Sustained serotonin syndrome in a treatment-resistant depressed patient during maintenance treatment with combination of three serotonergic agents
Serotonin syndrome (SS) is a relatively rare but potentially life-threatening condition caused by agents affecting serotonin (5-Hydroxytryptamine; 5-HT) metabolism or acting as direct 5-HT receptor agonists or both.15-HT is a monoamine neurotransmitter synthesized from the amino acid tryptophan. In the central nervous system,it regulates functions such as mood, appetite, sexual activity, sleep and some cognitive functions. Peripherally, 5-HT promotes platelet aggregation and also affects peristalsis and vascular tone2,3. A large number of agents, such as antidepressants (monoamine oxidase inhibitors-MAOIs, tricyclic antidepressants-TCAs, selective serotonin reuptake inhibitors-SSRIs, serotonin-norepinephrine reuptake inhibitors-SNRIs, buspirone, St. John’s wort),antibiotics (linezolid), antiemetics (ondansetron) antimigraine medications (sumatriptan), drugs of abuse (amphetamine, cocaine, LSD, ecstasy), herbal supplements and others have been associated with SS1.The vast majority of antidepressants can cause SS either by direct receptor agonism (buspirone), through decreased reuptake of 5-HT(SSRIs, SNRIs, TCAs) or decreased 5-HT breakdown(MAOIs)1. Lithium is used in combination with other antidepressants and has also been implicated in the development of SS4,5.
a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).