Published online Apr 19, 2021. doi: 10.5498/wjp.v11.i4.124
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
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.
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.
To describe the epidemiological, clinical, and other aspects of chronic SS.
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.
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.
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.
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.