Serotonin Toxicity: Associated Agents and Clinical Characteristics

Area of Science:

• Toxicology
• Pharmacology
• Clinical Medicine

Background:

• Serotonin toxicity is a frequent cause of drug-induced altered mental status.
• Limited data exists on its causes, symptoms, complications, and treatment rates.

Purpose of the Study:

• To evaluate the causes, symptomatology, complications, and treatment of serotonin toxicity.
• To analyze data from the international ToxIC registry.

Main Methods:

• Retrospective analysis of 1010 cases of serotonin toxicity from the ToxIC registry (2010-2016).
• Cases were diagnosed by medical toxicologists via bedside evaluation.
• Data on patient demographics, reasons for encounter, signs/symptoms, and treatments were collected.

Main Results:

• The majority of cases (67%) were adults aged 19-65, with intentional overdose being the most common reason (76%).
• Common symptoms included hyperreflexia/clonus/myoclonus (59.5%), agitation (33.4%), and tachycardia (25.3%).
• Antidepressants were the most frequent cause (44.7%), with bupropion being the most common single agent (7.2%).

Conclusions:

• Serotonin toxicity predominantly affects adults via intentional overdose, with antidepressants as the primary culprits.
• Bupropion, a norepinephrine/dopamine reuptake inhibitor, was notably frequent.
• Severe toxicity and mortality were infrequent, and cyproheptadine use was limited (15%).