For example some case reports have implicated atypical antipsychotics in serotonin syndrome but it appears based on their pharmacology that they are unlikely to cause serotonin syndrome. Many medications may have been incorrectly thought to cause serotonin syndrome. cite journal |author=Sternbach H |title=The serotonin syndrome |journal=Am J Psychiatry |volume=148 |issue=6 |pages=705–13 |year=1991 |month=June |pmid=2035713 |doi= |url=] Many MAOIs inhibit monoamine oxidase irreversibly, so that the enzyme cannot function until it has been replaced by the body, which can take at least four weeks. The combination of MAOIs and other serotonin agonists or precursors poses a particularly severe risk of a life-threatening serotonin syndrome. cite journal |author=Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM |title=The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity |journal=QJM |volume=96 |issue=9 |pages=635–42 |year=2003 |month=September |pmid=12925718 |doi= |url=] It may also occur in patients following ingestion of a single serotonergic agent. Many cases of serotonin toxicity occur in patients who have ingested drug combinations that synergistically increase synaptic serotonin. ISBN 0-957] cite journal |author=Munhoz RP |title=Serotonin syndrome induced by a combination of bupropion and SSRIs |journal=Clinical neuropharmacology |volume=27 |issue=5 |pages=219–22 |year=2004 |pmid=15602102| doi = 10.1097/01.wnf.0000142754.46045.8c] cite journal |author=Karki SD, Masood GR |title=Combination risperidone and SSRI-induced serotonin syndrome |journal=The Annals of pharmacotherapy |volume=37 |issue=3 |pages=388–91 |year=2003 |pmid=12639169| doi = 10.1345/aph.1C228] Adelaide: Australian Medicines Handbook 2005. cite journal | author = Isbister G, Bowe S, Dawson A, Whyte I | title = Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose | journal = J Toxicol Clin Toxicol | volume = 42 | issue = 3 | pages = 277–85 | year = 2004 | pmid = 15362595 | doi = 10.1081/CLT-120037428] Ī large number of drugs and drug combinations have been reported to produce serotonin syndrome. Serotonin toxicity is more pronounced following supra-therapeutic doses and overdoses, and they merge in a continuum with the toxic effects of overdose. |chapter=Serotonin Toxicity/Syndrome|title=Medical Toxicology |publisher=Williams & Wilkins| location=Philadelphia |year=2004|pages=103–6| isbn=0-7817-2845-2] Serotonin excess was first noted in humans in 1960. It appears to be the result of overstimulation of primarily the 5-HT2A receptors and not by 5-HT1A receptors in central grey nuclei and the medulla as originally suspected. Serotonin syndrome is caused by increased serotonin in the central nervous system. Serotonin is a neurotransmitter, discovered in 1948, it is involved in multiple states including aggression, pain, sleep, appetite, anxiety, depression, migraine, and emesis. cite journal |author=Boyer EW, Shannon M |title=The serotonin syndrome |journal=N. This excess serotonin activity produces a specific spectrum of clinical findings which may range from barely perceptible to fatal. Serotonin syndrome is not a spontaneous drug reaction it is a consequence of excess serotonergic activity at central nervous system (CNS) and peripheral serotonin receptors. Rarely it may also be called serotonin storm, hyperserotonemia, or serotonergic syndrome. It is most commonly referred to as serotonin syndrome, but the terms serotonin toxicity or serotonin toxidrome are more accurate as they reflect the fact that it is a form of poisoning. Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, or the recreational use of certain drugs.
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