Sahiner Volkan, Erden Aki S Ozlem
Başkent U Psikiyatri AD, Ankara.
Turk Psikiyatri Derg. 2009 Winter;20(4):398-402.
The serotonin syndrome is a toxic state largely attributable to changes in sensitivity of serotonin receptor system in the brainstem and spinal cord resulting from increased serotonergic activity in central neurologic system, due to use of serotonergic agents either in overdose or in combination. Serotonin syndrome may present with neuromuscular (clonus, myoclonus, tremor, hyperreflexia) and autonomic (fever, mydriasis, tachycardia, tachypnea) symptoms and mental status changes (confusion, agitation) and may result in death in severe cases. The risk for the development of serotonin syndrome is increased with the combined use of agents from different groups such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). The growing use of SSRIs for depression and the introduction of pharmacological agents newly developed for the treatment of various medical disorders increases the risk of drug-drug interactions and toxic states like serotonin syndrome. In the presented case clinical presentation and outcome of the serotonin syndrome which has developed as a consequence of concomitant linezolid use in a young patient who was already on an SSRI antidepressant is discussed. Linezolid is an oxazolidinone antibiotic which has MAOI-like properties. This case is presented to inform psychiatrists especially working in consultation-liaison settings about the risk of drug-drug interactions and possible prevention of these.
血清素综合征是一种中毒状态，主要归因于中枢神经系统中血清素能活性增加，导致脑干和脊髓中血清素受体系统敏感性改变，这是由于过量使用或联合使用血清素能药物所致。血清素综合征可能表现为神经肌肉症状（阵挛、肌阵挛、震颤、反射亢进）、自主神经症状（发热、瞳孔散大、心动过速、呼吸急促）以及精神状态改变（意识模糊、躁动），严重时可能导致死亡。联合使用不同组别的药物，如选择性5-羟色胺再摄取抑制剂（SSRI）和单胺氧化酶抑制剂（MAOI），会增加血清素综合征发生的风险。SSRI在抑郁症治疗中的使用日益增加，以及新开发的用于治疗各种医学病症的药物的引入，增加了药物相互作用及血清素综合征等中毒状态的风险。本文讨论了一名已服用SSRI抗抑郁药的年轻患者因同时使用利奈唑胺而发生血清素综合征的临床表现及结果。利奈唑胺是一种具有MAOI样特性的恶唑烷酮类抗生素。本文旨在告知尤其是在会诊联络环境中工作的精神科医生药物相互作用的风险以及可能的预防措施。
