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.