denmark Hill London SE5 8AZ
*
∗ Correspondence
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Abstract

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Aims and method

To define serotonin syndrome and its symptoms and to discover which drugs or drug combinations are likely to cause it. A review of literature (including case reports) relating to serotonin syndrome collated from searches of MedLine and Micromedex covering the period January 1991 to July 1998.

Results

Most of the data found were either individual case reports or reviews of case reports. Reports of serotonin syndrome seem to be growing, certainly since the introduction of selective serotonin reuptake inhibitors. Particular combinations seem most likely to induce serotonin syndrome. Awareness of this syndrome as a distinct clinical entity seems to be growing.

Clinical implications

Serotonin syndrome is more likely to occur with drug combinations, especially those involving monoamine oxidase inhibitors. It can also occur when swapping antidepressant therapy, especially If changing from a long acting antidepressant such as fluoxetine. Caution is needed when changing antidepressants and particularly when they are used in combination.

Information

Type
Drug Information Quarterly
Information
Psychiatric Bulletin , Volume 23 , Issue 12: The Journal of Trends in Psychiatric Practice , December 1999 , pp. 742 - 747
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 1999 Royal College of Psychiatrists

References

Alderman, C. P. & Lee, P. C. (1996) Comment: serotonin syndrome associated with combined sertraline–amitriptyline treatment. Annals of Pharmacotherapy, 30, 1499 1500.Google Scholar
Benazzi, F. (1996) Serotonin syndrome with moclobemide–fluoxetine combination. Pharmacopsychiatry, 29, 162.Google Scholar
Bhatara, V. (1994) Venlafaxine–fluoxetine interaction? Current Affective Illness, 13, 14.Google Scholar
Bhatara, V. & Bandettini, F. (1993) Serotonin syndrome and interactions. Clinical Pharmacology Therapeutics, 1, 84 88.Google Scholar
Bhatara, V., Magnus, R. D., Paul, K. L., et al (1998) Serotonin syndrome induced by venlafaxine and fluoxetine: A case study in polypharmacy and potential pharmacodynamic and pharmacokinetic mechanisms. Annals of Pharmacotherapy, 32, 432 436.CrossRefGoogle ScholarPubMed
Brazelton, T., Blanc, P. D., Olson, K. R., et al (1997) Annals of Emergency Medicine, 30, 550 551.Google Scholar
Brown, T., Skop, B. P. & Mareth, T. R. (1996) Pathophysiology and management of the serotonin syndrome. Annals of Pharmacotherapy, 30, 527 533.Google Scholar
Brubacher, J. R., Hoffman, R. S. & Lurin, M. J. (1996) Serotonin syndrome from venlafaxine–tranylcypromine interaction. Veterinary and Human Toxicology, 38, 358 361.Google ScholarPubMed
Demirkiran, K., Jankovic, J. & Dean, J. M. (1996) Ecstasy intoxication: an overlap between serotonin syndrome and neuroleptic malignant syndrome. Clinical Neuropharmacology, 19, 157 164.Google Scholar
Diamond, S., Pepper, B. J., Diamond, M. L., et al (1998) Serotonin syndrome induced by transitioning from phenelzine to venlafaxine: four patient reports. Neurology, 51, 274 276.Google Scholar
Dingemanse, J., Wallnofer, A., Gieschke, R., et al (1998) Pharmacokinetic and pharmacodynamic interactions between fluoxetine and moclobemide in the investigation of development of the ‘serotonin syndrome’, Clinical Pharmacology Therapeutics, 63, 403 413.Google Scholar
Egberts, A. C. G., Ter Borgh, J. & Meijer-Brodie, C. C. E. (1997) Serotonin syndrome attributed to tramadol addition to paroxetine therapy. International Clinical Psychopharmacology, 12, 181 182.Google Scholar
Fink, M. (1996) Toxic serotonin syndrome or neuroleptic malignant syndrome? Pharmacopsychiatry, 29, 159 161.Google Scholar
Francois, B., Marquet, P., Desachy, A., et al (1997) Serotonin syndrome due to an overdose of moclobemide and clomipramine. A potentially life-threatening association. Intensive Care Medicine, 23, 122 124.Google Scholar
Gardner, D. M. & Lynd, L. D. (1998) Sumatriptan contraindications and the serotonin syndrome. Annals of Pharmacotherapy, 32, 33 38.Google Scholar
