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

Cliccare qui per andare alla sezione Riferimenti, 48 Hernandaz A.F., Montero M.N., Pla A. , e al. Fatal moclobemide overdose or death caused by serotonin syndrome? J Forensic Sci 1995 ;  40 : 128-130

Cliccare qui per andare alla sezione Riferimenti, 58 Kuisma M.J. Fatal serotonin syndrome with trismus Ann Emerg Med 1995 ;  26 : 109

Cliccare qui per andare alla sezione Riferimenti, 76 Neuvonen P.J., Pohjola-Sintonen S., Tacke U. , e al. Five fatal cases of serotonin syndrome after moclobemide-citalopram or moclobemide-clomipramine overdoses Lancet 1993 ;  342 : 1419  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</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

Cliccare qui per andare alla sezione Riferimenti, 15 Brennan D., Manus M.M., Howe J. , e al. “Neuroleptic malignant syndrome” without neuroleptics Br J Psychol 1988 ;  152 : 578-579

Cliccare qui per andare alla sezione Riferimenti, 56 Keltner N. Serotonin syndrome: A Case of Fatal SSRI/MAOI interaction Prospective in Psychiatric Care 1994 ;  30 : 26-31

Cliccare qui per andare alla sezione Riferimenti, 57 Kline S.S., Mauro L.S., Scala-Barnett D.M. , e al. Serotonin syndrome versus neuroleptic malignant syndrome as a cause of death Clin Pharm 1989 ;  8 : 8510-8514

Cliccare qui per andare alla sezione Riferimenti, 85 Power B.M., Pinder M., Hackett L.P. , e al. Fatal serotonin syndrome following a combined overdose of moclobemide, clomipramine and fluoxetine Anaesth Inten Care 1995 ;  23 : 499-502

Cliccare qui per andare alla sezione Riferimenti, 106 Tackley R.M., Tregaskis B. Fatal disseminated intravascular coagulation following a monoamine oxidase inhibitor/tricyclic interaction Anaesthesia 1987 ;  42 : 760-763  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 110 VanBerkum M., Theil J., Segovia A. A fatality due to serotonin syndrome. [abstract] J Toxicol Clin Toxicol 1996 ;  34 : 559-560

Cliccare qui per andare alla sezione Riferimenti</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.