
Serotonin syndrome (SS) is the most serious clinical manifestation of serotonergic agent use. It is presumed to reflect centrally increased serotonergic neurotransmission although this has not been proven. It has been referred to as a toxidrome or toxic syndrome. The diagnosis is made on clinical grounds in patients who have taken one or more agents that are presumed to ‘increase’ serotonin. The incidence of SS is quite low during routine treatment but increases to approximately 15% in patients who overdose with serotonergic agents.
Common side-effects associated with SSRIs
- Headaches: new onset or worsening of a pre-existing problem
- Gastrointestinal disturbances, particularly nausea, upper gastric discomfort and diarrhea
- Restlessness or akathisia, perhaps associated with suicidality in younger patients
- Tremor
- Sexual dysfunction
- Easy bruising
Other reported complications of SSRI use
- Increased risk of upper gastrointestinal bleeding, especially in conjunction with non-steroidal anti-inflammatory medications Increased risk of intra-operative bleeding
- Increased risk of developing osteoporosis
- Extrapyramidal side-effects
- Syndrome of inappropriate secretion of anti-diuretic hormone (SIADH), especially in the elderly
It is, therefore, important for the treating clinician to consider each patient’s medical and psychiatric history, with attention to the potential for SSRIs to complicate or worsen certain conditions such as migraines
Patients appreciate physicians’ awareness of the side-effect profile of the medications they prescribe and usually welcome the opportunity to be appropriately educated. This enhances compliance, primary prevention and early detection as well as timely intervention when problems arise
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