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Serotonin syndrome: A risk that should not be overlooked

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  1. Introduction
  2. Clinical case
  3. History
  4. Epidemiology
  5. Metabolism and serotonin receptors
  6. Pathophysiology of serotonin syndrome
  7. Clinique
  8. Tests
  9. Risks with successive administration of antidepressants
  10. Miscellaneous
  11. Bibliography

Serotonin syndrome is a complication potentially lethal psychotropic. It is characterized by altered mental status and the presence of disorders neuro vegetative and neuromuscular. In most cases, this syndrome is secondary to the prescription of several drugs responsible for an increased rate of brain serotonin, but it may also occur in mono-therapy to the usual doses. The interruption of medicinal products in question and symptomatic treatment allow a favorable clinical course in most cases, but the prescription antagonists receiving of serotonin may be necessary. The sometimes fatal outcome illustrates the difficulty of recognizing this syndrome in the practice and its severity in the absence of early diagnosis.

Clinical case

A patient of 87 years, for a known hypertensive and vascular heart disease and a history of gradual weakening of intellectual and then a year, was admitted to hospital for urinary incontinence, apathy and their pain secondary to a fall without loss knowledge. An evaluation neuro psychiatrical highlighted a major depression and dementia with moderate frontal damage and memory impairment.

[...] Despite their weak amphetamine-like effects (form it is not excluded that they play a role in promoting the occurrence of an SS by their stimulating effect on the release of sérotonin. Of serotonin syndrome were described in comedy with SSRIs (fluoxetine, sertraline and paroxetine) the tricyclic (two deaths) and fluoxetine pethidine. For a free interval of at least five weeks is required before introduction of selegiline because of the long half-life of norfluoxetine while an interval of two weeks is adequate when selegiline is stopped before the introduction of fluoxetine. [...]

[...] The usefulness of this review should be reassessed when the degradation pathway of serotonin is not blocked by this type of substance, serotonin syndrome is often described in the absence of MAOI. The serum of the offending drugs are most often the norm. This review does not exclude a serotonin syndrome, but to exclude an overdose of each of the molecules in isolation. Differential Diagnosis The main differential diagnosis is neuroleptic malignant syndrome. This syndrome is defined as an idiosyncratic reaction to neuroleptics, potentially fatal, characterized by muscle rigidity, fever, malfunction of the neurovegetative system and an altered state of consciousness. [...]

[...] These drugs are effective with a more rapid regression of symptoms, but in the case of neuroleptic malignant syndrome, their effect on mortality has not been demonstrated. Remember that? Serotonin syndrome is a complication of drugs influencing the rate of brain serotonin. It occurs early in the addition of a new substance, during a rapid increase in dosage or a switch of therapy without an adequate free interval is respected. Patients with depression, Parkinson's, migraine and chronic pain are particularly vulnerable because of their salary but no predisposing factor has been clearly demonstrated so far. [...]

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