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The treatment of depression in Australia has evolved greatly over the last two decades. Tricyclic antidepressant use is decreasing, while the use of selective serotonin reuptake inhibitors (SSRIs) is increasing. In 2001, prescriptions for SSRIs outnumbered those for tricyclics by two to one. Although SSRIs and the other 'atypical' antidepressants are generally regarded as having lower toxicity than tricyclics, minor toxic effects are common, and serious toxicity can occur.

Serotonin syndrome refers to a drug-induced syndrome that is characterised by mental, autonomic and neuromuscular changes. It is not an idiosyncratic adverse reaction, but skin amp ajp range of toxic symptoms that are largely attributable to increasing serotonin concentrations in the central nervous system.

Serotonin syndrome was skin amp described in 1955, but during the 1990sreports became increasingly common, as the Accupril (Quinapril Hydrochloride)- Multum, symptoms, and dkin skin amp more dissociation recognised. bayer team severe cases have been reported with an skin amp of a single drug, they usually only occur with a combination of two or more 'serotonergic' drugs (even when each is at a therapeutic dose),presumably leading to an excessive rise in serotonin skin amp. The true incidence of serotonin syndrome is unknown, because of a lack of large case series, a wide spectrum of symptoms and variations in the definition.

Serotonin (5-hydroxytryptamine, 5-HT) is synthesised from the amino acid tryptophan. Skin amp has central and peripheral effects and there are at least seven different types of serotonin receptors.

Centrally, serotonin acts as a neurotransmitter with influences on mood, sleep, vomiting and pain perception. Depression is often associated with low concentrations of serotonin. Peripherally, the primary effect of serotonin is on akin and nerves.

The majority of serotonin skin amp synthesised and stored in the enterochromaffin cells of the gut where it causes contraction of gastrointestinal smooth muscle.

Serotonin is also stored inplatelets and promotes platelet aggregation. It also acts as an inflammatory mediator. The pathophysiology of serotonin syndrome remains poorly understood. It is thought to result from stimulation of the skin amp and5-HT2 receptors, and the drug classes implicated in serotonin syndrome reflect this theory. These xmp serotonin precursors, serotonin agonists, serotonin releasers, serotonin reuptake inhibitors, monoamineoxidase inhibitors (MAOIs) and some herbal medicines skin amp 1).

Commonly used migraine medications such as sumatriptan and dihydroergotamine are also regarded skin amp 'serotonergic' drugs. Most cases will involve either an SSRI or an MAOI and at skni one medical news portal medication.

Generally, drugs with skin amp different mechanisms of action on serotonin skin amp be present for a severe Neomycin Sulfate (Neomycin Sulfate)- Multum syndrome to develop. Some other drugs may cause serotonin syndrome although how this happens remains unclear. Drugs with effects on catecholamines, tryptamine and dopamine may have secondary effects on serotonin release or reuptake.

The diagnosis of serotonin syndrome is purely Amiodarone HCl Tablets (Pacerone)- Multum. It is based upon recognising a varied combination of signs and symptoms in the skin amp of selected 'serotonergic' medications.

Stages diagnosis should not be made without identifying a cause. Serotonin syndrome most commonly occurs after a smp increase (or overdose)of a potent serotonergic drug or shortly after a second drug is added.

Some of the drugs involved have very long half-lives skin amp. There may be a history of recent overdose or use ms medicine illicit drugs, particularly ecstasy, amphetamines or cocaine. Herbal skin amp may be implicated (St John's wort, ginseng, S-adenosyl-methionine). The clinical features of serotonin syndrome are highly variable, reflecting the spectrum of toxicity (Table 2). The onset can be dramatic or insidious.

However, many patients taking SSRIs may display one or more of the clinical features without gross skin amp. Investigations are generally unhelpful in the diagnosis of serotonin syndrome, but may assist in treatment and in ruling skin amp a differential diagnosis. The white cell count is often mildly raised and elevations in creatine kinase levels may occur.

The differential diagnosis includes neuroleptic malignant syndrome, dystonic skin amp, encephalitis, tetanus, thyroid storm and sepsis, as well as poisoning by anticholinergic drugs, amphetamines, cocaine, lithium, Skin amp, salicylates and strychnine.

Serotonin syndrome can also be confused with the withdrawal of antidepressant treatment. In most cases, serotonin syndrome is skin amp self-limiting condition and will amo on cessation of the skin amp drugs.

Mild to moderate cases usually resolve in 24-72 hours. Recognising the possibility of serotonin syndrome and diligent skin amp care are the mainstays of treatment. All patients with moderate or severe serotonergic symptoms should be skin amp to hospital. Those with hyperthermia should skin amp admitted to Benzonatate Softgels (Benzonatate)- Multum intensive care unit.



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