Serotonin syndrome controversies: A need for consensus

Table 1 Epidemiological data regarding serotonin syndrome in different settings

Ref.	Year	Type of study	Setting of the study	Criteria used	Serotonergic drugs	Person screened	Prevalence
Mackay et al[17]	1999	Post-marketing surveillance study	General population	Sternbach	Nefazodone-therapeutic dose	11834 patients on nefazodone	0.04%
Isbister et al[18]	2003	Retrospective	Toxicology centre	Sternbach	Moclobemide poisoning and serotonergic agent	21 patients with overdose	55%
Isbister et al[7]	2004	Retrospective	Toxicology centre	Sternbach-clinical	Five different SSRIs. Overdose	469 SSRI poisoning admissions	14%
Koury et al[19]	2015	Retrospective. Database registry	Hospital	Hunter	Fentanyl and serotonergic agent-therapeutic dose	4538 patients	0.09%
van Ewijk et al[20]	2016	Prospective	ICU	Hunter or Sternbach	Multiple serotonergic agents-therapeutic dose	delirious patients on serotonergic agents (44 patients)	16%
Nguyen et al[21]	2017	Retrospective. Databases	General population	ICD-9-CM	Serotonergic drugs- therapeutic dose	15 million	0.19% to 0.07%
Karkow et al[22]	2017	Retrospective case-control	Inpatients	Hunter or Sternbach	Linezolid vs linezolid+ serotonergic agent. Therapeutic dose	87 vs 261	0.4% vs 1.1%
Orlova et al[23]	2018	Retrospective. Database registry	General population	ICD-9	Triptans and antidepressant. Therapeutic dose	30928 person-years	0.006 to 0.023%
Prakash et al[24]	2021	Prospective	ICU	Hunter	Multiple drugs. Therapeutic dose.	All 309 ICU patients	7.8%
Erken et al[25]	2022	Retrospective	Geriatric department	Hunter	Antidepressants. Therapeutic dose	238 elderly (> 60 yr)	25%
Cooper et al[26]	2023	Retrospective	Toxicology centre	No criteria used	Various combinations of serotonergic drugs. Overdose	1978 overdoses in 1520 patients	13.6%
Di Salvo et al[27]	2024	Prospective	Psychiatric ward	Hunter	Serotonergic antidepressant agent. Therapeutic dose	133	12%

ICU: Intensive care unit; ICD-9-CM: International Classification of Diseases, clinical modification; SSRI: Selective serotonin reuptake inhibitors.