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
ARTICLE HIGHLIGHTS
Research background
Serotonin syndrome (SS) is a life-threatening condition, and the clinical features largely depend on the degree of elevation of the intrasynaptic concentration of 5-hydroxytryptamine or serotonin. Mild elevation of serotonin levels causes mild serotonin toxicity and manifest as hyperreflexia, inducible clonus, tremors, anxiety, and restlessness. We hypothesize that mild SS may remain unnoticed for a longer duration and will manifest as insidious onset nonspecific symptoms.
Research motivation
Only very limited data are available about chronic SS. We believe that the diagnosis of chronic SS is important. Increasing the dose of a serotonergic agent or adding another serotonergic agent to a patient with chronic SS can be serious and fatal.
Research objectives
To describe the epidemiological, clinical, and other aspects of chronic SS.
Research methods
We retrospectively evaluated 14 consecutive adult patients (> 18 years) who had presenting complaints for more than 6 wk at the time of the first consultation and fulfilled the Hunter criteria of SS.
Research results
We identified 19 patients who met the inclusion criteria. Five patients were excluded for various reasons, and finally, the records of 14 cases were analysed. The mean age was 41.1 years (range: 21-61 years), with a male preponderance (64%). Generalized body pain, insomnia, and restlessness were common presenting features. The mean duration of symptoms before getting the diagnosis of SS was 13.5 ± 5.8 wk. Amitriptyline was the most common drug, followed by tramadol and sodium valproate. The response to cyproheptadine was satisfactory in all patients.
Research conclusions
Patients with chronic SS may have nonspecific symptoms. A detailed drug history and thorough physical examinations are essential to clinch the cases of chronic SS.
Research perspectives
The incidence of SS is increasing because of the widespread use of serotonergic drugs. There is a need to improve the awareness about SS among the physicians for early recognition and effective management.
