Martin T G
Department of Emergency Medicine, University of Pittsburgh, Pennsylvania, USA.
Ann Emerg Med. 1996 Nov;28(5):520-6. doi: 10.1016/s0196-0644(96)70116-6.
Selective serotonin reuptake inhibitors (SSRIs) are replacing tricyclic antidepressants (TCAs) with increasing frequency in the United States. Although SSRI poisoning tends to be less serious that TCA poisoning, the incidence of adverse side effects and drug interactions may be greater. The serotonin syndrome is a potentially severe adverse drug interaction characterized by the triad of altered mental status, autonomic dysfunction, and neuromuscular abnormalities. The serotonin syndrome is similar to the neuroleptic malignant syndrome, leading to misdiagnosis. Although serotonin syndrome may result in death, most patients recover completely with supportive care alone. The main pathophysiologic mechanism appears to be excessive 5-hydroxytryptophan stimulation; this finding is supported by reports of beneficial effects with serotonin-antagonist treatment. The incidence of the serotonin syndrome may increase as SSRIs continue to replace TCAs. Morbidity and costly diagnostic procedures may be avoided if prompt diagnosis and appropriate treatment are provided.
在美国，选择性5-羟色胺再摄取抑制剂（SSRIs）越来越频繁地取代三环类抗抑郁药（TCAs）。虽然SSRI中毒往往不如TCA中毒严重，但不良反应和药物相互作用的发生率可能更高。血清素综合征是一种潜在的严重药物相互作用，其特征为精神状态改变、自主神经功能障碍和神经肌肉异常三联征。血清素综合征与抗精神病药恶性综合征相似，易导致误诊。虽然血清素综合征可能导致死亡，但大多数患者仅通过支持性护理就能完全康复。主要的病理生理机制似乎是5-羟色氨酸过度刺激；血清素拮抗剂治疗有有益效果的报告支持了这一发现。随着SSRIs继续取代TCAs，血清素综合征的发生率可能会增加。如果能及时诊断并给予适当治疗，可避免发病和昂贵的诊断程序。
