serotoninsyndrom

Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonin activity in the central nervous system and peripheral nervous system. It most often results from the use of serotonergic medications or interactions between them, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, triptans, certain analgesics, and illicit serotonergic drugs. The onset is usually within hours to days after exposure, and risk is increased with polypharmacy, high doses, or dehydration.

Patients commonly show a triad of autonomic instability, neuromuscular abnormalities, and altered mental status. Features include agitation or confusion, tachycardia, hypertension, diaphoresis, fever, mydriasis, tremor, hyperreflexia, and clonus (often inducible or ocular). Diagnosis is clinical and relies on a history of serotonergic exposure; laboratory tests are not definitive, and conditions such as neuroleptic malignant syndrome or sepsis are considered in the differential. The Hunter criteria are frequently used to aid diagnosis in clinical practice.

Management focuses on rapid discontinuation of all serotonergic agents and supportive care. This may involve benzodiazepines for agitation and tremor, aggressive cooling and hydration, and careful monitoring, sometimes in an intensive care setting. In selected cases, the serotonin antagonist cyproheptadine is used as an antidote. With prompt recognition and treatment, most patients recover fully, though delays can lead to serious complications or death.