Bettina C. Prator

Disclosures

J Neurosci Nurs. 2006;38(2):102-105. 

In This Article

Pathophysiology

Serotonin is a neurotransmitter synthesized both peripherally and centrally from dietary amino acid L-tryptophan. Serotonin is produced peripherally by the intestinal chromaffin cells and centrally by nuclei found in the lower pons and upper brain stem (Mills, 1997). It regulates emotional, personality, sleep, appetite, temperature, pain, sexual, and cardiopulmonary functions in the central nervous system. It also regulates smooth muscle tone, specifically of the blood vessels and gastrointestinal tract in the periphery (Boyer & Shannon, 2005).

Serotonin syndrome is a state of excess serotonin activity caused by therapeutic use, overdosage, withdrawal, or drug interaction of one or more serotonergic drugs (Mills, 1995). The mechanisms that result in such a depressants (MAOIs, SSRIs, and tricyclics), analgesics, hyperserotonergic state include an increase in serotonin production or decrease in serotonin metabolism. Boyer and Shannon (2005) identified medications such as antidepressants (MAOIs, SSRIs, and tricyclics), analgesics, weight-loss medications, antibiotics, over-the-counter drugs, street drugs, and dietary supplements as common serotonergic agents that could precipitate serotonin syndrome ( Table 1 ). Specifically, dextromethorphan, meperidine, tramadol, fluoxetine, citalopram, imipramine, and MAOIs have been commonly associated with severe cases of serotonin syndrome (Gillman, 1998).

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