6. Treatment
The primary approach to treating serotonin syndromes involves immediate discontinuation of all serotonergic drugs and providing supportive care to maintain stable vital signs. With proper treatment, serotonin syndrome usually resolves within 24 hours without sequelae1,11.
In mild cases, discontinuation of serotonergic drugs, observation, supportive care and, if needed, benzodiazepines for sedation are generally sufficient. Moderate cases of serotonin syndrome has been suggested to be treated with a serotonin antagonist in the form of cyproheptadine, a histamine-1 receptor antagonist with 5-HT1A and 5-HT2A antagonistic properties 25, but the level of evidence for this treatment is poor 1,26. Severe, life-threatening cases – often presenting with hyperthermia >41°C – demands urgent treatment in the intensive care unit 1,4,8,11.
The prognosis of serotonin syndrome is favorable if the patient is diagnosed and treated. In cases of uncertain diagnosis, discontinuation of any serotonergic agents and initiation of supportive care is advisable 4.