Gillman, P. K. (1997) Serotonin syndrome – clomipramine too soon after moclobemide. International Clinical Psychopharmacology, 12, 339 342.CrossRefGoogle ScholarPubMed
Gillman, P. K. (1999) The serotonin syndrome and its treatment. Journal of Psychopharmacology, 13, 100 109.Google Scholar
Gitlin, M. J. (1997) Venlafaxine, monoamine oxidase inhibitors, and the serotonin syndrome. Journal of Clinical Psychopharmacology, 17, 66 67.Google Scholar
Hilton, S. E., Maradit, H. & Moller, H. J. (1997) Serotonin syndrome and drug combinations: focus on MAOI and REMA. European Archives of Psychiatry and Clinical Neurosciences, 247, 113 119.Google Scholar
Hodgman, M. J., Martin, T. G. & Krenzelok, E. P. (1997) Serotonin syndrome due to venlafaxine and maintenance tranylcypromine therapy. Human and Experimental Toxicology, 16, 14 17.Google Scholar
John, L., Perreault, M. M., Tao, T., et al (1997) Serotonin syndrome associated with nefazodone and paroxetine. Annals of Emergency Medicine, 29, 287 289.CrossRefGoogle ScholarPubMed
Lane, R. & Baldwin, D. (1997) Selective serotonin reuptake inhibitor-induced serotonin syndrome: Review. Journal of Clinical Psychopharmacology, 17, 208 221.Google Scholar
Lejoyeux, M., Ades, J. & Rouillon, F. (1994) Serotonin syndrome. Incidence, symptoms and treatments. CNS Drugs, 2, 132 143.Google Scholar
Mason, B. J. & Blackburn, K. H. (1997) Possible serotonin syndrome associated with tramadol and sertraline coadministration. Annals of Pharmacotherapy, 31, 175 177.Google Scholar
Mekler, G. & Woggon, B. (1997) A case of serotonin syndrome caused by venlafaxine and lithium. Pharmacopsychiatry, 30, 272 273.Google Scholar
Mills, K. C. (1995) Serotonin syndrome. American Family Physician, 52, 1475 1482.Google Scholar
Mueller, P. D. & Korey, W. S. (1998) Death by ‘ecstasy’: the serotonin syndrome? Annals of Emergency Medicine, 32, 377 380.Google Scholar
Muly, C. E., McDonald, W., Steffens, D., et al (1993) Serotonin syndrome produced by a combination of fluoxetine and lithium. American Journal of Psychiatry, 150, 1565.Google Scholar
Nierenberg, D. W. & Semprebon, M. (1993) The central nervous system serotonin syndrome. Clinical Pharmacology Therapeutics, 53, 84–38.Google Scholar
Neuvonen, P. J., Pohjota-Sintonen, S., Tacka, U., et al (1993) Five fatal cases of serotonin syndromes after moclobemide–citalopram or moclobemide–clomipramine overdoses. Lancet, 342, 1419.Google Scholar
Nisijima, K., Shimizu, M., Abe, T., et al (1996) A case of serotonin syndrome induced by concomitant treatment with low-dose trazodone and amitriptyline and lithium. International Clinical Psychopharmacology, 11, 289 290.Google Scholar
Rosebush, P. I. & Margetts, P. (1999) Serotonin syndrome as a result of clomipramine monotherapy. Journal of Clinical Psychopharmacology, 19, 285 287.Google Scholar
Roxanas, M. G. & Machado, J. F. D. (1998) Serotonin syndrome in combined moclobemide and venlafaxine ingestion. Medical Journal of Australia, 168, 523 524.Google Scholar
Singer, P. P. & Jones, G. R. (1997) An uncommon fatality due to moclobemide and paroxetine, Journal of Analytical Toxicology, 21, 518 520.Google Scholar
Sobanski, T., Bagli, M., Laux, G., et al (1997) Serotonin syndrome after lithium add-on medication to paroxetine. Pharmacopsychiatry, 30, 106 107.Google Scholar
Spigset, O. & Mjorn-Dal, T. (1993) Serotonin syndrome caused by a moclobemide–clomipramine interaction. British Medical Journal 306, 248.Google Scholar
Sternbach, H. (1991) The serotonin syndrome. American Journal of Psychiatry, 148, 705 713.Google ScholarPubMed
Taylor, D. (1995) Selective serotonin reuptake inhibitors and tricyclic antidepressants in combination: Interactions and therapeutic uses. British Journal of Psychiatry, 167, 575 580.CrossRefGoogle ScholarPubMed
Weiner, L. A., Smythe, M. & Cisek, J. (1998) Serotonin syndrome secondary to phenelzine–venlafaxine interaction. Pharmacotherapy, 18, 399 403.Google Scholar
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