SS

Q: Serotonin syndrome (SS) is caused by overstimulation of? (select one)

A) central serotonin receptors

B) peripheral serotonin receptors

C) central and peripheral serotonin receptors

Answer: C

The conventional belief is that SS occurs due to central serotonin receptors. It is partially true. SS occurs due to both overstimulation of central and peripheral serotonin receptors. Mild cases of SS may go unnoticed as they may involve only nausea, vomiting, flushing, and diaphoresis. Severe cases cause hyperreflexia, myoclonus, muscular rigidity, hyperthermia, and autonomic instability. Myoclonus, tachycardia, and hyperthermia may be the most important clues as the diagnosis of SS is clinical and no lab tests are available.

Treatment includes discontinuation of all serotonergic medications. The initial treatment of serotonin syndrome is with benzodiazepines and cyproheptadine. Cyproheptadine (Periactin) appears to be the most effective antiserotonergic agent in humans. 

#pharmacology

#neurology

References:

1. Scotton WJ, Hill LJ, Williams AC, Barnes NM. Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. Int J Tryptophan Res. 2019 Sep 9;12:1178646919873925. doi: 10.1177/1178646919873925. PMID: 31523132; PMCID: PMC6734608.

2. Werneke U, Truedson-Martiniussen P, Wikström H, Ott M. Serotonin syndrome: a clinical review of current controversies. J Integr Neurosci. 2020 Dec 30;19(4):719-727. doi: 10.31083/j.jin.2020.04.314. PMID: 33378846.