Features of serotonin syndrome associated with SSRI & MAOIs are -a) Tremorsb) Agitationc) Cardiovascular collapse d) Hypothermiae) Suicidal tendency
Serotonin syndrome 

Serotonin syndrome refers to a dangerous and potentially fatal syndrome caused by excess synaptic serotonin levels due to use of serotonin potentiating drugs.
This condition is associated confusion, altered consciousness, hyperthermia, tremors, myoclonus, rigidity and hyperreflexia.
Drugs causing serotonin syndrome are :-


Inhibiting 5-HT metabolism :- MAO inhibitors (e.g. tranylcypromine, phenelzine, meclobemide, selegilline)
Inhibit serotonin reuptake SSRIs, TCAs, amphetamine, cocaine, pethidine (mepridine),Pentazocin, MDMA, tramadol, Nefazodone, dextromethorphan.
Increase 5-HT release :- Amphetamine, cocaine, fenfluramine, MDMA, sibutramine.
Serotonin Agonists Buspirone, lithium, LSD, Ergots (Dihydroergotamine), triptans (Sumitriptan), Piperazine.
Other :- ECT, trazodone / Nafazodone, Carbamezapine.

Clinical features 

Clinical features of serotonin syndrome are :-


, Mental status :- altered consciousness, restlessness, insomnia, elevated mood, coma.
Neurological:- Myoclonus, tremor, shivering, rigidity, hyper-reflexia, agitation, incordination, akathesia, mydriasis
Vital and autonomic:- Fever (hyperthermia), sweating, tachycardia & palpitation, tachypnea or dysnea, diarrhea, hypertension or hypotension, cardiovascular collapse.

Treatment

Aggressive cooling and sedation with a benzodiazepine remain the basis of therapy.
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