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Serotonin Syndrome

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Movement Disorder Emergencies

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Serotonin syndrome presents with neuromuscular, autonomic, and mental status changes. Severe cases of serotonin syndrome are characterized by neuromuscular excitation (clonus, myoclonus, rigidity, and tremor), autonomic stimulation (hyperthermia, tachycardia, tachypnea, diaphoresis, and flushing), and altered mental state (anxiety, agitation, and confusion). These more severe cases may come to the clinician’s attention on an emergency basis. Serotonin syndrome is most often associated with the use of one or more serotonergic agents. Severe cases generally occur with combinations of serotonergic drugs, most commonly including a serotonin reuptake inhibitor and a monoamine oxidase inhibitor, although severe cases can also be attributed to use of a single serotonergic agent. Excessive serotonin (5-hydroxytryptamine) in the central nervous system (CNS) has been implicated. Certain patient populations and genetic polymorphisms may be predisposed to developing serotonin syndrome based on their use of various medications or other substances with serotonergic properties. When evaluating a patient with clinical features of neuromuscular excitation, autonomic stimulation, and/or altered mental state, prompt identification and management are critical, and treatment considerations are often complex. Awareness of all prescriptions, over-the-counter medications, herbs, and supplements can help identify drugs implicated in serotonin syndrome and encourage a prompt diagnosis and treatment.

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Authors and Affiliations

  1. Specialty Clinical Development, Teva Pharmaceuticals, West Chester, PA, USA

    Mark Forrest Gordon

  2. Adele Smithers Parkinson’s Disease Treatment Center, New York Institute of Technology—College of Osteopathic Medicine, Old Westbury, NY, USA

    Adena N. Leder

  3. New York Institute of Technology—College of Osteopathic Medicine, Old Westbury, NY, USA

    Laura A. Ketigian

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  1. Mark Forrest Gordon
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  2. Adena N. Leder
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  3. Laura A. Ketigian
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Correspondence to Laura A. Ketigian .

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  1. Department of Neurology, NYU Langone Health, New York, NY, USA

    Steven J. Frucht

Electronic Supplementary Material

This young man developed classic symptoms of serotonin syndrome, with lethargy, mild fever, and mild elevation of CK, soon after starting treatment with a serotonin-specific reuptake inhibitor for depression. Prominent lower extremity myoclonus is evident. (MP4 92260 kb)

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Gordon, M.F., Leder, A.N., Ketigian, L.A. (2022). Serotonin Syndrome. In: Frucht, S.J. (eds) Movement Disorder Emergencies. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-75898-1_8

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  • DOI: https://doi.org/10.1007/978-3-030-75898-1_8

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