Selective Serotonin Reuptake Inhibitor Toxicity Questions & Answers

Updated: Apr 24, 2018
  • Author: Tracy A Cushing, MD, MPH, FACEP, FAWM; Chief Editor: Michael A Miller, MD  more...
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Questions & Answers

Overview

What are selective serotonin reuptake inhibitors (SSRIs)?

What is serotonin syndrome (SS)?

What causes serotonin reuptake inhibitor (SSRI) toxicity?

What are the causes of serotonin syndrome (SS)?

Which serotonin-norepinephrine reuptake inhibitors (SNRIs) are associated with serotonin syndrome (SS)?

What is the role of trazodone in the etiology of serotonin syndrome (SS)?

What is the role of bupropion (Wellbutrin) in the etiology of serotonin syndrome (SS)?

Which opioids are associated with serotonin syndrome (SS)?

Which antimicrobial agents are associated with serotonin syndrome (SS)?

What is the pharmacokinetics of selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the complications of selective serotonin reuptake inhibitor (SSRI) toxicity?

What is the role of serotonin in the pathogenesis of selective serotonin reuptake inhibitor (SSRI) toxicity?

What causes serotonin syndrome (SS)?

What is the importance of medication history in determining the etiology of selective serotonin reuptake inhibitor (SSRI) toxicity?

What is the cause of the multiple signs and symptoms of selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the mechanisms of serotonin increase in selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the physiologic manifestations of serotonin syndrome (SS)?

What are the autonomic nervous system effects of selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the cardiovascular system effects of selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the GI effects of selective serotonin reuptake inhibitor (SSRI) toxicity?

What is the incidence of selective serotonin reuptake inhibitor (SSRI) toxicity in the US?

How does the incidence of selective serotonin reuptake inhibitor (SSRI) toxicity vary by age?

What is the prognosis of selective serotonin reuptake inhibitor (SSRI) toxicity?

What causes fatality in selective serotonin reuptake inhibitor (SSRI) toxicity?

What should be included in patient education about selective serotonin reuptake inhibitor (SSRI) toxicity?

Presentation

When is selective serotonin reuptake inhibitor toxicity most likely to develop?

What should be the focus of patient history in the evaluation of selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the diagnostic criteria for serotonin syndrome (SS)?

What is the Hunter Serotonin Toxicity Criteria for the diagnosis of selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the signs and symptoms of serotonin syndrome (SS)?

What are the general signs of excess serotonin in selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the neuromuscular findings suggestive of selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the mental status findings suggestive of selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the autonomic findings suggestive of selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the peripheral findings suggestive of selective serotonin reuptake inhibitor (SSRI) toxicity?

How is selective serotonin reuptake inhibitor (SSRI) toxicity distinguished from other toxic ingestions?

How is neuroleptic malignant syndrome distinguished from selective serotonin reuptake inhibitor (SSRI) toxicity?

How is anticholinergic toxicity distinguished from selective serotonin reuptake inhibitor (SSRI) toxicity?

DDX

Which conditions should be included in the differential diagnosis for selective serotonin reuptake inhibitor (SSRI) toxicity?

What are the differential diagnoses for Selective Serotonin Reuptake Inhibitor Toxicity?

Workup

What is the role of lab testing in the diagnosis of selective serotonin reuptake inhibitor (SSRI) toxicity?

What is the role of imaging studies in the workup of selective serotonin reuptake inhibitor (SSRI) toxicity?

Which procedures are used in the workup of selective serotonin reuptake inhibitor (SSRI) toxicity?

Treatment

What are the treatment options for selective serotonin reuptake inhibitor (SSRI) toxicity?

What is included in inpatient care for selective serotonin reuptake inhibitor (SSRI) toxicity?

How is symptomatic citalopram/escitalopram overdose managed?

Which specialist consultations can aid in patient care for selective serotonin reuptake inhibitor (SSRI) toxicity?

Which organization has issued guidelines for prehospital management of selective serotonin reuptake inhibitor (SSRI) toxicity?

What is included in prehospital care for selective serotonin reuptake inhibitor (SSRI) toxicity?

What is the initial emergency department (ED) care for selective serotonin reuptake inhibitor (SSRI) toxicity?

What is included in the emergency department (ED) care of mild selective serotonin reuptake inhibitor (SSRI) toxicity?

What is included in the emergency department (ED) care of moderate selective serotonin reuptake inhibitor (SSRI) toxicity?

What is the protocol for severe emergency department care for patients with selective serotonin reuptake inhibitor toxicity?

How is severe hyperthermia in selective serotonin reuptake inhibitor (SSRI) toxicity managed?

What are the pharmacological treatment options for severe selective serotonin reuptake inhibitor (SSRI) toxicity?

What is the role of nitroprusside and esmolol in the treatment of selective serotonin reuptake inhibitor (SSRI) toxicity?

How is selective serotonin reuptake inhibitor (SSRI) toxicity prevented in patients taking monoamine oxidase inhibitors (MAOIs)?

How is selective serotonin reuptake inhibitor (SSRI) toxicity prevented in patients who require ongoing treatment with a serotonergic agent?

How is selective serotonin reuptake inhibitor (SSRI) toxicity prevented when switching medications?

Medications

What are the pharmacologic treatment options for selective serotonin reuptake inhibitor (SSRI) toxicity?

Which medications in the drug class Neuromuscular Blockers, Depolarizing are used in the treatment of Selective Serotonin Reuptake Inhibitor Toxicity?

Which medications in the drug class Vasodilators are used in the treatment of Selective Serotonin Reuptake Inhibitor Toxicity?

Which medications in the drug class Anxiolytics, Benzodiazepines are used in the treatment of Selective Serotonin Reuptake Inhibitor Toxicity?

Which medications in the drug class Antidotes, Other are used in the treatment of Selective Serotonin Reuptake Inhibitor Toxicity?