Praktické lekárnictvo 3/2023

Serotonin syndrome – a common problem, or rare complication?

Serotonin syndrome is a potentially fatal complication caused by drugs or substances that affect the serotonin system of the human body. It can arise as a result of usage of serotonin-acting medication, interactions with other substances (especially addictive substances) and as a result of intentional or unintentional overdose. A recent cohort study of a sample of 15 million patients taking serotinin-acting agents reported an incidence in the range of 0.07–0.19 over a follow-up period of 4 years. The symptoms of serotonin syndrome are divided into 3 basic groups – alterations of the mental state, autonomic dysregulation and neuromuscular hyperactivity. The severity of the syndrom varies from mild symptoms that can be treated via discontinuation of serotonergic medication to severe conditions requiring lung intensive care unit and sedation. The therapy of the syndrome is given by the state of the patient, in addition to the discontinuation of responsible medication, benzodiazepines and anticonvulsants are also used, and in the case of a more severe course, symptomatic intensive care is aimed to stabilize vital functions. The incidence of serotonin syndrome is also related to a significant increase in prescription of antidepressants (especially SSRI group). Despite the good safety profile of prescribed drugs, it is appropriate to be aware of the existence of serotonin syndrome.

Keywords: serotonin, syndrome, SSRIs, antidepressants