PsychoTropicalResearch, serotonin and serotonin syndrome research.
Serotonin Syndrome - Treatment
Serotonin Syndrome - Treatment
Date Created: 09/07/2001 Last Modified: 10/07/2001 Last Checked: 20/10/2003
The risk of fatality from serotonin syndrome suggests the need for early and urgent referral to a medical intensive care unit.
The preceding notes provide a sound basis for assessing which cases may need such referral. Early consultation via the poisons information centers is likely to be advisable:-- 24 hr Telephone no. in Australia 13 11 26.
In summary urgent referral to hospital if:--
- MAOI (including a RIMA) has been co-ingested with any serotonin reuptake inhibitor.
- Any type clonus + agitation or diaphoresis
- Tremor + hyperreflexia
- Hypertonic + temperature > 38ºC + ocular clonus or inducible clonus
Especially if they are worsening progressively.
Associate Professor Ian Whyte and his toxicology group in Newcastle (Australia) have a long-standing interest in collecting prospective data on serotonin syndrome and have adopted the treatment with chlorpromazine (for severe cases) that emerged as the likely best option from my review of serotonin syndrome treatment.
They have recently suggested "the challenge is to.... identify those patients in whom aggressive intervention is indicated" because "...... many patients who satisfy the diagnostic criteria for serotonin syndrome may only require observation and variable levels of supportive care".
They support the suggestion I have made, when critising the often espoused view that "conservative management is all that is needed" and like me say:-- "Supportive treatment such as ventilation, active cooling and symptom control should not be the sole treatment. Patients should receive drug treatment with serotonin antagonists. Cyproheptadine appears to be well tolerated and safe; we use it if patient is afebrile, more than 4 symptoms no obvious progression. Chlorpromazine is our preferred treatment in those patients who are ventilated or have impaired absorption (e.g. recent activated charcoal) or whose serotonin syndrome is judged to be clinically severe (febrile, 4 or more signs with evidence of progression).
They conclude, "Toxicologists should concern themselves with treating serotonin toxicity". They mean that what is arbitrarily defined as serotonin syndrome is not a treatment issue. The term serotonin toxicity is becoming more widely used
All text ©Dr Ken Gillman MRC Psych - PsychoTropical Research®
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