Controversies in Serotonin Syndrome Diagnosis and Management: A Review

Over the past few years, Serotonin Syndrome (SS) has become a significant clinical concern. Over the last decade, United States saw a surge in antidepressant use. SS characteristically presents as the triad of altered mental status, autonomic dysfunction and neuromuscular excitation. Symptoms vary from patient to patient with mild cases presenting with subacute symptoms and severe cases progressing rapidly to death. Due to the protean manifestations of the syndrome along with non-specific prodromal, SS can easily be misdiagnosed if not carefully assessed. In severe cases, SS can be mistaken as neuroleptic malignant syndrome while mild cases are mostly misattributed to other causes such as flu. SS is a clinical diagnosis and therefore, requires a thorough review of medications and physical examination. Given the protean nature of this toxicologic syndrome various criteria were defined which includes Sternbach's, Radomski and Hunter's criteria. Keeping in mind the wide symptoms of serotonin syndrome from being barely perceptible to lethal emphasis there is a need to treat the syndrome on urgent basis. Mainstay for treatment of serotonin syndrome is to discontinue the offending drug. Improvement is seen in most patients within 24 hours.