Serotonin syndrome (SS) is an important drug-related complication of psychopharmacologic therapy for major depression, bipolar affective disorder, obsessive-compulsive disorder, anxiety disorders, eating disorders, attention-deficit disorder, and Parkinson's disease. Although these disorders are diverse, the pharmacotherapies directed at treating these disorders all share the common effect of increasing central nervous system (CNS) serotonin neurotransmission. SS comprises variable alterations in cognition and behavior, autonomic nervous system function, and neuromuscular activity.

Critical care physicians need to be able to recognize and treat SS because many of these patients require intensive care monitoring as well as tracheal intubation and ventilatory support. In its most severe presentation, SS rapidly progresses to cardiac arrest, coma, seizures, or multiple organ failure with disseminated intravascular coagulation. An estimated 15 to 20 deaths have been attributed to SS. Some reports of fatal cases contain mostly circumstantial evidence linking the deaths to SS and, therefore, the cause of death remains debatable.<sup>10 Beasley C.M., Masica D.N., Heilgenstein J.H. Possible monoamine oxidase inhibitor-serotonin uptake inhibitor interaction: Fluoxetine clinical data and preclinical findings J Clin Psychopharmacol 1993 ;  13 : 312-320

Cliquez ici pour aller à la section Références, 48 Hernandaz A.F., Montero M.N., Pla A. , et al. Fatal moclobemide overdose or death caused by serotonin syndrome? J Forensic Sci 1995 ;  40 : 128-130

Cliquez ici pour aller à la section Références, 58 Kuisma M.J. Fatal serotonin syndrome with trismus Ann Emerg Med 1995 ;  26 : 109

Cliquez ici pour aller à la section Références, 76 Neuvonen P.J., Pohjola-Sintonen S., Tacke U. , et al. Five fatal cases of serotonin syndrome after moclobemide-citalopram or moclobemide-clomipramine overdoses Lancet 1993 ;  342 : 1419  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Nonetheless, SS can clearly become life-threatening and in some cases deaths have occurred despite early and aggressive intensive care.<sup>10 Beasley C.M., Masica D.N., Heilgenstein J.H. Possible monoamine oxidase inhibitor-serotonin uptake inhibitor interaction: Fluoxetine clinical data and preclinical findings J Clin Psychopharmacol 1993 ;  13 : 312-320

Cliquez ici pour aller à la section Références, 15 Brennan D., Manus M.M., Howe J. , et al. “Neuroleptic malignant syndrome” without neuroleptics Br J Psychol 1988 ;  152 : 578-579

Cliquez ici pour aller à la section Références, 56 Keltner N. Serotonin syndrome: A Case of Fatal SSRI/MAOI interaction Prospective in Psychiatric Care 1994 ;  30 : 26-31

Cliquez ici pour aller à la section Références, 57 Kline S.S., Mauro L.S., Scala-Barnett D.M. , et al. Serotonin syndrome versus neuroleptic malignant syndrome as a cause of death Clin Pharm 1989 ;  8 : 8510-8514

Cliquez ici pour aller à la section Références, 85 Power B.M., Pinder M., Hackett L.P. , et al. Fatal serotonin syndrome following a combined overdose of moclobemide, clomipramine and fluoxetine Anaesth Inten Care 1995 ;  23 : 499-502

Cliquez ici pour aller à la section Références, 106 Tackley R.M., Tregaskis B. Fatal disseminated intravascular coagulation following a monoamine oxidase inhibitor/tricyclic interaction Anaesthesia 1987 ;  42 : 760-763  [cross-ref]

Cliquez ici pour aller à la section Références, 110 VanBerkum M., Theil J., Segovia A. A fatality due to serotonin syndrome. [abstract] J Toxicol Clin Toxicol 1996 ;  34 : 559-560

Cliquez ici pour aller à la section Références</sup> Fortunately, most patients with SS improve with supportive care alone, but specific drug therapy has been reported to produce significant improvement in many patients.