Prakash S, Rathore C, Rana K, Roychowdhury D, Lodha D. Chronic serotonin syndrome: A retrospective study. World J Psychiatr 2021; 11(4): 124-132 [PMID: 33889537 DOI: 10.5498/wjp.v11.i4.124]
Corresponding Author of This Article
Sanjay Prakash, MD, Professor, Department of Neurology, Smt. B.K. Shah Medical Institute and Research Centre, Sumandeep Vdyapeeth, Piparia, Waghodia, Vadodara 391760, India. drprakashs@yahoo.co.in
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sanjay Prakash, Chaturbhuj Rathore, Kaushik Rana, Department of Neurology, Smt. B.K. Shah Medical Institute and Research Centre, Sumandeep Vdyapeeth, Vadodara 391760, India
Diptangshu Roychowdhury, Department of Psychiatry, Smt. B.K. Shah Medical Institute and Research Centre, Sumandeep Vdyapeeth, Vadodara 391760, India
Deepali Lodha, Department of Medicine, Smt. B.K. Shah Medical Institute and Research Centre, Sumandeep Vdyapeeth, Vadodara 391760, India
Author contributions: Prakash S was involved in the conceptualization of the project, data collection, statistical analysis, supervision of the project, and writing the original draft; Rathore C was involved in the analysis and interpretation of data and writing the original draft; Rana K was involved in the analysis and interpretation of data and revising the manuscript for intellectual content; Roychowdhury D was involved in data collection and revising the manuscript for intellectual content; Lodha D was involved in data collection and revising the manuscript for intellectual content; All authors approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Sumandeep Vidyapeeth Institutional Ethics committee, Piparia, Vadodara, India (SVIEC/ON/MEDI/RP/20116).
Informed consent statement: Written informed consent was taken from all patients to publish this observation.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sanjay Prakash, MD, Professor, Department of Neurology, Smt. B.K. Shah Medical Institute and Research Centre, Sumandeep Vdyapeeth, Piparia, Waghodia, Vadodara 391760, India. drprakashs@yahoo.co.in
Received: December 14, 2020 Peer-review started: December 14, 2020 First decision: January 18, 2021 Revised: January 21, 2021 Accepted: March 9, 2021 Article in press: March 9, 2021 Published online: April 19, 2021
Abstract
BACKGROUND
Serotonin syndrome (SS) is an underdiagnosed drug-induced clinical syndrome resulting from the excess intrasynaptic concentration of serotonin. Very limited information is available about chronic SS.
AIM
To evaluate the epidemiological, clinical, and other aspects of the insidious onset SS.
METHODS
We retrospectively evaluated 14 consecutive adult patients (> 18 years) who had complaints for more than 6 wk at the time of consultation and met the Hunter criteria for SS.
RESULTS
The mean age was 41.1 years (range: 21-61 years), with a male preponderance (64%). Although tremors were observed in all patients, this was a presenting complaint in only 43% of patients. Generalized body pain, insomnia, and restlessness were common presenting features (50% each). Other common clinical features were stiffness of the limbs (43%), diaphoresis (43%), gait disturbances (36%), bowel disturbances (36%), dizziness (29%), sexual dysfunctions (21%), incoordination (14%), and fatigue (14%) The mean duration of symptoms before the diagnosis of SS was 13.5 ± 5.8 wk (range: 6-24 wk). Amitriptyline was the most common drug (n = 6, 43%), followed by tramadol (n = 5, 36%) and sodium valproate (n = 5, 36%). All patients received cyproheptadine, a 5- hydroxytryptamine2A antagonist, as treatment and noted an excellent response over the course of 4-14 d.
CONCLUSION
This study represents the largest study on chronic SS. We suggest that patients receiving serotonergic drugs should be physically examined for the presence of SS upon the development of new symptoms.
Core Tip: Chronic serotonin syndrome (SS) is an evolving concept. It may present with nonspecific symptoms such as generalized body pain, stiffness/rigidity, insomnia, restlessness, and tiredness. As misdiagnosis is common for typical cases of SS, a high level of clinical suspicion is required to identify patients with a chronic variant. A detailed drug history and thorough physical examinations are needed to detect a case of SS. Diagnosis of even mild SS is important as inadvertent use of another serotonergic agent may worsen the clinical symptoms, and sometimes it can be fatal.
