PATHOPHYSIOLOGY AND MANAGEMENT OF THE SEROTONIN SYNDROME

OBJECTIVE: To review the symptoms, pathophysiology, and treatment of t he serotonin syndrome (SS). DATA SOURCES: A MEDLINE search (1957-1995) of the English-language literature pertaining to the SS was performed . Additional literature was obtained from reference lists of pertinent articles identified through the search. STUDY SELECTION AND DATA EXTR ACTION: All articles were considered for possible inclusion in the rev iew. Pertinent information, as judged by the authors, was selected for discussion. DATA SYNTHESIS: The SS, an occasionally fatal disorder, i s characterized by symptoms such as mental status changes, seizures, m yoclonus, and blood dyscrasias. Both the central and peripheral seroto nergic systems and several serotonin receptor types are involved in th e symptomatology of the SS. The pathogenesis of SS may be due to endog enous as well as iatrogenic deficits in peripheral serotonin metabolis m, a stimulus for release of serotonin, and interactions with other ne urotransmitter systems. Lorazepam, serotonin-blockers, and nitroglycer in have been used successfully to treat SS. CONCLUSIONS: The SS is inc reasingly recognized and reported in the literature. Clinical and basi c science research have increased our understanding of the pathophysio logy, conditions, and agents that may predispose to the development of the syndrome. Newer treatment strategies are discussed.