THE SEROTONIN SYNDROME

The authors review case reports of the ''serotonin syndrome'' which includes tremor, myoclonus, diarrhea, confusion, hypomania, agitation, hyperreflexia, shivering, incoordination, fever, and diaphoresis. These cases followed treatment with L-tryptophan, monoamine oxidase inhibitors (MAOIs), serotonin re-uptake inhibitors and tricyclics. In animals, similar reports of hyperactivity, stereotyped movements and temperature increase have been reported after treatment with serotonergic agents. Most of the symptoms were specifically blocked by pre-treatment with a serotonin synthesis inhibitor. The authors discuss the specificity of this syndrome and also present results from a systematic evaluation of the serotonin syndrome in patients taking tricyclic antidepressants.