scholarly journals Serotonin syndrome: a spectrum of toxicity

2015 ◽  
Vol 21 (5) ◽  
pp. 324-332 ◽  
Author(s):  
Rabia Ellahi

SummarySerotonin syndrome (serotonin toxicity or serotonin toxidrome) is a potentially serious and theoretically predictable reaction that appears to be rarely diagnosed in practice in the UK. Some symptoms of serotonin syndrome overlap with features of other presentations in psychiatry and thus may be misattributed to mental illness (‘diagnostic overshadowing’). Further, there may be diagnostic dilemmas in patients on combinations of drugs, those receiving drugs with previously unknown serotonergic properties or where there are drug interactions. Prescriber vigilance and holistic review of the patient, including the pharmacotherapy, may be helpful in avoiding progression of serotonin syndrome to more serious outcomes.

2015 ◽  
Vol 207 (4) ◽  
pp. 298-298
Author(s):  
Rabia Ellahi

Numerous food and drug combinations, also ‘legal highs', may precipitate serotonin syndrome, yet it appears to be rarely diagnosed. This may be explained by diagnostic overshadowing when physical symptoms are misattributed to mental illness. Some symptoms of serotonin syndrome (agitation, tremor and rigidity) overlap with presentations in mental illness. Diagnostic confusion may occur in patients receiving polypharmacy, those receiving medications with previously unknown serotonergic properties or where unforeseen drug interactions occur. Acute medical presentations with hyperthermia and clonus should prompt holistic review to exclude other possible aetiologies. Discontinuation of the suspected agent may avert an array of possible serious outcomes.


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S152-S152
Author(s):  
Salakan Rai ◽  
Aizad Yusof

AimsTo determine the incidence of prescribing practice with associated risk of serotonin toxicity among patients with chronic pain conditions.BackgroundSerotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity, usually from drug interactions. Concurrent use of antidepressants is strongly linked to serotonin syndrome, with recent data revealing record numbers of NHS prescribed antidepressants in 2019. Antidepressant medications are also used in chronic pain management for their anti-neuropathic pain properties. However, it is well-recognised that a significant number of chronic pain patients suffer from anxiety and depression. This cohort of patients is therefore vulnerable to being exposed to multiple concurrent antidepressant agents, and thus at relatively higher risk of serotonin syndrome compared to other patient groups. Additionally, these patients are likely to be exposed to the concurrent use of antidepressants and certain analgesic agents particularly phenylpiperidine derivatives which increases serotonin toxicity risk.MethodMedications of patients presenting to a secondary care pain clinic within the last year were looked into. Patients were selected at random by pain management secretaries. Concurrent use of multiple antidepressant agents including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Noradrenaline Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs) or Tetracyclic Antidepressant (TeCA) was noted. Additionally, concurrent use of any of these antidepressant agents and phenylpiperidine derivatives such as Fentanyl and Tramadol was noted.ResultData on medications of 97 patients were collected. A total of 28 patients (28.8%) were observed to have at-risk medication combinations. Out of these, five patients were on both SSRI and TCA. Two patients were on both TCA and TeCA. Four other patients were on either a combination of SSRI and SNRI, SNRI and TCA, SSRI and TeCA, or TCA and TCA. Three patients were on both Fentanyl patches and an antidepressant. Fourteen patients were on both an antidepressant and Tramadol. None of these patients were diagnosed with serotonin syndrome; however, it is unclear as to whether these patients experienced milder symptoms of the syndrome.ConclusionA considerable number of patients in this group were on medication combinations putting them at risk of serotonin syndrome. Despite no documented patient harm, there is an urgent need for an increased awareness among prescribers on drug interactions which may lead to this syndrome and a subsequent change in prescribing practice.


CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 179-180
Author(s):  
Daniel Dowd ◽  
David S. Krause

AbstractBackgroundThere is a plethora of drugs available to psychiatrists for treatment of mental illness, which can vary in efficacy, tolerability, metabolic pathways and drug-drug interactions. Psychotropics are the second most commonly listed therapeutic class mentioned in the FDA’s Table of Pharmacogenomic Biomarkers in Drug Labeling. Pharmacogenomic (PGx) assays are increasingly used in psychiatry to help select safe and appropriate medication for a variety of mental illnesses. Our commercial laboratory offers PGx expert consultations by PharmDs and PhDs to clinician-users. Our database contains valuable information regarding the treatment of a diverse and challenging population.MethodsGenomind offers a PGx assay currently measuring variants of 24 genes relevant for selection of drugs with a mental illness indication. Since 2012 we have analyzed > 250,000 DNA samples. Between 10/18 - 8/20 6,401 reports received a consult. The data contained herein are derived from those consults. Consultants record information on prior meds, reason for failure or intolerability, potential risk-associated or useful drugs based on the genetic variants. Consultants only recommend specific drugs and doses consistent with a published PGx guideline.ResultsThe 5 most commonly discussed genes were SLC6A4, MTHFR, CACNA1C, COMT and BDNF. The 3 most commonly discussed drugs were fluoxetine, lithium and duloxetine. The most common reasons for drug failure were inefficacy and drug induced “agitation, irritability and/or anxiety”. SSRIs were the most common class of discontinued drug; sertraline, escitalopram and fluoxetine were the three most commonly reported discontinuations and were also the 3 most likely to be associated with “no improvement”. Aripiprazole was the most commonly reported discontinued atypical antipsychotic. The providers rated 94% of consultations as extremely or very helpful at the time of consult. An independent validation survey of 128 providers confirmed these ratings, with 96% reporting a rating of “very helpful” or “extremely helpful”. In addition, 94% reported that these consults were superior to PGx consults provided through other laboratories. Patient characteristics captured during consults via a Clinical Global Impressions-Severity (CGI-S) scale revealed that the majority of patients were moderately (54%) or markedly ill (23%). The most frequent symptoms reported were depression, anxiety, insomnia and inattentiveness.DiscussionThe large variety of psychotropic drugs available to providers, and their highly variable response rates, tolerability, capacity for drug-drug interactions and metabolic pathways present a challenge for even expert psychopharmacologists. Consultation with experts in PGx provides additional useful information that may improve outcomes and decrease healthcare resource utilization. This database may provide future opportunities for machine learning algorithms to further inform implications of included gene variants.FundingGenomind, Inc.


2009 ◽  
Vol 34 (4) ◽  
pp. 485-487 ◽  
Author(s):  
E. Montané ◽  
A. Barriocanal ◽  
I. Isern ◽  
T. Parajon ◽  
J. Costa

Author(s):  
Kevin T. Gobeske ◽  
Eelco F. M. Wijdicks

Serotonin syndrome affects the central nervous system, the autonomic nervous system, and the neuromuscular system and can have acute and potentially life-threatening manifestations. By definition, serotonin syndrome is associated with changes in serotonin exposure and thus might be described more accurately as serotonergic excess or serotonin toxicity. The central nervous system effects of serotonin involve regulation of attention, arousal, mood, learning, appetite, and temperature.


2017 ◽  
Vol 2 (2) ◽  
pp. 67
Author(s):  
Jennifer Yontz-Orlando

The United States is facing an epidemic of mental illness, affecting nearly 60 million Americans annually (http://www.nami.org/ ). The World Health Organization describes mental health as “a long neglected problem” and has established an action plan for 2013-2020 (http://www.who.int/mental_health/action_plan_2013/en/). One way to combat mental illness is through bibliotherapy, which is the use of written materials including fiction, nonfiction, and poetry to support emotional and psychiatric healing.Bibliotherapy has been in existence since ancient times, but began in earnest in the United States in the 1850’s during the “Great Awakening.” At that time, mental illness began to be seen as a medical condition rather than a supernatural phenomenon. Since then, due to the changing nature of our institutions, interest in bibliotherapy waned until the 1950’s when there was a slight resurgence in its practice. However, in the last 20 years, bibliotherapy has gained a stronghold in the United Kingdom. To relieve the stress of an overcrowded mental health system, public policy in the UK has supported the use of bibliotherapy in a variety of its institutions. There are many ways to conduct bibliotherapy, but studies show that when the process is interactive, such as in a support group setting, the results are better. Also, bibliotherapy can be conducted by many sorts of professionals, including doctors, therapists, social workers, teachers, and librarians. Studies also show that when the bibliotherapists are trained in the best practices of bibliotherapy, results improve. Bibliotherapy is an effective, low-cost alternative for people in need of therapeutic assistance. The UK model should be studied and implemented in the United States and in other nations to help solve the mental health crisis.


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