Treatment of the Serotonin Syndrome with Cyproheptadine

Abstract

To the Editor: The serotonin syndrome consists of behavioral, neuromuscular, and autonomic changes that result from increased activity of serotonin (5-hydroxytryptamine) in the central nervous system.1 Its symptoms and signs include confusion, fever, diaphoresis, hyperreflexia, ataxia, and myoclonus. The syndrome usually results from the concurrent use of two serotonergic medications, most often a monoamine oxidase inhibitor and either tryptophan or an inhibitor of serotonin reuptake, such as fluoxetine (Prozac) or sertraline (Zoloft). Because of the long-lasting serotonergic activity of both monoamine oxidase inhibitors and inhibitors of serotonin reuptake, however, the syndrome can occur when one drug is discontinued and the . . .