However, none of the cases reported by the FDA met even the very loose criteria described above. In 2006, the FDA issued an alert suggesting that combined use of SSRI, SNRIs, and triptans could potentially lead to severe cases of serotonin syndrome (Evans, 2007).
Other sedative that have nothing to do with serotonin, such as a benzodiazepine type drugs, are also commonly used. This makes some sense - if someone is agitated, a sedative should help. The recommended treatment for "serotonin syndrome" is a sedative that blocks serotonin called "cyproheptadine". Then you treat them with something to calm them down. Then rather than just saying that they are upset, you can use the much more interesting diagnosis of "serotonin syndrome". In other words, these criteria could include many situations where someone is taking an antidepressant, gets upset and starts to shake. Well, anyway.Įither sets of these criteria are very broad and might easily occur any agitated person who happens to be taking an SSRI type antidepressant. We are doubtful that this occurs in "serotonin syndrome", and if it does, we would love to see a video that proves it. We are familiar with the term " opsoclonus", which means wild randomly directed back-back saccadic eye movements. We are not entirely sure what these authors mean by "ocular clonus", as this is not a term commonly encountered in the specialties that deal with eye movements such as neuroopthalmology or otoneurology. The brisk reflexes make the criteria slightly tighter than the Sternbach criteria. If we consider these carefully, what you need to be "diagnosed" is to have taken a drug that is on the serotonin list, be agitated, and have brisk reflexes.
To meet the "Hunter" criteria (Dunkley et al, 2003), the patient must have a lot of "OR" criteria: Something like you might get from too much adrenalin. Boiling this down to the essentials, you need shaking, sweating, and agitation.
#BRISK REFLEXES PLUS#
Sternbach (1991) suggested that one needs exposure to a drug in the proper category plus a change in mental status, restlessness, myoclonus, diaphoresis, shivering and tremor. There have been a couple of attempts to define serotonin syndrome. We think that if there were a real method of diagnosing "serotonin syndrome", perhaps having to do with measuring serotonin, the # of papers would likely diminish very rapidly. As there is no "litmus test" for Serotonin syndrome, the medical system allows assignment of the diagnosis liberally, as there is no way to disprove it given these loose criteria have been met. Rather than having brown hair or a line in one's palm in fortune telling, one diagnoses Serotonin syndrome by deciding there is agitation, high blood pressure, high body temperature, and increased reflexes. "Serotonin syndrome" is not diagnosed using blood tests or imaging, but rather (like fortune telling) it is diagnosed by observing a combination of rather common symptoms. It seems to us that the reason for the large # of papers is that the criteria for"diagnosis" of serotonin syndrome are extremely loose. There were more than 7000 papers that had "serotonin syndrome" as an indexed word. It is a very popular topic for papers, and a search of PUBMED for papers with "serotonin syndrome" in the title in 2012 came up with nearly 1000 hits. While it is supposedly an overdose syndrome, most of the reports in the literature are idiosyncratic reactions. Serotonin syndrome is a set of symptoms, attributed to a drug reaction or an interaction between several drugs that affect serotonin. You may also be interested in our many pages on migraine on this site Serotonin Syndrome and Migraine Treatment
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